Burned Out of Burnout
Reading Time: 5 minutesThe Way Hospitals Are Tackling Their Burnout Crisis Is Actually Making It Worse, Doctors are at a breaking point. But we’re misdiagnosing the real problem., How to address physician burnout.
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This article is co-published with Zócalo Public Square.
In early 2020, weeks before COVID changed our lives, I sat uneasily with a dear medical school friend listening to a panel of experts discuss burnout, moral injury, and wellness. The speakers focused on categorizing and describing these terms, recited research and data, and prescribed self-care strategies including a healthy diet, exercise, yoga, and mindfulness. Many colleagues found these sessions helpful. I left feeling even more unwell.
These discussions began sprouting up at hospitals, including my own, well before the pandemic helped propel stress and burnout levels among healthcare workers to an all-time high. Health care worker burnout has been tied to physician and nurse suicides, depression, and medical error. It impacts cognitive function, patient safety, and quality of care.
My testy relationship with burnout and wellness presentations begins with their dominant focus on data. I don’t need research to explain what I’m feeling. Over three decades, I’ve navigated escalating obstacles to care for patients as an emergency physician in a broken health care system. In the past three years, the crushing constraints eroded my integrity as a healer. I knew patients deserved better, and I could feel their trust slipping away.
I often feel numbed by it all. I want to feel more, care more, and recognize myself again. I want to work with the uncertainty and understand that burnout can never be fully defined or mastered, only honored and engaged with.
Psychology researchers define burnout as experiencing depersonalization, emotional exhaustion, and a loss of accomplishment or efficacy. Wellness presentations are supposed to address such symptoms. But I’ve found that when interventions oversimplify and universalize complicated feelings under the banner of burnout, they compound my sense of losing control, depersonalizing an experience already marred by depersonalization.
The problem isn’t the message, but the framing. Why do hospitals and physicians approach burnout as a problem, and not a mystery?
French philosopher Gabriel Marcel distinguishes a problem from a mystery in a way that I find helpful. A problem, he writes, is external to us. It’s objective and universal, and its solution is available to everybody. Take a faulty electrical circuit that won’t light a bulb. We troubleshoot the power source, the wiring, and even the bulb to figure out how to fix it. The repair process is rooted in a shared understanding of principles, functions, technique, and scientific knowledge.
A mystery, Marcel explains, is ‘a problem that encroaches on its own data.’ We can’t study a mystery objectively because the problem itself is rooted in the person. We can’t lean on a generalizable technique because the individual is involved in the quest. With mysteries, we can’t substitute one person for another, one experience with another, without altering the question itself. The person asking the question matters.
Through a prism of mystery, we thwart the impulse to universalize, to define, to break a problem into its parts and analyze with detachment, which are standard techniques we bring to our study of problems in medicine. Despite the wealth of research on health care burnout, I fear it has become shorthand for a range of complicated individual experiences that are hard to put into words, let alone define, measure, or master.
The conversation changes when the focus shifts from the occupational syndrome of burnout to the individual, from ready answers to questions about the experience itself. What if wellness experts spared overworked physicians from their next PowerPoint presentation and instead asked them to come up with their own language to capture their experiences and feelings? Doing so would force us to drill inward, which can be difficult. But the struggle to articulate our stories is the struggle to wrestle control over our experiences.
If I had been asked, in early 2020, what nagged at me, I would have pointed to pointless medical bureaucracy and its torturer’s apprentice, the electronic health record. I would have bemoaned the way the system leans on emergency rooms to solve mental health and substance use problems that community leaders and other institutions don’t or can’t handle.
If you asked me the same question now, I’d say I was stumbling into the post-pandemic normal, concussed by all I’ve absorbed and not fully processed: needless death and suffering; patient anger, insults, and violence against ER staff; degradation of standards in response to constraints and resource limitations; staff exoduses.
Talking about burnout is easier than talking about being burned out. Physicians and nurses fear judgment and stigma—being perceived as not tough, smart, or resilient enough. To admit my feelings out loud instead of hiding vulnerability—and hear in return how colleagues struggled, too—would acknowledge our range of experiences in all their messiness, and blueprint possible bridges from isolation to community.
Building a culture that supports well-being is critical, as U.S. Surgeon General Vivek Murthy has noted in his recent call to get to the roots of the health care burnout crisis. System change begins at the level of human interaction. The pressures and waves of disturbances that make a life—different personalities, relationships, previous experiences, and institutions—are complicated and individual. Fostering authentic conversation is a good place to start.
To see ourselves differently, we must slow down and change our angles of understanding— or ‘make strange’—our previous ways of knowing. This idea of defamiliarization, made famous in a 1917 essay by Russian literary critic Viktor Shklovsky, builds on our tendency not to notice things we encounter frequently. Our perception becomes habituated. Defamiliarization disturbs all that and forces us to see experiences and objects anew.
Writing and the arts function as a medium for defamiliarization. Critics often perceive humanities and arts-based medical education—from collaborations between museums and medical schools to reflective writing courses—as soft, nice but extra, or as a pill for humanism. But the arts provide rigorous critical thinking skills—they foster perspective-shifting, remind us to consider cultural, historical, and social forces, and prepare clinicians for situations that push them outside their comfort zones. In 2020, the Association of American Medical Colleges issued a landmark report recognizing the need to integrate humanities and arts into medical education through writing, visual arts, dance, improvisation, museum-based experiences, and more.
Wellness or burnout initiatives should prioritize exploration and value curiosity and uncertainty. Interventions should regard easy answers with healthy skepticism. An authentic process, even without a ‘cure,’ is an end unto itself. In the ‘third space‘ between art and the science of medicine, we can encourage vulnerability and the emergence of different discussions and insights. I find that museums, with their quiet rooms and curated art objects, provide psychologically safe spaces for nourishing destabilization. In my experience, dialogue with artists and arts experts seeds different types of questions than typical medical wellness programs. It has forced me to engage with alternative ways of looking at, and appreciating, daily experiences.
The jury is out on the role of humanities and the arts for burnout. The effects of such programs are difficult to measure. Arts-based reflection doesn’t promise answers or lend itself to data sets. But it might allow each of us room for contemplation, a chance to recover that which is mysterious in our lives, a moment to recognize who we’ve become, what we’ve lost, and what is still within our grasp.
Let’s not forget that we’re talking about human hearts in peril, searching for that ferry from burnout to better. I can’t say what the journey looks like—only that it requires new maps.
Reference: https://slate.com/technology/2023/05/physician-burnout-covid-mental-health.html
Ref: slate
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