Why are doctors burning out and what can we do about it?
First and foremost I need to preface this with the fact that the reasons that anyone burns out are nuanced and personal. But there are also some widely accepted (source) general precipitants to occupational burn out such as:
Now let’s look at these specifically in relation to both hospital and community medicine.
1. Dysfunctional workplace dynamics
At last count there were 101 841 doctors in Australia, of those just over 95% work mainly in clinical medicine (source). Clinical medicine consists of a variety of inpatient, outpatient, hospital and community settings. Clinical medicine is the interface between doctor and patient. The one thing that these doctors have in common is that within all of these clinical settings, they are largely beholden to the assorted guidelines, procedures and pathways that each health service implements.
In a resource limited system like the Australian public health system, these guidelines and policies ensure as fair and as equitable access to finite beds and care as is humanly possible. As doctors, our heart often breaks having to watch our patients suffer from extended wait times or difficulties accessing care. Us not being able to change it, doesn’t mean we don’t care. Any of us who have worked in clinical medicine (whether doctor, nurse, allied health or even patient administration) know how heartbreaking it is to not be able to do any more than we are doing. This constant stretching of resources and people to their limits can inevitably lead to fractures or animosity between colleagues or patients. We’re all doing our best, but sometimes it can feel like bailing water out of the Titanic.
2. A lack of job control
Of the over 100 000 registered doctors in Australia, 16 500 of these doctors are in a specialty training program (source). These training programs range in duration from 3-7+ years depending on speciality. While on these training programs, Registrars (as these trainee specialist doctors are known) are required to move across a wide variety of placements, ranging from within a specified state area to all over Australia and in the case of post graduate Fellowship training, sometimes the world, in order to meet their training requirements. Quite simply, they will go where ever their speciality college says they must go.
For many of our specialists-in-training, things like starting a family are put on hold due in large part to the transient and demanding nature of these training programs. And while the rigour of the Australian speciality colleges is to be commended, it must also be appreciated that as more of our doctors come through graduate entry medical programs, many more of our specialists-in-training will desire to be starting a family during their training programs. Our speciality colleges must move with these changes and adapt to afford our trainees a greater degree of autonomy in their training pathways.
Gaining fellowship of your chosen college does change this point enormously, however it is important not to negate the distress caused by this point on the lives of trainees.
3. Lack of social support
From the above point, you can appreciate that during this time of frequent moving and renewing of contracts, it is often difficult to put down roots. From having social supports, to gym memberships, to knowing where the best take away food is- moving every few months makes it very difficult to build a network of support around our specialists-in-training.
4. Unclear job expectations
I have learnt the hard way that this point does become easier with time. Statistics show that older doctors are less prone to burn out (source). Some postulate that this is because more experienced doctors are better able to appreciate what is within our control in medicine and what is outside of it. That the wisdom of years allows us to separate the ‘wheat from the chaff’ better and learn how to focus our energy more productively on that which we can control or change.
I would offer a secondary thought to this concept though and add that this is also partly due to the fact that medicine is such a hugely dynamic field. Things that I learnt at medical school are now completely redundant, medications are superseded at an alarming rate and there are diseases that I was taught were life long and incurable during my medical training that we can not only now manage but even cure. The sheer level of information needed to be kept up to date with in clinical medicine is astonishing. Couple this with the ever changing digital health landscape, keeping up with the advances of modern medicine is a tough task. Google X’s Astro Teller is quoted as saying to author Thomas Friedman that the rate of human adaptability is being superseded by technology and that we must “learn(ing) faster and govern(ing) smarter” in an attempt to catch up and keep up (source). Medicine is the perfect example of this.
5. Extremes of activity
It will come as no surprise to anyone that the working life of a doctor involves long and often unpredictable working hours. The allure of General Practice is often quoted as being “family friendly” or “better work hours” than other speciality training pathways and post fellowship lives. But the reality of private practice is that medicine involves many, many hours of work outside our ‘work hours’ regardless of what speciality you choose because often it is simply not practical (not possible) to ‘hand over a patient’ to someone else. In the hospitals, this shouldn’t be occurring however. The ability to hand over a patient and leave a shift on time in a hospital that is staffed 24hrs a day 7 days a week is something that we must protect for the juniors that come after us.
Unfortunately, this seems to not be a sentiment shared by many medical administration departments as shown by a current class action admirably launched by a collective of junior doctors fighting to be paid their fair overtime (source). This is something that as doctors we must all call out and enforce in order to protect our junior workforce from burn out when it is obvious from the previous and above points, that our trainees are shouldering the lions share of these known ‘burn out precipitant factors’ (most notable of which is the lack of job control and limited social support).
6. Work life imbalance
For most doctors, we have taken a path of 10-15 years of education post high school. For those years, education, work and other aligned commitments have been front and centre in our lives. We’ve literally conditioned ourselves to place work above all else.
Medicine is often spoken of as ‘not just a career but a calling’. As noble as this sounds, doctors are people just like the rest of us. There was not course at medical school that took the fleshy vulnerability of humanity away from us. We too need to strike a balance between taking care of others and taking care of ourselves. These two things however are not the dichotomy that they may initially appear to be. One of the fundamental concepts around my model of Basic Life Support Self Care™ is that in the same way we first check for danger in our clinical BLS algorithm, we must take care of ourselves in order to take the best care of our patients. Learning how to integrate authentic and holistic self care practices into our lives as clinicians is not self indulgent but is in fact paramount to being a good doctor.
Clearly there are huge systemic issues that contribute towards physician burnout. No doubt there are also individual factors at play, after all, despite the fact that I burned out, not everyone one of my colleagues will. I’m not offering an ‘either/or’ solution here. What I am suggesting is that there are a variety of things that each of us can do to mitigate feelings of burnout for ourselves as well as systemic issues and structures that as a collective we can begin to shine a light on.
Most importantly however, I want to say to others in my profession who are feeling burnt out or overwhelmed that I see you. I know what that feels like and that is exactly the reason that I started The Healers Health Collective. That right now I am just one person, but that my hope and dream is that this resource will grow and flourish and that one day I will be able to “be the change that I wish to see in the world” (Gandhi).
Blogging for me has been an interesting thing. It’s so easy to think that the thoughts I have and the problems I encounter are mine alone. To identify myself with them and define myself by them. To think that no one else in the world has these thoughts or problems.
Blogging has opened my eyes to the fact that this really isn’t true.
We share so much of our humanity with those around us, yet often we feel like we must keep those ‘uncomfortable human bits’ to ourselves. To project our best self forward only.
My burnout doesn't define me, but it is a part of me.
Thinking back on when I burnt out, I remember how I felt then.
Tired. So tired.
Depended on. Suffocated.
Yet, I was still functioning.
Outwardly at least, I was ‘good’. Perhaps slightly ‘stressed’, but ‘good’.
When in fact I didn’t even know how ‘not good’ I was.
I remember saying at the time that I felt like my “doctor light globe had gone out”.
I was still happy at home as a wife and mother, but my fuse was shorter.
I wasn’t depressed, but my sleep was affected. I would wake most nights in the early hours and lie there, unable to get back to sleep. But I was productive in those early morning hours. Ever the lark, I got work done to maximise my bodies inability to hold onto the fitful slumber of those cold moments pre-dawn before my household and the world awoke.
I had started a new business. I had done all the branding and marketing myself. The website a shining example of my early morning exploits.
My body’s subtle calls to slow down and find balance were duly noted.
I threw the full force of over a decade of personal mindfulness practice to bringing mindful awareness to myself and what in hindsight was my impending burn out.
I practiced gratitude and self compassion.
I practiced my beloved yoga. In fact, ever the Type A person I was, I was in the process of undertaking a full 200hr Yoga Teacher Training. So yoga too had become a ‘job’ to me.
I ate well, I went to bed early (to counteract the 3am wakefulness).
I saw a psychologist.
I did everything that I told my patients to do when they found themselves in these difficult times.
But I still burnt out.
In the time since then, I’ve been blessed to be able to spend a lot of time in reflection on this. I’ve also been graciously supported through an intense period of personal growth and discovery by my husband and family. I feel like I have a better understanding of the stones that paved the path towards burn out for me.
This is of course only my path.
Perhaps others may find a stone or two common with their own and find these reflections helpful?
But here are some of the things that I have learned by walking this path to burn out and back again.
That a step back is often infinitely harder to make than a step forward in life.
Life has a certain inertia to it. Each day rolls around, as the seasons change, the world keeps turning. Life keeps moving on.
Even in the most untenable situations there is still momentum to time alone.
In choosing to take a step back from work, socialising, the online world, what ever it is we are considering taking a step back from, we are innately aware that these ‘worlds’ keep going without us. Nothing is on pause.
Stepping forward, in whatever capacity we can, continues to indulge us in the idea that we are ‘keeping up’.
Stepping back (or even sideways) involves the reality of falling behind.
Now I know that this isn’t a bad thing. Logically, we ALL know that this isn’t a bad thing. But I want you to think about the last time you turned down an opportunity or opted to take a leave of absence. How did you feel?
For most of us, the FOMO is strong!
And when we inevitably return to our own forward path in life, we are acutely aware of the momentum we feel we’ve missed.
Again, this is not a bad thing. Simply my own observation as to how I felt pre ‘stepping back’. That sometimes continuing to do something, even if we know it is bad for us, seems easier than making a change.
There is a threshold at which my brain functions optimally.
When I stress my operating system above that threshold, all functions tend to suffer. I and I alone am the one who knows where that limit is and therefore I and I alone am the one who must honour that limit.
That flattery of the Ego will often cause us to go beyond what we know we are capable of.
Is this a good thing or a bad thing? I guess it depends how much point 2) affects you or not?
That the thing that hooks our Ego in the first place, often begins to harm our Ego when we use it as an excuse to go beyond our optimal functioning limits.
For example, for me as a doctor it was helping people, a noble cause for sure. But when it became something that I allowed myself to make excuses for continuing to cause stress to my body as I watched it crumble around me, it was in fact merely a ‘hook’ that kept my Ego in the game. Helping people isn’t something you do as you’re drowning, that’s ‘saving’ people. And when your Ego is in the game, it becomes less about helping and more about saving and being a saviour.
Think about it, there’s got to be something valuable on the table to keep playing as you watch your world falling apart around you.
Now this was an uncomfortable truth for me to learn. My Ego story made it very easy for me to talk myself out of this fact. The praise and adulation of those around me made it even easier. But the more I made friends with my own Ego, seeing it not as a ‘bad’ thing but simply a construct that I had built around me over time. A reflection of the stories the world had told me and that I had absorbed about myself.
I was a ‘good person’.
I was smart.
I was a helper.
I could put aside my own needs for the needs of others.
As I began to see my own Ego as a small child in want and need of protection and affection. I saw that this steadfast push beyond even what I knew I was capable of at the time was not in fact ‘personal growth’, it was survival. Survival of an Ego and a person simply doing their best.
And this brings me to my final point.
No amount of mindfulness or yoga can outweigh a lack of self awareness.
Self awareness is about knowing when to say ‘no’ more than it is about knowing when to say ‘yes’.
It is about learning where that ‘optimal functioning point’ is for your brain and respecting it. Not about never going beyond it (after all that is where we are able to grow) but more about bringing mindful awareness to when you are existing at your growth edges. Being in control of that time. Knowing when to pull the throttle and when to hit the brakes.
It is about making friends with your Ego. I mean true, laugh until you wet your pants kind of friends with your Ego. About seeing your Ego with the most compassionate of eyes and thanking it for always being there to protect you when the chips were down. About loving it and then carefully strapping it into the back seat so your True Self can take over from now on.
Awareness of the Self is about knowing that we are beautiful, dynamic and complex creatures who need to commit to a daily practice of exploration and compassion as we move and grow over time.
Like I said, this story is not all burn out stories. It is just mine.
It is however, a road I walk with many other travellers and I’m sure there is a step or two we may walk together on.
This post was also published on Whole Hearted Medicine- a website offering luxury self care retreats for doctors to promote reflection on personal and professional wellbeing.
What happens when we meditate?
Does our mind magically clear of all thoughts?
Do we all of a sudden gain some super human ability to have a mind completely empty of any thought, emotion or angst?
Meditation (while arguably an amazing process and skill) doesn't in and of itself give us the ability to clear the mind. The mind is never and probably will never be empty of thoughts.
The 'problem' is not in fact the existence of thoughts, it's the attachment to them.
So if we can't clear our mind of thoughts, why do we meditate???
Meditation helps us to begin the process of disentangling ourselves from our thoughts.
Cogito, ergo sum.
So, are we the owner of these thoughts?
Or the subject?
And if we own the thoughts, can we control them?
I certainly can't. Thoughts tend to pop into my head at the most inopportune of times.
With all this power of thought, it can be difficult not to get caught up in it all.
To be 'owned' by the thoughts.
So, if not ownership of thoughts. Then perhaps we are the experiencer of thoughts?
This is where we must begin to explore the concept of an observer vs an examiner.
An observer is only there to take in each moment as it appears. No planning for the next move, no attachment to the end outcome.
For most of us however, we examine our thoughts. Critiquing the content, trying to plan their trajectory.
Trying to control the uncontrollable.
And with this illusion of complete control, that we can forcefully remove unwanted thoughts from our mind- comes angst when we find we are sadly unable to do that.
Through meditation, we learn how to bear witness to these thoughts (and thoughts about thoughts) without the need to step in and change them.
We learn how to step back from the stream of thought. How to watch it evolve.
How to be curious about how these thoughts often take us to the same destinations within ourselves. The points of fear, or anxiety, or self loathing. Or points of happiness too.
How thoughts of happy past experiences, our children or family might be tools we find that we naturally use to try and 'break the pattern' of more negative thoughts.
How we unconsciously feel that some thoughts are inherently negative and some are positive.
That we find ourselves actively seeking out perceived positive thoughts over the ones we feel are negative.
All this involvement in the thoughts comes from our own illusion that we can and should be able to control them.
What if instead, we learn how to be with our thoughts rather than trying to control them?
I'm not talking about simply sitting back passively and never formulating an original thought again. Just waiting for thoughts to pop into your head only ever watching like a cloud floating by.
I'm talking about adding a tool to your toolkit that allows you to DECIDE which thoughts you want to engage with and formulate into ideas and which ones you want to simply watch.
By learning how to step back from the thoughts, we give ourselves space between the thought itself and what we want to do about it.
We are able to ACT rather than REACT.
This is what meditation- both in the formal sense as well as the more informal practices of mindful awareness- give us.
And while daily mindful awareness is a wonderful skill to gain in it self, committing to a practice of both informal and formal mindfulness (or other meditative practices) is how we cultivate and build upon this skill over time.
A consistent and compassionate meditation practice is the 'gym training' for the muscle of our minds.
If you're not already familiar with the concept of Basic Life Support, it's the idea that we learn the DRSABC framework so that we can draw on it immediately in case of an emergency. We check for Danger, assess Response, Send for help, assess Airway, Breathing and Circulation and start CPR if needed. In healthcare especially, this framework is like second nature. We use this framework to jog our mind in times of high stress to make sure we know where to start and where to go next.
This innate 'muscle memory' of a process to guide us through high stress times is helpful as we don't tend to "learn to swim when we're drowning". That is, times of stress or crisis are difficult times to learn new skills.
Self care is no different.
It is often difficult to begin and learn new self care skills when we are on the verge of burnout.
Yet so many of us are guilty of doing just that, waiting until we are under immense stress or difficulty before we recognise the need to "take better care of ourselves".
It is for this reason that I developed the 'Basic Life Support Self Care' model of proactive, authentic and holistic self care practices in 2020. Drawing on the familiarity we have in the healthcare environment with systems and protocols to drive memory recall and of the widespread awareness of the DRSABC acronym, I developed a set of simple & actionable self care practices to help guide others in their execution. From mindfulness to self awareness, breath work and self compassion, the framework is a useful reminder for everyone to use in their day-to-day lives in order to take better care of themselves.
The below was originally published on The Healers Health Collective website on 7th September, 2020.
We must start looking at Self Care in the same way we look at our yearly CPR training-
We all know it, we need some time when our nervous systems aren’t primed and thinking about work. Yet in reality (and private practice) it can be difficult to do. One part of this is removing ourselves from the environment so we can put some physical distance between ourselves and our work stressors to allow our nervous system to down regulate. The bigger issue however is many of us are unable to place any psychological distance between ourselves and our work even if we’re not there, the ‘tiger’ comes home with us every day.
What does this mean on a systemic level? It means that staffing is done with contingency plans for sick and compassionate leave. We used to think that this was impossible to do, but COVID-19 is showing us that when there is no other option, we can get creative & find a way. None of us are indispensable in this system. It also means that workplace structure integrates and prioritises self care education and practice to be as important as the core clinical competency of Basic Life Support.
Perhaps more importantly than this however is the personal level- how each of us feels when we find we need to take some time or focus away from work in order to practice self care. How many of us have been home sick in bed and still be genuinely feeling like we should be at work? We can change the system all we want, but until each and every one of us has the self awareness to truely believe our own right to practice self care how we see fit and not how others tell us we should practice it, nothing will change.
I really want to emphasise that stress is normal, our bodies are designed to respond to it. Too often we are told that to be resilient is simply to be able to shoulder the burden of stress without faltering. But this amazing system is also designed to switch off in order to reset. It’s the return to normal after a stress response that is an often unrecognised part of the definition of resilience.
Resilience represents the amount of disturbance that can be absorbed by a system before the system changes or loses its normal function, or the time taken to return to a stable state, within the normal operation range following the disturbance
Permanent resilience isn’t designed to be a part of the stress response. We need to be able to give ourselves some down time, both physically and psychologically, to allow for the elastic recoil. To make space for resilience.
When we exist in a state of default thinking, everything we encounter is allowed to move unfiltered through to our amygdala (the 'stress centre' of our brain) to start the finely tuned cascade of events that is our stress response. The switch is permanently left 'on' for this amazing system with no down time to return to a stable state. Collapse is a frequent but not altogether unexpected consequence.
For both creating psychological space between work and ourselves as well as being able to filter out what information actually makes it through to our brain to start the cascade of our stress response, mindfulness is an immensely powerful tool. Mindfulness helps us to notice things without judgement. It helps to hone our awareness and ability to process stimuli so that we're not constantly bombarding our amgdala with otherwise innocuous information. Like the goalie who isn't paying attention, the mind in default mode is letting a lot through to the net that it needn't be. So the control we have over this process is right at the beginning, with the noticing.
For those of us who have become used to ‘healing’ others, it can be very easy to lose the ability to allow ourselves to be helped. While we as humans thrive on connection, to ask for help and to be helped, takes a huge amount of humility and vulnerability. So many of us in the health and healing professions struggle to do it, we struggle to let go of the urge to ‘fix’ things ourselves.
So, why do we find it so difficult? There was no course at university that removed the fleshy vulnerability of humanity from us. Perhaps we need reminding, that in order to be truely self aware we must know that we will all give and receive assistance in this lifetime?
Somehow we’ve come to equate success with not needing anyone…
I have a phrase I use often in my work- “you don’t learn to swim when you’re drowning”. Likewise, it can often be very difficult to know and find the support you need at a time in your life when you need it most. In the same way you don’t want to be rummaging around in the drug room for the Adrenaline mid cardiac arrest, holistic self care is about building and maintaining a support network everyday, not just on the ones when you need to use it.
Self awareness is an interesting concept. Most of us think we know who we are. But if I asked you to describe yourself in one sentence- not referring to your job, family or where you live- how would you do it?
Awareness is very different to thinking. You don’t need to think of your foot being attached to your ankle, it is just there and you’re aware of it. Self awareness by the same token is not something you need to ponder or think about. It’s the innate sense of knowing who you are and what you need.
When we exist in a state of constant arousal, it can be difficult to pin point exactly what it might be that is making us feel bad at any given time. So many of us are guilty of filling any down time that we have with a variety of distractions that take us away from this innate self awareness. Social media, alcohol and other drugs, busyness, even exercise when used in excess can all be ways that we are unconsciously taking our attention away from our sense of selves. It can be a difficult thing to develop true self awareness. When we are confronted with aspects of ourselves that we perhaps wish were different, it is much easier to distract ourselves away from this than it is to look inwardly with compassion and a desire to change. However, our ability to know what we need and be able to practice self care in a truely authentic way, depends on our ability to practice self compassion without judgement.
Paradoxically, it takes time to become what we already are.
The path to self awareness is not one that we can take for granted, it is an attribute that takes daily work. We must be willing to be introspective, spend some time in solitude and contemplation, as well as talking openly with those around us about our struggles in a compassionate way.
Very few things have the capacity to change how we feel so profoundly as how we breathe. The practice of pranayama in yoga is entirely devoted to the breath due to the fundamental importance it has in our health. Over twenty-three thousand times a day we fill our lungs with air, every single day of our lives. The sheer consistency of this process means that even small changes and benefits are amplified significantly.
There are plenty of breathing practices aimed to help calm our bodies and our breath. As with all breathing practices, they will have a paradoxical effect on our nervous system (excitatory) if the breath is unnaturally prolonged. So we are much better to aim for consistency with gentle expansion over time than forcing the breath in any one exercise. One simple practice to master is that of ‘box breathing’. Simply, we breathe in for 4 seconds (or whatever length of time you feel comfortable doing), hold for 4 seconds (or what ever length of time you have inhaled for), breathe out for 4 seconds, hold for 4 seconds. This process is repeated for a few minutes with careful attention that you are not forcing the breath. Gently prolonging our exhalation over time and within our comfort level can further enhance this exercise. When practised daily, breathing practices have the potential to gradually improve our cardiovascular fitness and parasympathetic tone, an important factor in down regulating our stress responses.
Most of the worlds wisdom traditions tell us that when we can look to ourselves with compassion, we can then extend that compassion to others more readily. Practicing self compassion is one of the most fundamental aspects of self care.
True self compassion comes from viewing ourselves with curiosity rather than judgement. When we perceive our failings, we approach gently just as we do with a timid puppy, bringing a tone of guidance rather than retribution. Eckhart Tolle talks in his book ‘The Power of Now’ about the concept of the Ego and the True Self. Our Ego’s are fragile, turbulent guard dogs that exist to prevent our True Self from coming to harm. It is only when we have compassion for our Ego’s that we are able to thank them for trying to protect us, lovingly strapping them into the back seat to allow our True Self to take over. Our True Selves on the other hand are the calm beneath the deep ocean, that we find through a process of reflection, self awareness and self compassion. When we can do this, we are finally freed from the reactionary lives full of indecision, searching and regret that so many of us lead. Self compassion is the key to setting ourselves free and unlocking the very best parts of us to then offer to the world.
There is no one in this world more worthy of your kindness than you.
While authenticity is certainly a buzz word that gets thrown around, it is a wonderful descriptor for the sense of self that comes from 'doing the work'- the exploration of The Ego, the never ending demand for self compassion, the quiet reflection and meditation.
To be truely authentic requires us to be flexible- flexible in our thinking, flexible in our sense of self.
The 'work' never ends, it is a constant journey of discovery.
Always unearthing something new for us to work on and integrate into ourselves.
This is the 'changing face of authenticity'- what feels right for me now may not in a few years time.
Most of this seems self explanatory. Do we really need to spend valuable time reflecting what it means to be authentic?
I would suggest that we do. Like many things in life, mistakes and/or consequences seems to flourish within a state of inattention. When we bring light and awareness to the many default states within which we exist we bring the opportunity to change. We bring the opportunity for growth.
Reflecting on my own journey, it's so nice to finally feel like I'm living in alignment with myself and my values more than at any other time in my life. The joyful contentment that right now comes from being able to make a life decision by simply "checking in" with myself and how an opportunity makes me feel rather than the constant pros/cons lists, fear of making the wrong choice and subsequent regret when I inevitably felt I had (FOMO), is something I cherish more than anything.
This sense of authenticity comes not as a destination but rather an ever evolving process of self reflection, of curiosity and of self compassion.
It comes from being able to change things we desire to change about ourselves not because of guilt or self flagellation, but rather from a striving towards personal growth.
Authenticity comes when we are able to embrace the many faces of ourselves with compassion.
It comes when we are able to extend that compassion to the perceived failings of others too.
Authenticity comes when we are able to relish the opportunity to exist at our 'growth edges', accepting the mild discomfort of change for the unbounded opportunities of the expanse in front of us.
Authenticity comes from learning to exist in our 'personal ecosystem', symbiotically bringing together mind, body and soul in a balanced union of self.
It is within this 'personal ecosystem' that we find the True Self.
Almost as an explorer venturing into the untamed jungle, not sure what we will find- the exploration of self that comes from this journey to authenticity often uncovers surprises.
Be it past trauma that we've never fully processed, personality traits that we wish were different or even just an awareness that there is a lot of 'work' for us to do- this exploration of self demands self compassion as we navigate this path. There are many things that need to be FELT rather than FIXED on this path and for some (myself included) that means that professional help is an important part of this journey. There is nothing more comforting than having someone walk beside you through the bumpy bits in the road.
In the last 2 years I have burnt out, rebuilt and come back totally invigorated and ready to carve out a new path for myself. To call the whole process a 'blessing' would certainly downplay the pain of it all, however the lessons I've learnt I feel are invaluable. The doors that are opening in front of me are ones that I simply didn't have the cognitive space within me to contemplate in the past.
This is the thing about 'survival mode'- we can certainly exist within it (albeit not indefinitely) yet we are often unable to THRIVE within it. Rather, as we move towards the True Self- one within whom we know how to build and honour compassionate boundaries, how to retain authenticity in the face of flattery of The Ego and how to practice truely holistic self care- we find that thriving is as much about the opportunities we turn down as it is about the ones we take on. That innate self awareness that comes from having an intimate working knowledge of your own personal ecosystem at any given moment means that you are more quickly able to discern and act on opportunities that come before you.
Right now, I'm relishing having the opportunity to explore my own sense of self and what authenticity means to me through this online scrapbook of sorts that makes up my blog. A virtual 'dear diary' that may mean something to someone else... or may not. Personally, I find that the longer I go between meditating, the more I notice my sense of self slipping. My emotional agility slows and my ability to respond to triggers in a way that mirrors my True Self (that all important authenticity) lags.
So while authenticity, meditation and mindfulness all seem like buzz words from an HR managers toolbox, they are in fact delicately interconnected. As you master one, you tend to more easily begin to master the others.
As life gets busy and we start to let one slip the rest swiftly follow.
This post was also published on Whole Hearted Medicine- a website offering luxury self care retreats for doctors to promote reflection on personal and professional wellbeing.
Call it 'Imposter Syndrome', call it self doubt. It doesn't really matter what name you give it, most of us feel it to some extent at some point in our lives.
Medicine is full of high achieving individuals often with perfectionistic traits. Why wouldn't it be? People's lives fall into our hands every day. This sort of precious cargo demands as close to perfection as possible.
As a patient, I completely get it. I want a 'perfect' doctor. Who doesn't??
As a patient, I also benefit from this collective of immense knowledge and dedication.
As a doctor, I demand 'perfection' from myself.
Yet, as a human being, I understand that no one is perfect.
How can I reconcile these facts?
This tends to be where self doubt creeps in.
We set the bar at perfection and berate ourselves if we ever fall even a millimetre short.
We see our colleagues with more compassionate eyes than we see ourselves.
We put ourselves or our family members in our patients shoes and understand the need for attention to detail, for the constant striving for perfection.
Imposter Syndrome or pervasive self doubt is the natural consequence of this constant self flagellation.
Mindfulness teaches us that we can be an observer to our thoughts.
That we can watch that stream of berating thoughts and self doubt as they come to us just as we might watch a train pulling into a station. That we can choose to step back and not engage, to not 'hop on' the train as it takes us on a journey to Imposter Syndrome Station.
Self compassion comes when we gain this ability to disengage with our thoughts.
Mindful self awareness is a state of mind in which the default mode of the brain is set to compassion. Compassion for ourselves and compassion for others. This comes from practice. Whether it be a daily meditation practice, regular prayer or even informal mindfulness cultivation. The key is consistency.
When we begin to see the goal of perfection not as some unattainable star, always seemingly out of our reach but rather the balance to our own practice of self compassion- we can see that striving for perfection isn't in fact a linear path along a spectrum but rather a constant state of being.
Sustainable, but only when in balance with our practice of self compassion.
This blog was originally published on The Healers Health Collective on 17th December, 2020.
I actually wrote my first blog piece "So I've burnt out" just a few short weeks after I stopped working. Little did I know it then, but there was an immense journey ahead of me. A journey that in some ways I think I'll always be on. This path of life that we all walk, I now walk more intentionally. No longer swept just onto the 'treadmill'.
Some people are fortunate to have the self awareness to have always been on this intentional path. Yet for many of us, this path is in fact a treadmill. A moving conveyer belt on which we feel sometimes passively shifted along. The 'Medical Treadmill' has such inertia from school, to medical school, to internship, residency, unaccredited positions, being a junior reg, senior registrar, fellowship and eventually consultant. Don't get me wrong, there are huge life decisions to be made in that time.
"Which college do I want to join?"
"Will I have any say into where I go?"
"When will I have time to have a family?"
Ultimately however, this process does tend to move along in a fairly linear pattern. Unless we are forced to or choose to step off.
What do we say to our colleagues who express a desire to 'step off' the treadmill at any point? Whether for a short break or even forever?
I experienced a lot of well intentioned encouragement not to do that.
That I would have to work too hard to "get back". Or that I would "miss opportunities". That it would be a "waste of my skills".
The dialogue here is really important I think.
As it turned out, I ended up needing to 'step off' for a while anyway. Perhaps I could have done this in a more intentional way sooner? Perhaps not.
For me personally, I am immensely grateful for the journey I have been on as a result of the last couple of years and my 'burning out'. That doorway I felt myself standing in all that time ago was in fact this doorway into working to support the wellness of the healthcare workforce. Healing the healers. Caring for the carers.
I am excited and hopeful for the future.
If you are feeling swept up on the medical treadmill, passively shuttled through your professional life towards some seemingly far off goal, I'd encourage you to try and familiarise yourself with the concepts of mindfulness.
Of self compassion.
Self awareness comes as we take our consciousness inwards to become more familiar with our own internal environment rather than only focussing on those things outside of ourselves and our control.
Sometimes it involves some time "off the treadmill" for self reflection. And that is OK.
Sometimes it involves staying "on the treadmill" but building a support structure around you so that you can lean on that and just lift your feet up every now and again.
Sometimes it involves the speed and incline being turned up so far that eventually you end up flying off the end of the treadmill, unable to keep up anymore (like I did...). Look, it's not ideal- but that too is manageable.
The most important thing to realise is that ultimately, you control the treadmill.
Even at the times when you feel like you don't, you always have the choice to step off for a while.
There's a lot of things that I want to talk about (hence the blog), but it strikes me that the most important thing right now as those of us in Victoria are looking at the start of another lockdown and potentially the actual start the COVID-19 pandemic in Australia- is kindness.
I am very lucky to have met very few people in my life who don't actually want to be the nicest, kindness person they can be. For most of us, the thing that gets in our way of this intention is our own Ego. Most people when they think about our ego's, think about someone who is "egotistical". But that's not what I'm talking about. Our Ego is anything that we associate with an "I" or "me" statement. For example "That person cut in front of ME", "I shouldn't have to be doing this, it's not my mess/problem", "I can't believe they said that to ME". Our Ego is a protective layer that we often build between our Self (the true self) and the world. It is therefore often our Ego that gets hurt in the day to day happenings of life, not the true self.
The problem here is that our Ego's can be a bit turbulent- kind of like the choppy waters at the surface of the ocean. The Self on the other hand sits beneath that, calmly and quietly. Most of us are existing every day on the surface, dealing with the ups and downs, the insults and constant questioning of whether we're doing the right thing or going the right way. From this uncertainty it can be easy to deflect away from our pain and towards others. We can cast blame or insults ourselves, we can see perceived imperfections in others because it hurts too much to find them in ourselves. This is a pretty exhausting place to be.
By actively choosing kindness when our Ego is trying to tell the story, cast blame or get angry- we're CHOOSING to duck beneath the water for a bit. We're CHOOSING to find calm in an ocean of turbulence.
Right now, there's a lot of blame going on- towards those leading us and making the tough decisions in a time of crisis, towards others we perceive to be "doing the wrong thing" and not locking down appropriately. Our Ego's are driving the narrative away from kindness. Do we feel better for it? Probably not.
Choosing kindness isn't always the easy path to take. Whether it's kindness towards ourself- towards our actions in the past or thoughts as they come, or kindness towards others- greeting their shortcomings with compassion and forgiveness, choosing kindness often means putting aside those thoughts driven by our Ego. The one's that tell us WE have been personally affected by something and WE deserve to be annoyed and angry. As if our anger is likely to change things. Like I said earlier, most people I've met in my life really want to be kind but like all humans- we struggle sometimes. Dr Rick Hanson (PhD) says in his book The Buddha's Brain- "Paradoxically, it takes time to become what we already are". We need to work hard to move past our own Ego's to find a place where kindness is the 'default' reaction. By actively CHOOSING kindness, we're re-wiring our brains.
I'd challenge all of us to take this thought into the world today. To CHOOSE kindness when our bodies and minds want to naturally default to anger, fear, blame or any other emotion our Ego's conjure to protect themselves. Start to become familiar with what it sounds like when your Ego is talking- when you hear the "I" and "me" thoughts that sneak into your head, twisting and turning through you trying to keep your little boat being tossed around violently on the surface of ocean.
Choose KINDNESS. Choose calm.
One year. One year since I 'Burnt out'.
At the time it felt like a soul crushing lesson in defeat. Not something I was familiar with feeling as I was so used to pushing, pushing, pushing until I achieved what I desired. Yet I couldn't push through this. So I stopped. I gave in. I relinquished control. The last year has been amazing, overwhelming, enlightening, difficult, affirming, sometimes challenging but ultimately a blessing.
So today, I've spent the afternoon messing around with this website in preparation to finally clicking the 'publish' button for the first time. This website that I've had mocked up for years but never felt robust enough to shine my light out into the world for scrutiny. Yep, that one. And I came across the blog post I wrote one year ago now (you'll find it in the archives). I had written about the feeling of standing in a doorway, not so much stuck as just aware that I really wasn't able to move forward or backwards at that point in time.
One year later and the delicious inertia of the last year has finally brought me to clicking 'publish' on this site. I've been listening to the amazing Amy Ahlers and Dr Lissa Rankin MD as part of their Visionary Ignition Switch course and as Lissa said "speak your truth" I knew that this was the time for me to do this. Now I know that my "truth" isn't everyone's truth, and I'm certainly no 'expert' on much else other than my own opinion. But that's what a blog is, my own opinion.
So here I am, stepping out of the doorway.
I plan on blogging about the many things that interest me- mindfulness, meditation, yoga, breathing, stress management, sleep, motherhood, behaviour change, relationships, eating and generally just trying to be the best sort of human that I can possibly be. The 'simple' stuff that seems so damn obvious and straight forward but really takes up at least 90% of my (and I'm assuming many other peoples) brain space at any one time.
Join me if you wish to. Scroll on by if you don't. There's no medical advice here just my thoughts.
Time for me to step out of that doorway...
I've had this website mocked up for a while now. Like every other over achieving person (doctor or otherwise), I usually have a plan for most scenario's. This one was meant to be an adventure in self promotion. Something I have historically been terrible at. Hence the unpublished website gathering cobwebs in my own little corner of the internet.
So here I am, three weeks into a surprise sabbatical from work, writing a blog post on my long ignored (and as yet unpublished) personal website. Facing the gnawing feeling of dread at simply the idea of going into work and seeing a patient. Left to consider the moments, thoughts and feelings that pave the path behind me.
I am a good doctor, an empathetic doctor. The sort who listens intently to you and tries to reflect back what I've heard you say with a mixture of comprehension and gentle advice. I've spent the last 15 years either training towards or being a doctor. But right now, I am a doctor who feels jaded and empty. Like the 'doctor' light globe inside me has gone out. The weighty responsibility of trying to help people in their darkest hours finally causing my legs to buckle under me. An unfamiliar mixture of panic and despair stopping my whole being from even getting out the door to go into work. To a job I am good at. A job that helps people. A job that (outwardly at least) appears so fulfilling. So why do I feel like this?
In the last three weeks that I've been hiding from the world since panic set in and stopped me in my tracks, I have come up with a variety of explanations. My amazing GP helpfully offered "Anxiety likely secondary to burnout" as a reason for taking some time off. Seems reasonable. Right now I am incapable of seeing a patient. One, because of what it evokes in me (the afore mentioned fear, dread and panic for the most part). And two, because it is not fair to patients for me to be seeing them right now. There is a certain amount of resilience and strength required to take the worries and ailments of others and help them carry this burden. Have you ever stopped to consider the health (both physical and mental) of your doctor the last time you went to see one? We are all human also. There is no special course at medical school that takes the fleshy vulnerability of humanity away from us. We, like you, sometimes struggle to sleep with worry (which in my case is often about you, my patients). We feel that sickening sense of overwhelm and fear that we may make a mistake while at work. Except in our cases, people lives are the fragile cargo we carry. We also deal with all the behind the scenes issues that everyone else is, family, money, life in general.
I feel as though I am standing in a doorway. Three weeks ago, all I wanted to do was close the door and hide inside. In the last three weeks, I have found some satisfaction in the fact that I no longer want to do that (everyday at least). Some days I am quite content to remain standing in this open doorway, pondering the space in front of me.
I write all this not to garner sympathy, but simply to muse and offer support to those walking a similar path. A silent call into the ether of the internet to encourage those reading to look outside themselves. Consider whether the job they're working, the life they're leading, is congruent with their values and self. And maybe, just maybe, as I stand here in what feels like a doorway of change, waiting to see what path there is in front of me, I may begin to contribute to the world in a way I had never imagined.
Emily is an always learning, forever dreaming, list making mind mapper who loves cheese.