Burnout Prevention and mitigation Thomas Benzoni DO AOBEM
Burnout: Prevention and mitigation Thomas Benzoni, DO, AOBEM, FACEP May 10, 2018 Foodbank of Iowa
Recitals • Agency • None • COI • None • FDA • Likely off label • Rules of engagement • Adult conversation
Objectives • Examine origins of Burnout • Learn personal protections • You’ve been given a Ferrari • Know institutional contributions • Combine personal/structural factors • KNOW THE DIFFERENCE!!
Order of the day • Explore burnout’s history. • Learn signs/symptoms • Review the characteristics making us uniquely susceptible. • See where systems can be the problem • Explore together a path forward.
Roadmap Grant me the serenity To accept the things I cannot change, The courage to change things I can, And the wisdom to know the difference.
Definitions count Burnout is: • Emotional exhaustion • Alienation from job-related activities • Reduced performance • • Something new? Source
Source
Signs/symptoms • Work • • Cynical/critical Irritable/impatient Unmotivated/low-E Satisfaction low/disillusioned • Home • Drugs/alcohol/food problems • Poor sleep/appetite • Headache/backache/somatic symptoms (Does this sound familiar? )
Is this depression? • Depression • Constant/global • Increased suicide risk • Amenable to medication • Burnout • Situational • OK on vacation • Induced at work • Non-medical treatment best Likely some overlap
Susceptible population High-achieving personality (Type A) • Selected for in the medical fields • • • Type B ER doc? Surgeon without OCD? High achievers Goal oriented Highly self-critical Varies by specialty
Personal/intrinsic factors • Work/life balance Defined by individual Generational/gender roles? • Time in career Early: idealistic/driven, debts Mid: experienced, expert Late: seasoned/veteran, curmudgeon Each stage has vulnerabilities.
Grant me the serenity To accept the things I cannot change, The courage to change things I can, And the wisdom to know the difference. These are INTERNAL factors.
Mitigation • • Home is where you go to get recharged. Personal care is a must. Keep your body fit; this is a marathon. Practice mindfulness (all sides. ) Have anchoring relationships. Sleep – a discussion unto itself. Choose your friends wisely. • Gin is not your friend.
External factors • Things you don’t control; above your pay grade • Changes with your station in the company • Let’s list a few: • Rate of pay • Work hours/location • Client expectations • Clients’ life situations • More? (your turn)
Systems issues, untenable situations • You can’t fix a problem with the same tool that created it. - Einstein • The beatings will continue until morale improves. • Never worked, never will • No one can take advantage of you without your cooperation. “Every system is precisely engineered to achieve exactly the results it gets. ” –Don Berwick
Grant me the serenity To accept the things I cannot change, The courage to change things I can, And the wisdom to know the difference. These are EXTERNAL factors.
Learned helplessness Initial research: 3 dogs, A, B, C A control, B & C harnessed together B could stop shocks, C had dummy lever then Harnesses removed, dogs could jump fence C did not try to escape; learned futility Threat, rewards, commands not effective Escape only after passive leg movements Foundational research in depression/control
Internal + External = Situations Source
Grant me the serenity To accept the things I cannot change, The courage to change things I can, And the wisdom to know the difference. These are combined factors
So what’s to do? Take care of yourself first. Get a dog. From the pound. Feed him and learn unquestioning love. Skip the gin. Ok, take care of your family first. Sheesh! Anopheles is immune to quinine. Buy a Ferrari. And leave the keys in it; you know where I work!
Picture of Ferrari
Coping strategies – healthy ones Community Like-minded people who share your purpose. Humor None of us are getting out of this alive. Perspective At the end of the day, you’re going home; they’re not. Forgiveness They’re doing the best they can with what they have. And maybe it’s all they’ve got!
Healthy practices • Mindfulness • Awareness of where you are; situational. • Resilience • “I get knocked down, I get up again. ” (Chumba Wumba) • Presence • 100% there when at work; takes practice! • Cathexis • Donning and doffing “the other. ” • This is the practice of borders; survivors do this.
To do list • Your first priority is you. Period. Before clients and family. • Unless you want to be part of the problem. • Diet and exercise; come on here! • It’s a lot tougher than this…; more yoga, anyone? • Regular non-cerebral exercise. That you enjoy! • Biking v running v yogurt • Alone time is crucial; read some (trash. ) • Learn from long-lived participants.
Grant me the serenity To accept the things I cannot change, The courage to change things I can, And the wisdom to know the difference.
If you think you’re burning out You probably are already there. Reach out for the life preservers. This is not a job you can finish; work will always be there. Make your escape. There are people all around who care. Take care of yourself and your family first. Many assets: See ACEP Wellness pages What is your “Escape fire” plan? Stay or go?
Resources • Wellness Worksheets • ~300 page workbook put online by SAMHSA (Sub. Abus. Ment. Hlt. Adm) • Assessment tools and activities • The Black Dog • A short You. Tube video about depression; WHO/Australian • The Wellness Wheel • An exercise in balancing your life, a workshop in and of itself • I like this version because insightful questions are posed.
1927 – Max Ehrmann
- Slides: 28