In her series on top skills for general practice, Sonia goes into more depth on how to recover after burnout.
In my previous article, I covered how to spot if you have burnout and how a “personalised burnout prevention and recharging action plan” might be a good thing to work on if one has incipient or frank burnout.
It’s very difficult to handle burnout, or the things that are causing it, entirely on one's own, since it tends to creep up slowly and has many potential contributing factors:
- organisational culture
- peer pressure
- time management skills
- expectations from patients
- personal values
- one’s own egos (need to please, fear of failure etc)
- assertiveness and ability to let go of things
- demands from family life
- underlying workaholism issues
- perspective on work/life balance
- overlay of anxiety and/or depression
Key to identifying which part is making the biggest contribution to your burnout really benefits from having a sounding board - a coach or even a counsellor - to discuss it with; someone who you can be completely and utterly honest. For most, it is a mixture of some or all of the above list, and it is important to realise that there will be things within oneself that are likely to be contributing to it. Yes, one can blame work or career, but only up to a point.
Here is one possible approach:
- Accept that you may have burnout (see previous article)
- Accept that reversing burnout, and even preventing it, may require some help
- Take action - don’t sit on it.
None of these three will seem easy.
Make a huge effort and start some self-nurturing activities e.g. yoga or tai chi class (yes I know you are busy, busy, busy and have no energy, but it may be at least partly because you are not doing enough self-nurturing and calming and energising stuff just for you that the burnout situation has arisen).
- fit in a swim once a week, or a jog
- book yourself a sports or aromatherapy massage
- book a game of tennis or golf once a week
- read a mindfulness book or do a course on it
- book a weekend away on your own in a retreat or health farm or eco camp
- do a meditation class or listen daily to meditation recordings
- raise the issue at next appraisal.
Start with one of the above and build up to several. If doing this “turns the tanker” of burnout, great. If it doesn’t, think about proceeding, below, to prevent it getting any worse.
- visit your own GP or an occupational health doctor, privately if need be
- decide with them if patient care is at risk and if your own health is suffering enough to warrant some sick leave
- arrange to see an appropriate therapist
- do the things for mild burnout, if you are up to it, during any sick leave.
In all cases, if the intermittent sick leave cycle keeps on going, it must be taken seriously as it is rarely a sustainable situation. Burnout affects all aspects of life and will not be helping relationships or enjoyment of life outside work.
The point at which to seek career planning support is a difficult one, because once a person has burnout, they are far less able to take on anything extra in their lives. This is because they often feel as if they are working at maximum stretch as it is. At such points, even the suggestion of doing a one hour yoga class a week often meets with derision and excuses why that can’t possibly be done. Hence, the four hours or so a week required for in-depth career reevaluation and planning just isn’t going to happen.
In addition, once anti-burnout measures have been taken, this may
- resolve the situation completely
- be enough to keep things ticking for now, or start to reveal measures to taken that will make a real difference
- be merely putting a finger in the dyke
- resolve nothing at all and the cycle repeats, or merely continues on the downward spiral.
The question to ask is “Am I in control of my career, or is it in control of me?”. The nearer you are to the “It’s in control of me” end, the more likely I would think some external expertise will be needed.
Rectifying burnout is often as much a matter of replacing the locus of control within the individual as it is doing self-nurturing activities (the latter of which can sometimes feel a bit like sticking plasters, but can have an important supporting effect). The challenge of placing the locus of control back with the individual can at times warrant some mentoring or even career guidance, but either way an objective look at how you fit your work and how it fits you should be part of the mix.
Choosing the right moment for a career revaluation in the resolution or development of burnout is important, and will be different for each individual, but a discussion about “timing” is essential. The rule of thumb is that during severe burnout, it is rarely appropriate to be doing the in-depth work required for career planning or change. The ideal time is probably during the resolution phase or even better...well before the burnout gets incapacitating.
So to summarise, if you think you may have burnout:
- Recognise the symptoms and admit to yourself fully if you have it
- Realise that seeking help is appropriate
- Take action - however small
Oh, and teach your registrars and students about burnout and what to do about it because the risk of burnout is not going to go away any time soon.