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How To Beat Burnout
Episode 26 • 8th August 2022 • Stress-Less Physician • Sara Dill
00:00:00 00:36:24

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Burnout is a frequently used term in our society. But what exactly is it? What goes on inside your brain and your body when you experience burnout? What are some signs that you’re burned out and need to make changes?

In this episode, I open up about my experience with burnout. I had pushed myself and my mind to the point that I had to get away. I needed a sabbatical. And even though it wasn’t easy to make happen, I took that time. And within it, I discovered the power of mindfulness and coaching. I learned that you can, in fact, retrain your brain. You can heal the damage from burnout and even prevent it in the future. Let me share with you what I’ve learned about how to beat burnout.

“Can you start to choose thoughts that reinforce a sense of your own empowerment, your own ability to respond to the world and the events in it?... Maybe it’s something like: This too shall pass… This won’t last forever… I can do hard things… Those are just some examples… in which the way I think about it can cause me to feel less stressed out, less burned out.” – Dr. Sara Dill

What You’ll Learn

  • Definition and signs of burnout
  • My experience
  • Your brain on burnout
  • Recovery from (and prevention of) burnout
  • De-escalate stress
  • Retrain your brain
  • Focus on what you do control
  • Alter your self-talk
  • Change your thinking
  • Examine your willingness to suffer 

Contact Info and Recommended Resources

Book: 

The Upside of Stress by Kelly McGonigal

Podcast Episodes:

Connect with Sara Dill, MD, The Doctor’s Coach

Transcripts

I’m Dr. Sara Dill, and this is the Stress-Less Physician podcast, Episode Number 26. Welcome to the Stress-Less Physician podcast. I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feels good to you, you are in the right place.

Hey, everyone, welcome back to the podcast. Happy Monday, if you’re listening to this on the day it’s published. I actually record it the preceding Monday, usually. So, it’s Monday for me today too, which is trash day here. And so I feel like I’m always timing when I record this with the trash people, who I greatly appreciate, but they do seem to come right when I’m ready to finally record.

So, let’s see, hopefully, this is clear and without the crash bang or beeping of the trash trucks. So today I wanted to talk about burnout. And I used to give some talks on this. I was invited to speak about burnout with several groups in several institutions. And for a while, I was starting my talk on burnout with the slide that said “Burned Out, On Burnout.” Because I felt like there was a time where we all were sort of burned out on even hearing about it or talking about it. And that was before COVID. And then with COVID, I think we went through another phase. And it just seems like burnout is one of those things that is always important to think about and talk about, because it’s so common.

I talked to a lot of clients about whether they should leave their jobs, or how to make their job more sort of sustainable, more tolerable. I coach a lot of people in the middle of burnout, which can be difficult because one of the hallmarks of being burned out is feeling overwhelmed and exhausted. And often, the last thing you want to do is do anything else than the bare minimum, what you have to do to get through the day. And yet, the problem with that is that then you typically stay stuck and burnout.

So, I also talked to a lot of clients who’ve been through burnout, and are on the other side of burnout. That’s where I am myself. So today, I wanted to talk about burnout, I wanted to talk about what it is, I want to talk about how and why our brain is largely responsible for our experience of burnout. I want to talk about how to solve for burnout, how to sort of become burnout proof, and then also how to repair it, how to heal it if you’re in the middle of burnout, and again, prevent it in the future.

So, let’s first start with a definition of burnout, which is challenging because everyone uses it differently. Just like when we say we’re stressed out, burned out, or burnout is one of those catch-all terms that we use to mean a lot of different things. So, burnout for the purposes of studies and the Maslach Burnout Inventory, which some of you may be familiar with, really is characterized by feelings of exhaustion, both emotional and physical exhaustion, cynicism, and reduced efficacy or a loss of feeling, like what you do matters.

The way I would define it, really, and the way I think that most of us sort of use the term is really as a manifestation of sort of chronic, unrelenting, unmitigated stress. And then the repercussions of that are often a variety of physical sensations, but also physical illnesses, including things like insomnia, irritability. Often, we will tend to numb out with food or wine or Netflix, all sorts of things that we do to sort of cope with burnout in ways that are not particularly healthy or conducive to really healing from it or preventing it in the future.

So, this is how I think about burnout or how you can recognize whether you were burned out. Some people just feel sort of numb and tuned out. A lot of the time, people describe feeling like they don’t have time to rest, they’re too busy, too much to do, too stressed out. And then when you do rest, you still feel tired. So, one of the hallmarks of burnout is this emotional exhaustion and physical exhaustion that’s unrelieved by a weekend off or time off, or getting a good night’s sleep. It’s not fixable with a day or two off?

Do you feel like you’re always on the verge of breaking down? Or do small things set you off emotionally? Do you dream about maybe escaping your life or your career? When I was more burned out, I used to just fantasize about, I don’t even know, I think just going and sailing with my dad or something like that. Just escaping my life completely. Do you feel like what you’re doing lacks value or sort of meaningless or less meaningful than you used to? And then again, some people feel more cynical, more checked out. Others feel more irritated or angry all of the time. And then again, some people just don’t feel much, they just feel sort of numb and they’re just going about their day, but without much engagement.

So again, this isn’t really a clinical diagnosis of burnout. But these are some of the characteristics that might clue you in that this is relevant to you. I just want to start by saying that, although I’m going to talk about steps and strategies to both recover from burnout and prevent burnout, burnout is not your fault at all, right? It’s not the fault of any one person. Burnout is the result both of how our brain is wired, right, the stress response, that’s a normal and natural part of how we evolved and how our brain functions, as well as the result of both our medical culture—and I’ll speak more to that—as well as a lot of aspects of our Western culture, and how we think about work and productivity, and often, how we use work and productivity and achievement as a way to sort of earn our self-worth or earn a feeling of worthiness or value. I think all of these feed into this sort of culture and epidemic of burnout that we’re experiencing, not only in the medical profession, but really more widely.

What I’d like to also talk about in this podcast is how we can really retrain our mind, retrain the brain to not sort of go down the road to burnout, regardless of life and its challenges. So again, if burnout is sort of a manifestation of chronic, unrelieved, or unmitigated stress, as I talked about, I believe in my first podcast, is I don’t really believe that there are “stressors” out there, I believe that what each one of us perceives as stressful, might be something different than what someone else perceives as stressful. Often, though, most of us feel stressed out about things that we can’t control, or that we perceive we have no control over. And then in medicine, we often feel stressed about making mistakes, about disappointing other people, about outcomes, and about so many other things.

So, I’d like to talk about how we can learn strategies and skills so that regardless of what’s going on in our life and its challenges, we can be more resilient, we can enjoy our relationships, we can not feel anxious all the time. We can, again, have this sort of sense of emotional resiliency, where we aren’t on an emotional roller coaster all the time, where you can recover quickly from unexpected events or challenging events. How can you learn how to feel more confident and in control of yourself and your experience of life? And then, especially, how can we learn how to recharge ourselves in our life? How can we sort of catch on early when we’re on the road to burnout and really reverse it?

And again, I really learned this through my own experience of burnout. And in fact, I didn’t even know I was burned out. I just thought I really didn’t like my job as a dermatologist. And on top of all of the sort of stress and overwhelm I was feeling, I also then felt a lot of guilt and really shame about not enjoying myself as a dermatologist about feeling stressed out and overworked as a dermatologist, because we all know dermatology is not known for being the most taxing of all specialties. It certainly has its areas that are busy and challenging. But the guilty and shame I felt about even my own experience just added to my burnout. And so I felt stressed.

I had always put this pressure on myself to do well and get A’s. I’ve already talked about a lot of my imposter syndrome thinking, and self-guessing and self-doubt and lack of confidence. I definitely was always trying to get approval from other people and make sure people were happy with me and pleased with me. When I was in training, we all learned that patients come first. And for a long time, I didn’t even recognize that my own sense of value and self-worth came from my helping other people. Rather than feeling that I had intrinsic value and was already sort of worthy, and valuable, regardless of what I chose to do with my life and career. I took things personally, especially patient feedback and other people’s opinions. I didn’t really know how to understand my own emotions, and how to allow them or process them, I was really very terrified of making mistakes.

And then as I said, I already felt guilty and sort of ashamed of not enjoying my career as a dermatologist, and not enjoying my life, which on paper looked pretty amazing. So, I ended up switching jobs multiple times. And then I ended up actually taking a sabbatical from practice. It was supposed to be a year, and I think it turned into about five years, actually, I had tried academics and private practice, I tried managed care, when I stepped away from practice is when I discovered coaching. And I also took on a role in a pharmaceutical company as a medical director in research and development. And it was interesting to see myself recreate a lot of the same patterns in a very different profession.

And then even in dating at that time, I look back now and I see that I just wanted someone to fix my life and make some decisions for me. I just was sort of tired all the time, and felt pretty out of control. And so this is the podcast that I wish I had had available. And this is one of the reasons that I love talking to other physicians who are in the middle of their own burnout, because it really can get so much better.

So again, I took a sabbatical from practice, and I discovered coaching and mindfulness. And together, both of those really, were what allowed me to start to change a lot of the patterns I had, that kept contributing and recreating this pattern of burnout and unhappiness and exhaustion. So now I’m back in practice as a dermatologist, I work part time, and I really enjoy it, even with the challenges of COVID. And so certainly, there are a lot of challenges. And they are continuing and ongoing, with staffing and shortages of equipment, etc. But again, I sort of know how to manage my own mind, and that makes all the difference.

So, I’ve managed to practice through COVID without getting burned out, probably because I’ve already experienced it and because this stuff really works—at least it works for me. And I would encourage you to try it. Now I really don’t have impostor syndrome thinking. I generally feel confident and calm at work and in my coaching and consulting business. That does not mean that I don’t have moments where I freak out, I get irritated, I get impatient. My boyfriend can attest to this. We just went to LA this weekend, and I am not someone who likes traffic at all. It was definitely not at my best in heavy LA traffic, and I can acknowledge that and move on. These days, I can handle conflict and not take other people and their opinions personally. I think it actually helps me to have better closer relationships. I have much more compassion and understanding and forgiveness both for myself and for other people.

And again, I still get activated and freak out a little bit, but I recover very fast. And I understand what’s happening and how I am causing it. But without making myself wrong for it and without beating myself up for it. And overall, I really enjoy my life. I’m more okay with mistakes. Perfection is not the goal and my self-worth and value is never on the line. And I think that is such an important distinction. And I’m always open to making changes in my life, it doesn’t mean that anything is fixed, that I won’t stop practice or practice more or anything. But I don’t really worry about it.

And I also don’t beat myself up or others for choices or decisions, really any of it. I really believe we’re all doing the best we can. And sometimes our best isn’t amazing, and that’s okay. So, I just want to suggest what if it is possible to reverse and prevent burnout, regardless of your career, what’s happening in your life or what you do. So again, I would define burnout, as really a lack of this emotional resilience, of not being able to bounce back any longer, not being able to recover and rest and go back out into the world. And it often happens over time.

So again, this exhaustion, lack of meaning, maybe cynicism, over reactivity, all of that. Sometimes burnout is explained as the result of stressful situations or stressful work environment. To me, that feels very disempowering, and very out of control, and hopeless and helpless. Because, as you know, we can’t control the outside world. The only thing we could do would be to quit our jobs or change our circumstances. Sometimes we can do that. It’s never a problem, you’re always welcome to do that. But what if you could learn how not to feel burned out, regardless of whether your job is full of uncertainty, challenges, or any other sort of source of stress.

And then, as I mentioned before, one of the catch 22s of burnout is that once we are burned out and feeling exhausted and overwhelmed, the last thing we typically want to do is have something else that we have to do to fix it, right, we’re already exhausted. But this pattern, the cycle just keeps us stuck in burnout. So the way I understand burnout is that it’s really the result of our human brain, and how it’s perceiving the events in our life. So,, we have this brain that actually has a lot of sort of different parts. If you think about the evolutionary patterns of our brain. And our brain, the way it operates, it often hasn’t really caught up to the modern world.

So we have this stress response. Most of us are familiar with it, where something happens in the world, our mind perceives this event as a threat. And it triggers a stress response, which is appropriate in some circumstances, right, we get the sympathetic, overdrive, fight, flight, freeze, or faint, a variety of neurochemicals are stimulated and cascade which causes a variety of physical responses and sensations. The problem is that this is happening multiple times a day, in response to things that are not actually physically harmful, that are not actually a threat—like emails, or a negative comment, a negative patient, critique or review.

So, it’s often our excessive stress response, that can cause sort of burnout or variety of health problems, as well as our inability to sort of go back to baseline, to relax and reset, to sort of inhabit that normal level of parasympathetic. The other thing that can be harmful, sort of paradoxically, is also our response to feeling stress. So, there’s some interesting research that shows that the stress response itself is not always harmful. Again, it’s chronic, repetitive stress from which we can’t recover. And also, the way we think about it, that can then make us even more stressed out. Burnout is also much more likely when we are strongly or even over identified with our careers, or other roles that we have in life.

So, I can ask you, are you so identified with your career, as a physician, as a helping professional, as someone who wants to help and heal others and maybe the world? Because then it becomes harder to see that our suffering, right, our burnout doesn’t mean that we care more, right? It’s not a badge of honor. Because some of us, I think, at least unconsciously, or subconsciously, maybe have a belief that being burned out, is inevitable as a physician or sort of a badge of honor, or may be required to be a good caring doctor. Is that something that you believe? And if so, are those beliefs going to continue to create a pattern of burnout?

So many of my coaching clients think that the more they care, the more they inevitably are likely going to suffer in some ways, that somehow one equals the other. So just good to notice. A question to ask yourself is, am I caring? Is the way I’m showing up at work as a physician coming at my own expense? I think it’s amazing to go above and beyond for patients, for colleagues, for friends, for family, but only if it’s not coming at your own expense, or at least not most of the time, right? Are you aware of it?

So, let’s talk about how to recover from and how to prevent burnout. So, the first step really in this is learning how to de-escalate your natural inherent stress response. We are not going to get rid of the stress response. A lot of that is unconscious, we go from zero to 10, very quickly. So again, there’s these fascinating studies that show that sometimes stress itself is not harmful. But it’s often our inability to get ourselves back down to a sort of more calm state rate to get ourselves out of that stress response.

And often, if we are labeling stress as dangerous or harmful, it actually can be more harmful. If you’re interested in that, you can go check out a book by Kelly McGonigal called The Upside of Stress. So, the way I think about this, learning how to de-escalate your stress response is, as with everything in coaching, is becoming aware of how you’re feeling of how you’re responding as quickly as possible, right? Can you be aware, almost instantaneously, “Oh, my gosh, here I am. I’m getting stressed. I’m feeling anxious, and feeling overwhelmed.”

So I like to practice being aware of when I’m stressed or upset or scared or anxious, and then talk myself through it, like, “Okay, you’re feeling anxious, or you’re feeling irritated right now, that’s totally fine.” This is actually how I talk to myself, in my mind, sometimes out loud, right? It’s okay. I like to remind myself that emotions last on average, 90 seconds. I like to check in: what am I thinking right now? Because a lot of us will have a pattern of our own particular stress response, things that we find stressful, whether it’s certain patients, whether it’s been on call, whether it’s the uncertainty of what you’re going to see, in the hospital, or in your clinic, whether it’s making mistakes, whatever it is, patient feedback, patients being disappointed running late, right? So, you want to check in: what am I thinking right now that’s causing this emotional response that’s stressing me out. Get to know your patterns. And can you start to just talk yourself down in the moment and de-escalate very quickly?

Oh, this is me being a human. I’m having a stress response right now, this is my brain, doing what it’s supposed to do, it just doesn’t realize that this is not actually a threat. Okay, that’s the first step. So, learning how to de-escalate your stress response and recover from stress very quickly so you aren’t in that chronic fight, flight, freeze state. The second step, and this is a big one, this is what I work on a lot, on myself and with clients is to change your thinking on purpose. So notice, if you’re telling yourself that you have to do things, or you can’t do things. Even things like “I have to go to work” will often have a lot of my clients feel trapped and burned out and resentful. When really, you could just notice, like I’m choosing to go to work because I want to get paid, or I signed a contract, or I don’t want to deal with being unemployed right now. Notice, if you remind yourself that you can always quit your job, you can always change jobs, nothing is forever. Those would be examples of changing your thinking, noticing the thoughts that are creating a lot of your own personal stress response.

So, both our thoughts about the external world, and our thoughts about ourselves, can cause or worsen burnout, and also reduce our ability to recover, reduce our emotional resilience. Can you start to choose thoughts that reinforce a sense of your own empowerment, your own ability to respond to the world, and the events in it? I’ve already done a podcast on what we can control and what we can’t. How are you choosing to focus on what you can control versus what you can’t? How are you thinking about those things? Can you start to choose thoughts that again, de-escalate your stress response? So maybe it’s something like this too shall pass. This won’t last forever. I can do more hard things. People are capable of doing amazing things in spite of overwhelming odds. Those are just some examples that I can think of in response to the outside world and challenges we face, in which the way I think about it can cause me to feel less stressed out, less burned out.

Notice all the things you do control. Feeling out of control, feeling helpless and feeling hopeless, is a huge factor in burnout. Often, we tell ourselves, we can’t control things, and yet we really can. So maybe you can’t control the hospital administration or hospital policies, you can control whether you work at that hospital, you can control whether you go to work that day, you can control how you show up. So, start to spend time, paying attention to what you do control, rather than what you don’t. Again, it will start to reinforce a sense of being in control, rather than helpless, hopeless, and out of control.

The other thoughts to work on changing on purpose are your thoughts about yourself your own internal self-talk, right? I’ve done a podcast on this because it’s so important. Are you mean or self-critical, or shaming or judging to yourself? This just leads to more burnout, especially because we often then try to solve our self-criticism, and our feelings of a lack of self-worth and self-confidence by trying to do more for others, to achieve more, to be more caring, to be more self-sacrificing? So if I don’t feel worthy and I try to fix it by doing more for other people, that directly leads to my burning out, it does not help me feel better about myself, because then I’m probably going to beat myself up by asking what’s wrong with me? Why can’t hack it? I should be able to do more, etc.

Again, you can’t earn feelings of self-worth or worthiness by doing more in the outside world. It’s backwards. It’s a thought problem, not a doing problem. So these self-critical thoughts also create a stress response in your body. And as we talked about a lot of burnout, the way I think about it, is this chronic unmitigated, unrelieved stress response. So rather than beating yourself up, you can notice if the way you talk to yourself is how you would talk to a friend or a child. If it’s not, then you shouldn’t talk to yourself that way either.

Do you tell yourself you’re doing the best you can? Do you tell yourself no one’s perfect? And that’s okay. Can you focus on thoughts you already believe about yourself that are more positive, and sort of stop focusing on the thoughts that are more negative about yourself? Can you try to get to a more neutral or a warmer thought about yourself, right, trying to shift your negative thoughts to slightly more positive and yet, still believable thoughts? I talked about this in believing new things. That will help, too. So again, burnout comes from the thoughts were thinking and our escalation of our stress response, both internally and externally.

Another factor in recovering from burnout and preventing burnout, is to ask yourself, do you see overworking and over caring and always doing more for other people as a positive thing, right? Is that something that you sort of think is a good habit to have? Or means you’re being a good doctor? Can you stop seeing overworking and over caring and the always doing more as a positive thing? Are you more willing to suffer yourself than to say no to others? Think about little areas here. Do you see late patients so that they don’t get upset? Or maybe even, right? Because you tell yourself they really need help? Even if it means that you work through your lunch break every day? Are you more invested in your patient’s wellbeing or health are the choices they make than they are? Do you put other people’s needs and desires and wellbeing above your own at work or maybe in your personal life, or maybe both? Do you do this all the time some of the time? Can you stop it? Can you stop this pattern? I guess I should say, please stop it. My recommendation is to stop it.

And then also, are you trying to prove or bolster your own sense of self-worth and value by working harder and at your own expense? Is it possible for you to care for others in the world and yet not have it be at your own expense? And another aspect of this, too, is noticing how do you see, how do you think about people who aren’t exhausted? How do you think about doctors who don’t overwork, who have a lot of time off, who seem to have lots of energy? Do you sort of judge them? Do you feel like maybe they aren’t really working hard enough? And that the fact that you’re exhausted and that you’re working a lot, and you don’t have time off? Or you feel like you always have to fill it and be productive, again, do you sort of carry that as a badge of honor? Do you take pride in being too busy and being productive all the time? Do you enjoy resting and relaxing and maybe not doing anything?

A lot of people who are used to being busy and finding personal value in their taking care of other people and their productivity, don’t always enjoy resting and relaxing, it’s actually a skill set to learn how to enjoy time off and not use it against yourself, right? Not tell yourself you’re being lazy or unproductive or wasting time, or misusing it, not taking advantage of it. All of those are sort of subtle self-criticisms again. You have to learn how to allow yourself to have free time and not be doing all the time. Are you okay with just being rather than doing?

So, I know this is a lot. I think we’ll come back maybe in touch on sort of a follow up to burnout. I’d be happy to have any questions emailed to me, and I’d be happy to talk about that in a future podcast. But what I want to add here before I sign off, is that for many physicians, there’s this idea that if I’m telling you to work on yourself, to work on being more resilient, it’s somehow blaming you or blaming ourselves for our own burnout, that somehow this is letting medical institutions and medical culture and CEOs and administrators and insurance companies, all of it, off the hook.

And I just want to say again, that I in no way want to intimate or believe that burnout is ever one’s own fault, right? It wasn’t my fault. It’s not your fault. I think nothing could be further from the truth. I think the culture of medicine—and again, this is just my opinion—the culture of medicine absolutely contributes to and creates the epidemic of burnout we’re experiencing. And yet, we are a part of that culture, the culture of medicine, and even our larger culture. So, in some sense, we can’t burn out without ourselves being somewhat complicit, or allowing ourselves to be taken advantage of or to be burned out.

Just notice how we might keep saying yes or making things work, when they are not sustainable, or healthy, or how we want to be living. Just start to notice, where we can take responsibility, not in a way of blaming ourselves. But in true empowerment, making ourselves responsible gives us the authority to be able to change it. As physicians, we’re trained explicitly to work harder when asked to, to say yes, when asked, to put ourselves last, right? I mean, how many of us don’t even take a bathroom break or a lunch break? Or any sort of eating break at work? How many of us are perpetually dehydrated at work, because we somehow don’t even have time for water, or anything, right? I think all of us have experienced that. But we can’t do better or do differently until we understand that there are things we can do to heal and prevent our own burnout, to recover from burnout. Taking responsibility, again, not in a self-blaming, shaming, or guilting kind of way, is the first step. And again, that’s focusing on what we can control, not what we can’t.

And if we want to change the culture of medicine and the way medicine is practiced, and how physicians are valued and cared for in our society, and in our medical culture, we need to be at our best, not burned out, not overwhelmed, not exhausted, not numb. So again, I think that caring for ourselves is the first step. Especially if we want to be a part of the larger changes so many of us want to see in medicine. Maybe I would think of these steps to healing and preventing burnout is how we can be part of the change part of the solution that we want to see. I would say it starts with each one of us. So again, not letting other institutions or entities off the hook. But empowering ourselves to be the ones to change them.

Thank you so much. Again, if you have any questions, comments, any feedback, anything you want me to talk about on the podcast in the future, please email me at sara@saradill.com. I read and respond to each and every email. And if you’re listening to this next Monday when the podcast drops, it will be the last day to join my new three-month small group coaching program. We start Monday night, August 8, and I would love to have you there. So, check out my website, send me an email, and I will talk to you next week. Bye.

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more, and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at www.saradill.com. That’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.

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