2 Responses to “Recognizing You Are on the Road to Burnout—and What to Do”

1. 

   December 25, 2017

   Mark Buettner Reply

   These solutions lack the courage to confront the power that forces an unhealthy work environment upon us. Instead, it recommends that we as individuals make change in ourselves to avoid burnout. What changes should we make? 1) Alter our brain chemistry with “Pharmacologic Support” and/or 2) Work Less. This advice serves to enable the power that binds us. By definition this advice is cowardly because it charges the powerless individual physician with the responsibility to prevent burnout while excusing the powerful federal government for the unhealthy work environment that it mandates.

   It is a detachment from reality to recommend working less to avoid burnout. We have families to support. We have student loans to pay while at the same time saving for our children’s future education. Most of us have our own retirements we are responsible for funding. Seeking a less intense work environment translates to less income. Are these recommendations to the benefit our patient population? I think not. Who will care for our patients in our absence? Notwithstanding, I believe the overwhelming majority of us enjoy the true core of our work as Clinical Emergency Physicians. We did not seek this career field to hide from it. When the time comes whereby an overwhelming majority of us are unable to recognize a career of full time clinical Emergency Medicine without burning out, then a call for immediate change should be in order. Where is the call for change?

   Finally, there seems to be a cottage industry opening up in the physician wellness arena. Is there really any serious call for change? There comes a time when merely writing about physician burnout is just self-serving. We all should be demanding of our physician organizations and academia to use their platforms in an effort to make change. The time is Now!

2. 

   February 11, 2018

   Laura McPeake Reply

   Dear Dr. Buettner,

   Thank you for your response. I completely agree with you that we need to do much more as a specialty, and in the house of medicine in general, in addressing systemic burnout, and having institutional level interventions to combat burnout.

   The scope of this article was purposely narrow, to make suggestions to help physicians evaluate their safety to practice and perhaps recognize symptoms and benefit their colleagues who might also be suffering from severe incapacitating burnout. This is important because, as experts in keeping a straight face in the most disturbing adversity, it isn’t always obvious who is burnt out and who isn’t. This is similar to how we need all emergency physicians to understand the warning signs of impending respiratory collapse in a failing asthmatic. Once the patient is hypoxic, you have lost the battle. Similarly, once a physician is too far down the road to burnout, he or she is at personal and professional risk.

   Your response also highlights a very important topic in the realm of burnout and wellness, the belief that solutions are either individual or organizational, and that emphasizing one undermines the other. This false dilemma negates much of the work that is being done and needs to be done to combat burnout on any level. Essentially, this polarization lets the good be the enemy of the perfect. Systemic change is crucially needed, as called for in much of the most current literature on burnout. And while needed, that level of intervention will not be immediate. In the meantime we also need to support the individuals working in a difficulty system. In fact, those same burnt out physicians, when supported can be some of the most powerful catalysts for change. When we support the individual, as well as the organization, we empower people to speak up, advocate and innovate to move toward a healthier healthcare system. Increasing polarity just pits one side against the other, and we waste limited energy bickering amongst ourselves on whose approach is better and little is accomplished. Whereas in reality, both well meaning sides of this false dilemma need to work together. We need all hands on deck, including yours and I truly appreciate your willingness to speak your objections, to forward an important cause both for the physicians we work with and the patients we serve.