The Burnout Box  

 

Burnout: It’s personal

 

It is helpful to think of your current situation as box of your construction (no blaming, just naming), with a floor, walls and a ceiling. The floor is your cumulative learning, experience and education. The walls consist of work environment, mental, physical, financial, spiritual and social elements. The ceiling is any limiting beliefs you may hold. 

 

To effect change:

 

Assessment and action are critical. It is a simple process that when repeated is like peeling an onion. Start with the outer layers, then progress to the next, once you have success with the first.

 

To assess burnout:

 

Pick one aspect of any “wall” of the burnout box, or current situation that seems to be the major driver of your burnout. In other words: What makes your blood boil on a regular basis? Write that down. Next, think of one action or planned intention you can take to improve, change or reduce the problem. Write that down. Let money or cost for the solution be no object in this thought experiment, for now. It will expand your creativity for possible solutions.

 

Next, put a deadline on your action plan.

 

Behavioral science research shows that planned intentions with actions and deadlines triple the likelihood of completion of the task. Finally, take action on your plan! You have successfully attacked your first burnout driver. Now, repeat with whatever is next on your list of problems. 

 

Systemic changes are addressed in the same way, but simply require interaction with your group, employer or hospital system. Engage with your system, let them know how you are or are not doing, what is good and not so good, and what you need to care for yourself. That should start a very productive conversation. Then, repeat the problem solution process detailed above. Problem. Intention. Deadline. Action. 1. 2. 3. 4. No more burnout anymore. Sorry, couldn’t resist. 

 

Let me give you examples of how this process worked for me personally and systemically.

 

Personally, I had some real issues with insomnia, waking up at 2 and 3 am, thinking and stressing about my practice and any other problems going on, and then being completely unable to return to sleep, making the next day a draining, fatigued fog.  This was something affecting the physical wall of my box.  So, I wrote down:  Insomnia. 

 

Next, I educated myself about strategies for treating insomnia. I gave myself a week deadline to learn and start implementing new strategies.  I wrote down four of the strategies I thought I could apply.  I stopped using devices 30-60 minutes before bed. I ‘scheduled’ time to attack my insomnia-creating practice problems during the day.  I had a bedside journal for writing down any of these thoughts when they occurred at night to get them out of my head.  Finally, I used meditative breathing while drifting off to sleep, counting the breaths. I rarely make it past 6 or 7, before I am asleep.  If I wake up in the middle of the night, I repeat the breathing process with very good results.

 

Systemically, our EMR was very inefficient.

 

(I know, surprise!) at generating new or return notes, taking me about 30 minutes per day just to get them opened.  So, I wrote down:  EMR Note Opening.  My strategy was teaching my medical assistant how to open the notes prior to me seeing the patients. I gave myself a one-day deadline. Teaching her how to open new notes took 15 minutes and permanently saved me 30 minutes+ per day. Voila! I magically had 10 hours per month and 120 hours per year of my life back!

 

You may think this plan seems too simplistic or straightforward.

 

But the real issue is lack of action once a problem is identified. Doctor, diagnose and treat this problem! We all do this all day, every day for our patients. Turn your energy, initiative and integrity towards yourself. 

 

This is what I have done for the past several years, and continue to do every day. The wonderful aspect of taking action is that you are taking back your control. The peace, sense of calm, new hope for my future practice of medicine, while taking action, have empowered me.  

 

I am no longer a helpless bystander, but an active change agent in my practice and my life. Small changes over time yield large results. Even a 1 percent per day improvement, if compounded over a year, will yield a 3,700 percent improvement. I’ll take that.