Watch Out for the Subtle Mind-Shift that Comes Before Burnout

You Want to go into Medicine?

I suspect that my story may be similar to yours. In the 5th grade, I wanted to be a dentist. In the 6th grade, it occurred to me that teeth were boring and so I decided that I wanted to be a physician when I grew up. Why? Because I enjoyed science and wanted to help people.

I said “no” to a lot of other things so I could say “yes” to medicine. I made the commitment to long hours of study, few hours of sleep, and a much-celebrated victory over organic chemistry. Then came hours of volunteering, hospital janitorial work, and the tender experience working in a hospice where I learned to listen when people weren’t speaking.

Getting accepted to the University of Washington School of Medicine was one of the greatest moments of my life. I believed that I had the power to make a difference. My purpose was to heal, to serve, and to love.

Fantastic collegiality offset the three grueling years of residency. We had a blast. We were the only residents in a 350-bed hospital.

After residency, I joined a large multi-specialty clinic where there was a focus on excellence and productivity. Blessed with the ability to serve patients, I felt like I was making a difference.

The process of implementing our first electronic medical record (EMR) was like getting Bengay in our underwear. There were four distinct phases:

  1. This could be great! (Lasts just a few seconds.)
  2. Agonizing pain and suffering.
  3. Everything that was ever important goes numb and falls off.
  4. “It is what it is.”

It was the beginning of less time with patients and more time with the chart.

Soon after that, coding became more complex. Insurance companies realized that they could manipulate physician behavior (and save lots of money) by requiring prior authorizations. The government jumped in with ever increasing regulatory demands. It required more hours at the clinic and less time with the patients to see the same number of patients each day.

In the midst of this increasingly demanding environment, a shift occurred that I didn’t notice at first. There was a sense of a loss of power and a clouding of purpose. I shifted from trying to make a difference to just trying to survive. My focus shifted from others to myself. I started to think that I should have been a dentist after all.

The Mind-Shift

There is a subtle mind-shift that proceeds burnout. Most people go into medicine because: 1) they believe that they have the power to make a difference and 2) they want to give to or serve others. The mind-shift that leads to burnout involves one or both of these foundations.

Efficacy: from powerful to powerless

When people shift to see themselves as powerless, they develop a lack of efficacy. They no longer believe that they have the ability to make a difference. A lack of efficacy is one of the three symptoms of burnout.

Disengagement: from giver to taker

The second symptom of burnout, disengagement, occurs when people choose to shift from a giver to a taker. With an eye on self, they begin to believe that no one is meeting their needs and so they pull back and disengage.

Emotional Exhaustion: lack of fulfillment leads to depleted stores

Thrivers (powerful givers) are renewed by their sense of purpose. Simon Sinek, in his famous TED talk, stresses the power of the WHY. People are empowered to overcome tremendous challenges when they have an unshakeable sense of WHY (purpose). In contrast, whether choosing the mindset of the victim (powerless taker), the bystander (powerless giver), or the controller (powerful taker), they all lead to a lack of fulfillment. Fulfill comes from the Old English word “fullfyllan” which refers to the process of “filling up” a ship for a journey. When we are not filled up by our work, it isn’t long before the stores run out and we are left emotionally exhausted... the third symptom of burnout.

Environment and the Individual

There are two dimensions to burnout: the environment and the individual. The healthcare environment has become difficult, to say the least. There are urgent problems that demand our attention. If we ignore them, we are setting ourselves up for a catastrophic healthcare disaster.

It’s Not Going to Improve if We Don’t Get Involved

As individuals we all face two questions:

  1. Will I choose to be powerful or powerless? Holocaust survivor, Viktor Frankl, says that we always have the “right to choose how we are going to respond to any given situation.”
  2. Will I be a giver or a taker? Those that make the biggest impact are those who are willing to contribute without concern for who gets the credit.

When healthcare professionals choose to shift back to being empowered givers, the healthcare culture will begin to change for the better. We can’t improve the environment without engaged professionals who believe that they have the power to make a difference and who show up with a willingness to give.

What are your thoughts?