There is More to Burnout Than What You See


Healthcare burnout is threatening the foundation of medicine. There is a lot of talk about the outward symptoms of burnout: emotional exhaustion, feeling detached, and feeling ineffective. However, if we hope to make a significant impact, we are going to have to look deeper... several layers deeper. Of course, there are obnoxious workplace stressors that contribute to the risk of burnout. These include the electronic medical record, regulatory requirements, and insurance mandates. Unfortunately, our discussions tend to focus on these issues because it is easier to point to the external factors than it is to take an in-depth look at what's going on inside of us. I don't believe that we are going to experience any lasting change until we take a deep dive and understand the impact of subtle and hidden shifts in our thinking.

I've been doing disaster medicine for over 30 years, and I've found disasters to be a unique study in human behavior. In our day-to-day lives, it is easy to hide behind our roles, our belongings, and our relationships. Disasters, on the other hand, are raw. I'm convinced that earthquakes and hurricanes don't change people; they merely reveal people as they are. Similar to the exposed root structure of a tree that has been ripped from the ground by a massive storm, in disasters we see human dynamics that usually remain hidden below the surface.


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When we come in contact with other people we first notice the fruit that they bear. Some people have the most incredible tasting fruit. It brings a smile and provides nourishment. On the other hand, others have fruit that is bitter and makes us sick. Sometimes the fruit looks great but leaves a foul taste and horrible belly pain. To understand why our fruit tastes the way it does we have to consider our emotions.


Emotions determine the type of fruit we produce. You can't get apples from a fig tree. Emotions are like the trunk of a tree: partially visible and partially hidden below the ground. Several studies have documented that when we approach our work with joy, errors decrease, patient satisfaction increases, and patients receive better care. The opposite is true as well. If we come to work with anger and frustration, everyone suffers. However, it isn't constructive to just give someone the advice that they should just "be happy." In fact, such advice may only produce a more abundant crop of anger. To understand what causes emotions, we need to consider words.


The words that we ponder have a profound impact on the emotions that we experience. Our internal dialog is well hidden from the outside world and often hidden from ourselves as well. We may not be aware of the words we are thinking about because we've have been entertaining them for so long that we no longer notice. Words can be negative or positive, destructive or supportive, and directed at ourselves or others. Mindfulness practice allows us to stop long enough to become aware of this internal dialog. While it does take practice, it indeed can be an eye-opening experience. The power of words is one of the reasons that the practice of gratitude can make such a difference. Mindfulness and gratitude by themselves, however, will not lead to lasting change because it is mindset that fuels our thoughts and our words.


There are four mindsets that we all employ at one point or another: Victim, Controller, Bystander, and Thriver. Two choices determine our mindset: Powerless or powerful? Giver or a taker?

The Victim Mindset is that of the powerless-taker. The words are focused inwardly and full of pity and powerlessness. Some of the emotions that we experience may be sadness, resentment, and jealousy. The fruit that we produce is small and lacks flavor.

The Controller Mindset is the powerful-taker. The internal words are focused inwardly and full of self and success. Some of the emotions that we experience may be anger, frustration, and fear. Our fruit is bitter.

The Bystander Mindset is the powerless-giver. The internal words are outwardly focused and full of frustration and need. Some of the emotions that we experience may be numbness, defeat, and doubt. We produce no fruit with the Bystander Mindset.

If I choose the Thriver's Mindset, my internal words will be full of hope and opportunity. When my words are full of hope and opportunity my emotions will be full of joy. When I am full of joy, my fruit will be a source of nourishment for those around me.

Deep down, it all starts with choice.