One Day at a Time

The Burnout Is Real: Advice for Health Care Workers

Daily insights on life in the face of uncertainty, by psychiatrist and habit change specialist Dr. Jud Brewer

Even before the coronavirus pandemic, we faced a growing epidemic of burnout and anxiety among doctors, nurses, and other health care professionals. That strain is unfortunately only going to get worse with the new demands on our health care system. But there is hope based on new research that health care professionals (and all of us) can put into practice today.

Have you ever seen a doctor in a movie or on television taking a break from the emergency room to use the bathroom? I haven’t. While TV isn’t reality, there is a lot of truth to this representation. When my classmates and I took our Hippocratic oath in medical school to “first do no harm” and we put on our white coats for the very first time, we were also silently agreeing to shoulder the responsibility to put others first. This necessary promise makes a lot of sense, not just for doctors or health care providers, but for all of us. In the face of danger, parents will literally sacrifice themselves for their children. Historically, martyrs have been praised and respected rather than reviled.

As humans, if we don’t take care of ourselves or do the work to make sure we’re helping out from a place of wholeness, we can’t function, much less help anyone else.

Yet in modern society, martyrdom has taken on a different meaning. In the era of social media, where good deeds go viral, our very human reaction after the wow, that person is amazing moment of appreciation is to then compare ourselves to them. As discussed in a prior column, this comparison can lead to guilt that we’re not doing enough, or shame that we’re not good enough. And that can plant a poisonous seed that grows unseen if we don’t look inside ourselves or take the time to self-reflect. If that seed germinates, it can cause us to feel like we should be doing more. And since helping others feels good, modern martyrdom can even get grooved and reinforced in a similar manner to other habits. It feels bad not to help, and it feels good to help. Remember, all we need is a trigger, a behavior, and a reward. To see someone in need, that’s the trigger, to help out, that’s the behavior, and to feel good, that’s the reward.

So though we know helping out feels good, there’s another big piece to this. As humans, if we don’t take care of ourselves or do the work to make sure we’re helping out from a place of wholeness, we can’t function, much less help anyone else.

Before coronavirus, health care providers were dropping like flies due to another plague — professional burnout. Though doctors often preach to patients about eating healthy and getting plenty of sleep and exercise, we aren’t always so good about doing those things ourselves. Oftentimes, the behavior most modeled on the wards is toughness and sacrifice. In the hospital, we learn to show empathy for our patients, but not to show concern for ourselves or even our own emotions. Instead, we learn to “armor up,” which is a heroic-sounding term for stuffing our emotions deep down so we can get on with the business of helping our patients.

So, of course, after years of a steady diet of martyrdom, doctors burn out. The burnout estimates that I’ve seen range from 50–80%. Even the low end here is staggering.

As a psychiatrist, I’ve treated my fair share of burnt-out physicians, and have seen many turn to alcohol and other drugs to cope with getting stuck in habitual thinking patterns of self-judgment, anxiety, and worry. As a translational neuroscientist, I study anxiety as a habit loop. A couple of years ago, my lab got a grant to see if our work could help doctors reduce anxiety levels. As part of the study, we threw in a couple of burnout questions to see if anxiety and burnout were related.

We measured anxiety using the Generalized Anxiety Disorder 7 scale (GAD-7), a clinically validated tool to track anxiety. We also measured cynicism and emotional exhaustion using the Maslach Burnout Inventory. At a baseline, we found that anxiety and both aspects of burnout were highly correlated. Then we had physicians learn to identify and work with anxiety habit loops using mindfulness tools. We used app-based mindfulness training because doctors reported that committing to time-consuming, in-person training was a barrier to entry.

After three months of using the app, physicians reported a drop of 57% in anxiety and 50% in cynicism. Interestingly, there was also a significant reduction in emotional exhaustion — but it was only 20%. This makes sense because helping doctors learn how their minds work directly applies to anxiety and cynicism. Exhaustion, on the other hand, is indicative of more systemic issues in the business and practice of medicine. Though my lab was thrilled to see such large shifts in anxiety and burnout, I should point out that this was a pilot study that didn’t have a control group.

If you are a health care provider or a provider in general… please please please check in with yourself to see if you are becoming a modern-day martyr.

Fortunately, we just finished a NIH-funded randomized controlled trial of people with generalized anxiety disorder, and found a 63% reduction in anxiety in the group that used our app, whereas the control group, which received standard care from their doctors, showed a 15% reduction. That study is still under review and we hope it will be published soon.

So what’s the take-home message today? If you are a health care provider or a provider in general — whether you are taking care of patients, clients, parents, children, or community members — please please please check in with yourself to see if you are becoming a modern-day martyr. Are you in the habit of sacrificing yourself for others? Are you feeling exhausted, yet trying to armor up and push on? Can you take a moment to remember what it felt like the last time you got a good night’s sleep, and nourished yourself? We’re in the midst of a global pandemic, so this may not be fully possible for everyone, but even 10 minutes of self-care each day can make a huge difference in your overall well-being.

First, remind yourself that you can’t help anyone if you are sick or burnt out. Second, make sure you at least eat some healthy food. Third, take mini-mindfulness breaks throughout the day to reconnect with your mind and body, and build awareness of what you need to keep from burning out. Remember that keeping yourself healthy both mentally and physically is the best way you can help others.

I’ll end with a page from the book I’ve been sharing in these columns, The Boy, the Mole, the Fox and the Horse.

“Tears fall for a reason and they are your strength, not weakness.”

So today, see if you are holding back tears. If they are born of exhaustion, let them guide you toward taking care of yourself. If they are born of self-judgment or feelings of inadequacy, listen to the horse, and let them flow as a form of self-care.

Onward, together. I’ll have more to share tomorrow. If you’re interested in a video recording of this material, I’ve created one here.