How I Practice Now

Managing Burnout During the COVID-19 Pandemic

In this video, W. Clay Jackson, MD, DipTh, discusses physician burnout during the COVID-19 pandemic, including the difference between burnout and mental illness, the 3 main domains of burnout, and ways to prevent burnout

W. Clay Jackson, MD, DipTh, is an assistant professor of clinical psychiatry and family medicine at the University of Tennessee.

TRANSCRIPTION:


 

W. Clay Jackson: Hi, I'm Clay Jackson from Memphis, Tennessee. I'm delighted to be with you today to discuss a topic that some of us may be a little bit reluctant to bring up, and that's the idea of burnout.

The truth is burnout is different from some mental illnesses such as major depressive disorder in that mental illness tends to be global whereas burnout tends to be specific. It's work oriented, not oriented toward the totality of our lives.

Researchers tell us that there are three main domains of burnout that we experience. Those are emotional exhaustion, depersonalization, or not being ourselves in our workplace. And finally, a low sense of personal accomplishment.

Burnout really occurs when there's a mismatch between our challenge level and our skill level. When we're at our work and our challenge level and our skill level are evenly matched then that's referred to by some authors as the state of flow. It's a creative process, a fulfilling process where we feel like we're having a good effect in our workplace locationally.

However, when our challenges far outweigh our skills or our resources then there's anxiety about our work and that can cause burnout. Also, when our skills far outweigh our challenges we can get bored. That can cause burnout as well. So many of us because the pandemic have experienced a great deal of work related stress, sometimes small injury or compassion fatigue, and all of these things can manifest themselves in burnout.

How can we prevent this? What does the research actually show? Well if you're married, if you've got a domestic partner that's helpful according to the literature. If you have children that's helpful according to the literature. If you're involved in a spirituality community of faith or practice that also tends to mitigate the effects of burnout. The importance of giving back can't be underestimated. Those who are involved in voluntary activities and giving up time and effort actually you'd think wow, there's not enough of me to go around, I can't give more, but actually people who contribute to the larger community seem to divest themselves the professional role which is taxing, and then they gain the ability to have reserve through giving through voluntary organizations and activities.

I want to mention today also the importance of self-compassion. Now compassion is a virtuous response, it seeks to address suffering and needs of people through relational understanding and action. There are basically three valances of compassion. We can have compassion toward others, compassion from others and compassion within ourselves. I think we're trained very early on as healthcare clinicians to have compassion to others, but what about compassion toward ourselves?

Well self-compassion is actually associated with a more adaptive psychologic profile, less rumination, less avoidance, lower rates of burnout, lower rates of compassion, fatigue, better emotional validation skills, and increased emotional intelligence, so-called EQ, and increased life satisfaction. So having a little bit of grace toward yourself can be very helpful.

This was studied actually in palliative care professionals, one of my core specialty trainings, and they looked at about 2,700 Spanish palliative clinicians and they found that the self-compassion was associated with professional wellbeing. It was predictive.

Finally, I think it's good to think about work not only as a way that we give away energy but it's a place where we take energy. I find often that my patients ask me, "Hey, how are you doing?" It's a powerful question because it places us on an equal playing field in terms of at least our emotional balance and how we view each other as human beings. They're reminding me that they're also caring for me, they're also concerned about me as well as my concern about them. It's not just a place where I give energy up at work, I receive emotional, psychological and spiritual energy from those that care about me, and they let me know about that.

Starla Fitch taught us that grinning and bearing it is not a good coping mechanism. We need to address burnout, we need to acknowledge it and recognize that we do have finite resources. We're limited, and needs of humanity are unlimited, and so there is a mismatch there that we need to acknowledge and address.

Finally, one of my favorite quotes from someone who's if you will guru in this field, Rachel Naomi Reman, who said, "Although we work in a world that's broken our work is not broken."

Best wishes to you as you continue to help your patients, as you support your staff. And yes, as you have compassion toward yourself in a challenging time, not unprecedented in the history of our professions, but perhaps unprecedented in our lifetimes. My thoughts, my prayers are with you as you continue to give the excellent care that you desire. Thanks.