How to avoid burnout

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host Toyosi Onwuemene, and it is such a pleasure to be talking with you today. I'm especially excited to talk about today's episode because it's about strategies to avoid burnout. And I think this is sorely needed because there's so much burnout in medicine.

1:21 So over 60% of docs in 2021 reported that they were burned out. And yes, to some extent, there was a greater increase in burnout before the COVID or during the COVID pandemic. But the reality is that burnout has always been present with us. And it's a function of the field in which we practice and the high intensity and the high stakes and the fact that there is this feeling we get that we're responsible for everything. We're responsible for keeping the patient alive. We're responsible if the patient has a bad outcome.

2:02 There's a lot that drives us towards burnout in medicine. And therefore, I am certainly not the first to talk about strategies to avoid burnout. But I did want to talk about strategies to avoid burnout in a different perspective. Is this an exhaustive list of all the things that you can do to avoid burnout? The answer is definitely no. But I think it's important to think about things differently. So this will be a little bit different from perhaps what you've been told as to how to avoid burnout. And this is especially pertinent for me because I feel like by the time, I mean, I've had burnout throughout stages of my medical training and my time as a faculty person.

2:53 I will say that when I look back on my training, it's hard to say when the highest levels of burnout were because I was ready to quit medicine even in medical school. So definitely, there was burnout there, you know, and certainly as a resident. And oh, goodness, was I the crabbiest first year fellow ever? Wow, it feels like I've been burned out a lot in medicine. But anyway, I say all that to say that the time in my life that was most critical as far as being burned out was really as a faculty person.

3:36 And I feel like I tolerated a lot when I first started in terms of all the resources I didn't have and all the things I was required to do. But everybody else was doing the same. So there was always the sense that, well, you know, everybody else is sucking it up and doing the work. Why don't I? But we can't measure our experience against other people's experiences, right? Because we don't know what resources they have access to. We don't know what other challenges they're facing. And so the right comparison is really to yourself. But anyway, I feel like I tolerated it for a long time until it got to a time during the pandemic where I just had given actually a lot, given everything.

4:24 And I finally came to a day where I was just literally waiting. I was like a day from vacation and I was desperate. I was desperate to get away from the hospital. I was desperate to leave everything and I was exhausted. I was worn out and my spirit was so beat out. It was bad. I remember I came home that day having left behind the weight of work or at least, you know, shed as much of it as I could. And I saw my neighbor in the driveway and I forget what question she asked me. And I remember telling her that if I died right now, it would be a good outcome.

5:09 And I won't say that I was suicidal, but I definitely had this sense of, you know what? The after life is looking really good right now. It won't be a bad outcome. You know, you know, you're you're kind of wow, nearing or at rock bottom when it feels better to be dead than alive. Yeah. So I would say that that may have been the lowest point of my time in medicine. Certainly was the lowest point of my time as a faculty member. The good news is about being at your lowest point is that there is nowhere else to go but up.

5:51 You know, you can stay where you are. That's one option. But but up is a possibility. And so I'm on the other side of that now. And I feel like I work probably as hard now as I did then. But I have a sense of purpose about my work and I have joy and so much energy around my work. So even though I am still working hard, I'm definitely in a different place today than I was before. So I want to share with you seven strategies that I employ to avoid burnout. And I invite you to consider them as well.

6:35 Here we go. Number one is to look around you with discernment. So another way to say it is to take off the rose colored glasses and really give your environment a long hard look. If you are a clinician, a physician who went through at least four years of medical school, possibly more, couple of years of residency, and couple of years of fellowship, you would count relative to the general population as a crazy person. And what I mean is that your baseline is very high functioning relative to the people around you.

7:19 So recognize that as a person in medicine, as a clinician in particular, your tolerance of crap is very, very high. And if that were the end of the story, that would be good. But it gets worse because you look around you and there are people who can push the limits. That's like, oh, you can stay up three days in a row without going to bed, oh, I can do four. There's a lot of pathology in medicine. There are a lot of people who are sick in medicine. There are a lot of unhealthy doctors trying to care for patients.

8:02 And we cannot give the health that we do not have. And oh, yeah, we can push medication and do chest compressions. We can do stuff, bring people back. We can help people feel better. But if we are unhealthy, we can physically help people, but emotionally, we don't serve them and potentially we're pulling them down. And so it's important for us to look around our environment and recognize the sickness that pervades the healthcare system. And I'm talking in particular about the healthcare workers within the healthcare system, particularly clinicians.

8:50 And if you are a clinician scientist and you don't spend as much time doing clinical work, maybe you spare yourself some of that. But I will guarantee you that this is not a problem only for clinicians. It is a problem for scientists as well. This whole idea that you work and work and then you work again and the whole idea that rest is a problem. So it's just important to look around you with discernment and recognize that this is not the real world. The world that you inhabit on a daily basis as a clinician going into an academic medical environment is not a healthy world, not the real world.

9:41 And so I invite you first to look around with discernment so that you recognize that this is not the environment by which you should set the standards of operating your life. Now we do that because it's the default environment. What are we going to do? But we can choose. And when we look around with discernment, not with judgment, not with blame, we're like, oh, all right, there are a lot of sick people around me. Got it. It's really powerful because it allows us to choose. What do I do to stay healthy in an environment where I'm surrounded by people who are not healthy?

10:24 How do I avoid contagion? You could leave the environment. That's one option. You could come in with personal protective equipment. That's another option. The extent of the personal protective equipment that you come in with can vary, right? But you get to choose when you look around with discernment. You take off the rose-colored glasses. You stop saying, oh my gosh, it's such a wonderful environment. It is wonderful. There's so many great things that happen in medicine. And it's full of many clinicians, many clinician scientists who are sick.

11:08 You can continue to be one of them, or you can choose how you're going to navigate this environment the moment you recognize that a sick environment could be making you sick. Again, this is not an invitation to quit medicine, though maybe that might be the answer for you right now. But it's an invitation to stop lying to yourself, to stop living in denial of being in a healthy environment because when you're no longer in that denial, then you don't ask yourself what is wrong with you. You recognize that the environment is driving some of the experiences you're having, and it gives you power to choose how to manage your experience.

11:52 Okay. Number two is to recognize your ultimate weakness. Recognize your ultimate weakness. Your ultimate weakness, no it's not kryptonite, oh Superman. The ultimate weakness is that you don't have very much control over many things. But you do have control over yourself. Let's just get to the next thing right away. But it is important to recognize how little of anybody else beyond yourself you control.

12:32 This is really powerful and important to recognize that you are so weak when it comes to controlling other people, that it is a waste of energy to invest time trying to do that. You are so weak, you are such a loser when it comes to controlling other people, I use that word intentionally, that you should stop trying. Because you cannot successfully control somebody else. Now, you know, some people are pretty skilled. So there's a lot of skilled people out there. I've seen skilled manipulators.

13:13 I've seen people who are skilled at using fear tactics. There are a lot of strategies in medicine. But ultimately, you're pretty weak because you don't have power to control other people. If you're going to work to control other people, and some people are actually successful in controlling others, you're going to invest a lot of energy. And if you're investing a lot of energy in controlling people, you're probably not accomplishing anything of significance. But your weakness is that the power you have available to you is to control yourself to the best of your ability, because sometimes you can't even do that.

13:59 But in recognizing your ultimate weakness, it allows you to think about, number three, shrinking to your circle of influence. If you cannot control a wider circle outside you, what can you control? You can control yourself. You can learn to control your thought life. You can learn to control the way you respond. You can learn to control you. Wow. How much power is there? How much is freed up? How much energy is freed up? When you stop running around chasing other people to fix the environment, and instead you change yourself.

14:47 The power of changing yourself in an environment of sickness is that you stop asking the environment to fix itself so you can be better. You ask, how do I fix me so I can be better, whether the environment chooses or not? Because I have to tell you in medicine, we complain a bit a lot about our environments, but the reality is the environments we have are the environments we have collectively created. And the reason that they have not changed is that we connive to keep them alive. We do. We're like, I hate this system, it sucks so much.

15:29 And things don't change. It's because we collude to keep things going. There is secondary gain. Maybe you don't see it personally, there are people who see the benefit, the secondary gain of the constant complaining and griping that happens because people aren't happy. But a lot of it won't change. Not unless you do, when you change, everything changes. When you change, it doesn't matter that people don't want to work. Doesn't matter. Because you get to choose how you respond. Whether you stay or you go, you get to choose.

16:10 So number three is to shrink to your circle of influence. That's really you. Oh yeah, you can influence other people who are closest to you. For the most part, as you focus on yourself, then what you have the opportunity to do is to inspire others. It's much more powerful than trying to control them or manipulate them into doing what you want them to do. Number four is focus. Focus like a laser. Focus like a laser. Once you've discovered your superpower of changing yourself, it's time to focus. It's time to focus on growing that power.

16:52 So how much of you can you control? Can you keep your cool even when a patient is yelling at you and you can feel his saliva in your face? Yeah. Focus like a laser on yourself allows you to increase your superpower to a place that you didn't even know existed. And so focus like a laser, focus your energy like a laser on yourself. Cause that's the person that you ultimately are able to control. I mean, yes, yes, you ultimately able to control yourself. Now does that mean you have power to control other people once you figured out yourself?

17:40 No. You focus like a laser on yourself and that empowers you to make change happen for yourself. Other people see that you are changing and then they follow you. Focus like a laser. Number five is to choose to give people a pass. People are going to get it wrong. They're going to do the wrong thing. They're going to mess up. You could stand, you could judge them and yell at them and say, I can't believe you are so stupid. I can't believe this person we hired them. What's wrong with them? Or you can say, oh, that's interesting. You did that. Okay. And walk away.

18:20 Choose to give people a pass. They're not perfect. They'll never be. Stop being surprised when this person who's always lying lies again. You're like, I can't believe you lied. But this is the 199th time you can't believe they have lied. When are you going to believe it? When are you going to believe that this person who's so amazing, so awesome, this guy that you refer and look up to is a liar? When are you going to accept it? And so you just say, oh, you lied again. There it is. Choose to give people a pass because the energy you use to try to convince them to change is somehow not being well spent because it's wasted.

19:03 So choose. Choose to give people a pass. Say, oh, there you go. The guy who lies all the time, the guy who's always wheeling and dealing and trying to pull a fast one on you. And you just know that, okay, the moment you walk in the door and walk out the back door, right, you just have a plan. You don't have to stand and judge them and say, I can't believe you're like this. You just let it go. Just let it go. And that's why number six is know when it's time to walk away. Know when it's time to walk away. And this is so important because in reality, some of the people who are the sickest in our environments are some of the people who are the most decorated, right? The most decorated generals in medicine are some of the sickest in medicine.

19:47 You can recognize them. Other people recognize them, but they're so successful. Nobody says anything. But you know, you know who they are. And that's why it's important for you to know when it's time to walk away. When all of a sudden you are growing in bad habits that don't serve you. Even no matter how amazing this person is, no matter how much of a mentor they were to you know when it's time to walk away from a culture that hurts you.

20:29 Number seven is own your power to choose. I hear physicians saying all the time, I have no choice. You always, always have a choice. The reason you think you don't have a choice is because you do not know the options. Because the moment you figure out that you have options, then you know, you know beyond the shadow of a doubt that you have the power to choose. Own your power to choose. And you can choose not to have it. You can choose to have it in a little dose, but you're choosing. So own your power.

21:10 Own your power to choose. As you do these things, you're going to begin to avoid burnout. You're going to begin to avoid burnout because number one, you look around with discernment and you just are not, you're not disillusioned. You're like, do people behave badly? Oh, okay, they do. There you go. Now use your energy for something else. Number two, recognize your ultimate weakness, your inability to control another person, except by fear or coercion or extreme craziness. But if you're going to be a normal human, recognize your inability to help people unless they want to be helped.

21:50 Recognize that you don't successfully control people. Okay. Number three, shrink to your circle of influence, that's you. Number four, focus like a laser. Number five, choose to give people a pass. Number six, know when it's time to walk away. Oh, number seven, own your power to choose. And so those are seven strategies to avoid burnout, especially for clinicians trying to make the transition towards research. All right. It's been a pleasure talking with you, Jay. Thank you for listening. Go forth and prosper.

22:30 Have a great week. Thank you. It is important to know that we do have a webinar coming up on December 20th at noon. This is when you don't have a mentor. And I'm betting there are many people out there who have no mentor. Come and listen to strategies to succeed, even whether or not you have a mentor. All right. It's been a pleasure. Thank you for listening. Please share this episode with someone and invite them to like and subscribe. Take care. Bye-bye. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor.

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