112. Burnout in Medicine: Recognizing the Signs Before They Scream

Burnout isn't about doing too much. It's about doing too little of what brings you. Meaning, there might be things that you can't change in your day to day, but we can still focus to the things that bring us meaning, fulfillment, joy, whether it's at work or outside.

Are you a woman in medicine, feeling overwhelmed and disconnected from the personal fulfillment that you desire? You're in the right place. Join doctors Joanne and Erin as they rewrite the rules for women in medicine. Let's begin.

In this episode, I am joined by my Amazing Co host, Dr. Joanne Sotello, and we are doing a little miniseries on the topic of burnout that may not resonate as a term for you. I know for myself, exhaustion and overwhelm were my words that I resonated with in our last episode, number 111 with Dr. Pamela Buchanan. She talked about her interaction with burnout and some of the ways she managed to get out of it. We're doing a deep dive on that today with Dr. Joanne Sotelo. Thanks so much for being willing to talk about this topic, Joanne. Something that some people shy away from, that word, burnout. So again, I'm going to encourage our listener whatever that word is that you use that's getting in your way of being fully present in your medical practice. So let's think about that term burnout with some fresh eyes. And I would like to know, what are some of the new things that we need to know about burnout?

Yes. Thank you, Erin. And burnout, it's something that we've talked about for years, right? Especially right after Covid, that the numbers were so high and we've talked about, you know, mental health in, in the medical field and suicide and all those things. And even though it's a term that a lot of us don't resonate with, like Erin was saying, it is an important topic to talk about. And I believe that even though some of the numbers are a little bit better compared to the peak of COVID it doesn't mean that it's actually getting better. It's just like, you know, the situations have softened up and it's still a serious, serious situation. And it's also kind of quieter, sneakier. So it's, it's important for us to not ignore it, especially within ourselves. So it's good to think about how is it, how it might be showing up differently for the people around you or in yourself, and how often we're still suffering in silence. And some of the last numbers, according to the American Medical association, it Said that a little bit more than 60% of physicians report at least one symptom of burnout. And you might be thinking of, oh, there's a bunch of symptoms, but it's actually one of three. Like, one of the. One of three of the main categories. So that's significant. And a lot of times it's that emotional exhaustion and the physical exhaustion, and then also the feeling disconnected or kind of that cynical attitude. And I think that we were seeing more of that obvious physical exhaustion before. That's easier to identify and easier to report. And now the sneakier parts. It's like we're showing up more as exhausted. I'm just tired. The kind of unmotivated. It's like, ugh, another day and just not feeling yourselves. Right. So these are very different words. And thinking like, oh, I'm burned out, or I'm overwhelmed. They're more subtle. And we still doesn't mean that it's full burnout, but there are still red flags that we need to be paying attention. And are you disconnected? Right? Like, and you don't find any sense of fulfillment. You believe that the work no longer matters. So pay attention to those subtle things.

And I love how you bring up that emotional aspect of exhaustion, because in medicine, I think we are just so used to going, and if we don't have a reason to be physically exhausted, then we don't understand, why am I so exhausted? Not paying attention to what happened in your practice, your medical practice. Did you have a patient who passed away? Did you have an outcome that wasn't what you wanted? What's going on in your own family life with your partner or your kids or your own health? And let's give credit to that emotional aspect, that those can be extremely exhausting, even if you're not putting yourself out physically and may need just as much or even more rest and recuperation to recover and get back to ourselves. And we talk about this more in an upcoming episode with Candace Vandertholen, episodes 114 and 115, where she talks about resetting our energy. And I know when I poll my own coaching clients as part of their intake, I ask, where's your energy level? And oftentimes they rate it as a 3 or 4 on a scale of 1 to 10. And I just think, like, that is not sustainable.

A lot of the women physicians that I coach, some do come in saying, I'm burned out or I've been burned out. But when we talk about the specifics, I think everyone, at least on some point has shown some of the symptoms, which could be also kind of feeling numb or indifferent. Or you start building a little bit of resentment even with the things that you love in the practice or your colleagues or even at home, or you dread going back to work even after a vacation that refueled you. And then you go back and it feels almost the same as the day you left. You know, another sneaky way is then we get hyper productive or extra busy, right? Like you've heard me say before, like the, the healthy denials. And it's still a way to numb ourselves. It's just a known way that makes us feel good. But we're still avoiding emotion. We're still making ourselves feel good because we're right. Like that's better than numbing ourselves with other things. But there's still that, that disconnection. And then sometimes we can have more of that kind of on edge. It's a phrase I hear a lot. Maybe not full on irritability, but kind of that edgy. And then of course the physical symptoms, you might not identify it as that physical exhaustion, but then you might be having more headaches or difficulty sleeping or stomach problems. Those are very common ways that we somatize and kind of physically feel a lot of this emotional exhaustion. So it's again things to pay attention to if you're dealing with any of those things. Again, it doesn't necessarily mean that there's a problem, but use it as a red flag and ask, am I okay? Is there something going on? How am I feeling at work? What can I do right, like all those important things?

And that makes me think of like a check engine light on your car and how when you see that check engine light, are you the type of person that's going to address the issue right away or are you going to wait so long that you end up with a car that completely shuts down and the engine burns up because you ignored it? And can we be better at figuring out where our own check engine light is? And oftentimes, you know, as Joanne shared about physician suicide, that check engine light might have been on for weeks, months, years, or circumstances change. So you, you know, that check engine light didn't make such a difference, but then some key factor changed and it made all the difference in the world. And I would encourage our listener to pay attention. Those red flags or those little hints, as Joanne says, sometimes they're very sneaky. Maybe the check engine light flickered on and went away. And can we be get better about focusing on that and saying, getting Curious. I wonder what are these migraines trying to tell me? I wonder what is this poor sleep telling me? I wonder what this fatigue is telling me. And can we pay enough attention to ourselves, prioritize ourselves enough so that we don't get to something as full fledged as burnout? Are there any other symptoms that we might be missing? Joanne?

I think I mentioned most of them. And you know yourself the best, so pay attention to, to how things are different for you. And I've shared this before, like, I am someone who I like. I like to be in the hallway at work. Like, I like to socialize. I like to say hi to everyone. I like to keep my door open. And again, I didn't identify myself as burned out either. I was just. But I was definitely disconnected some and my energy was lower and I would just kind of go straight to my office and close the door. So it's not like a symptom, but. But I noticed it in myself as a change in my behavior of what's common for me. And then I asked myself, like, what's this about? Because if it's just every now and then you could just be tired for another reason. But then I was earlier in the day wondering, like, how many more patients can I see? Like, my energy is low. Like, let me thank goodness I could reset and get into a good mood and do it anyways. But. So it's. Maybe that would be. The other thing I can add is, you know, what's out of character for you and pay. Just look at it a little bit deeper and see if, if it means anything to you and if it could be related to this. Like I say, like burnout. It's more of a spectrum. Right. And. And the word burnout might be towards the end of the spectrum, but there's many things that could be happening along the way. If a lot of those symptoms that.

I've shared and two things that came to mind as you were listing some of those symptoms for me, I remember when I would compare, like what. How many patients did I see versus the partners see? How many times was I on call versus the others? How many hours of extra duty did I put in versus others? And looking for that validation. Oh, yes, you're working hard when. When you know, and feeling unappreciated by others. And another one was just. You use the word irritability a lot. I was grumpy. And I'm thankful that my meditation practice has helped me be less grumpy on a regular basis. But I think for decades I was grumpy by the time I got home because I'd left it all at the office and gave so much away. And I'm thankful that my kids still speak to me and my husband and I are still married. And, and yet I think, oh, I wish I would have known what I know now to do a better job at getting myself out of that chronic state, because it wasn't bringing my best. And even though my patients loved me, I was always in leadership positions. I just think how much better could I have been if I didn't go at my medical practice with such a chronic cycle of depletion? And I wonder, is there any way we need to talk about burnout differently these days?

Joanne I believe that it's also looking at it kind of as in the source of the problem, like we're still thinking about it very reactively, like when we're not feeling well, then let's do something about it instead of getting curious about the root cause. We're not anymore in this survival mode. So it's, and it's easy to externalize the blame and think that it's just systemic problems. And that can be true, but then also thinking, are there changes that you need to have in your life to set yourself up to feel better and really take care of your wellbeing? That it sounds cheesy, but that's the base of this. And, and knowing that it's, it isn't a weakness, it's a signal that something needs to change either in the environment or within you. And that that's what we, or both. And that's what we need to look at. And, and I think it's the focusing now should be more in, in the root cause, rather than wondering what's wrong or if I'm a failure, if there's something broken, but really thinking about it. And, and I like this phrase that it says, I don't remember where I got it from. But it's that burnout isn't about doing too much, it's about doing too little of what brings you meaning. And that's another way to think about it. There might be things that you can't change in your day to day, but that doesn't mean that then we give up hope. We can still focus with and bring our attention and our intention to the things that bring us meaning, fulfillment, joy, whether it's at work or outside. And that's a great place to start. And that will start refueling your tank to deal with the other things while you keep on looking at the Other things that might need a little bit more work to change or adjust.

I love how much you're talking about change, Joanne, and we've talked about this before. I would love for our listener, if you're feeling some of these symptoms that we've been talking about that might be related to burnout or somewhere along the spectrum, what is the cost to you if nothing changes? Think about that. Six weeks, six months, six years, and nothing has changed. And sometimes that's what we need as the motivator to try experiencing something different or try to create something different if the cost of doing the same is not going to serve you, and recognizing that's still a choice and that you're making to keep things the same. And Joanne, we like to focus on what are the things that we can do about burnout or about not being happy with the place we're in. What are some ideas that you have for our listener?

So I have three different areas of focus that can be helpful. The first one is personal, and I can go on and on about what we can do here. So I'll. I'll say summarize it. We can audit our energy, specifically, where is it leaking? Because a lot of times it's very subtle and it's just things that have been there for a long time. So think about it. What drains you and also what refuels you reclaim your spark moments daily. It could be little things. We can't minimize those details. And like, I've loved to talk about redefining success, like, really for you in this season of your life, what are those things that really fulfill you and focus on that, even if it's a little bit at a time. So that's so personal. The second one, it's more systemic. And yes, there might be less control that we have there, but we can't get stuck with thinking that we can't do anything about it. We can still be advocates for our needs for the people around us. We can be supportive of leadership and think of what's our psychological safety and create the breaks that you need and more fair workload if you can, and then talk openly about these issues without shame. We need to normalize these conversations about overwhelm and burnout and not and take away the stigma. It's too common to make it be like it's an individual problem. Right. Like we know that the numbers are still even. Overall burnout, it's around 50%. Right. Like one in two doctors have, are currently or have struggled with at least some of the symptoms of burnout so it's, I mean it's significant. And then also thinking of what can we do in our caregiving roles. And then the third one, it's more of what we love talking here in terms of community and the collective work that we can do and normalize all of these conversations. Right. Like the reason Erin and I even started this podcast and be role models of change and what's possible and build this micro communities where well being is protected and celebrated. And we keep on talking about this, different tools and see what works.

I love that we've covered many issues related to burnout on this episode. We talked about how our energy, it can be impacted. Our emotional energy, physical energy, how some of the symptoms can be sneaky. I love that word. And not so obvious. And can we do a better job paying attention to those subtle signs, the red check engine light our red flags and ask ourselves what's going on and see what we can do about it. And then Joanne shared some of that. What can we do that some of the actions are personal, what do we have control over? Some of them are external. And what are the ways that we can have some impact on what's going on in the bigger medical world? And then also who's in your community and how can you leverage that to your advantage? And Joanne, I wonder if there's one other piece of wisdom that you would like to share with our listener on this episode about burnout.

My message is don't wait. Really pay attention to all this details and the signs that your body gives you along the way. And because remember, burnout, it's a whisper before a scream. So we, we cannot ignore it or just work harder and push through. And it doesn't mean that you're broken. It means that you're human. And that's part of what we're here for.

I love that we'll be talking more about the topic of burnout. We shared information from Dr. Pamela Buchanan on episode number 111. And we also interview Dr. Todd Otten in our next episode, episode 113. So stay tuned. Our next episode is coming right up.

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