Burnout and back again

Let me tell you a story I hope you never relate to…

As a classic high-achiever, my progression through medical training, foundation years, GP training, salaried General Practice and then partnership was an unhindered process. I rushed through to the end goal with blinkers on. At 30 years of age I had reached the top of my profession. So what now?

Just another 38 years of doing the same job.

And the job was fantastic, I was motivated, I loved what I did, I worked hard and I had a great rapport with my patients. I threw myself into the work, I started up-skilling in diabetic medicine and research. We had just had our second child, so things were full-on, but life was good.

As time went on, my work-life balance began to suffer. My workload was increasing, I needed to spend longer and longer at work. I felt constantly tired, I had no energy when I got home. I had decision fatigue. I was neglecting my health. I started to become cynical and disillusioned. I blamed my work and became overly critical of how I was performing.

My usual response when people asked how I was: “tired”.

So how did I get from this highly motivated, energetic, driven individual to what I had become. I hadn’t burnout out, but reflecting now, I slipped down the slope towards it.

What is Burnout?

Burnout tends to be the result of prolonged stress and pressure. It is becoming increasingly common in modern society, especially in medicine. It has some clear signs. Signs which on reflection I had, but at the time was too engulfed by the situation to realise.

  • Exhaustion - a feeling of emotional, mental or physical tiredness all the time. The sense of not having any energy.
  • Lack of Motivation - lost your drive? Struggling to get up in the morning?
  • Cynicism - loss of self-worth or a feeling that what you’re doing doesn’t matter. Feeling disillusioned or generally more pessimistic
  • Concentration - and attention reduce, you develop a focus on the negative in situations. You lose the ability to make decisions and your creativity and problem solving suffers
  • Performance - particularly at work starts to suffer, things feel harder and take longer to accomplish
  • Interpersonal problems - either more arguments and conflicts with people or withdrawing, talking less, tuning out.
  • Health problems - drinking too much, smoking, becoming sedentary, eating too much junk food, not eating enough or not getting enough sleep
  • Preoccupied with work even when you’re not there
  • Loss of enjoyment - less satisfied with your job, hobbies or home life
  • Physical symptoms - digestive upset, depression and weight-gain

I didn’t have all of these, but enough to make work unpleasant. Unpleasant to the point that I made a decision to change career. I submitted my resignation and felt instantly better, perhaps even a little euphoric. From this point forwards, everything was going to be better. And it was and has been better since, but it wasn’t actually leaving the job that did it.

How did things get better?

What doesn’t kill you makes you stronger

Friedrich Nietzsche

My work became more ad-hoc, I could pick when I worked and the location varied. Working as a locum, I no longer had the burden of administration that came with being a full-time salaried GP. I was happy for a while, content in the knowledge that it was nothing to do with me, it was just the system and the job, its too stressful. After a meeting with my appraiser, I was able to reflect, pick apart and review what had actually happened.

The job was stressful, but in fairness, I hadn’t looked after myself. Only when I started to read about burnout did I realise what had happened. It had insidiously weaved its way into my life, a little at a time and it wasn’t until I started to understand what it was, did I realise all the points that I could have intervened to stop things getting worse.

I had to face the truth, I had been unprepared and because of that, I had failed. I had missed all those opportunities to understand why the job was getting harder, why I wasn’t sleeping, why the enjoyment was not there as it had once been. I realised I needed fixing. It was time to take on the most important project to date, me. Something had happened to my brain that I needed to correct.

And that is the real starting point, understand what burnout is. Once you understand it and realise you are on the burnout train, there are things you can do to correct it, to get off. So do I regret leaving my job? Yes and no. I left some fantastic people (the cup above was a gift from some of them - fortunately it’s now ironic), the job was really good, but my leaving has had some benefits. Personally, I am doing a job now that I love, something I have always wanted to do, but somewhere along the way I had forgotten that. I have a new perspective on life, things stress me less (I still get stressed), but if I wake up 3 days in a row questioning what I am doing, I now do something about it.

Possibly a greater benefit that my leaving had, was that it made people question how it had happened. My colleagues, both who I worked with and from other practices, reflected on how the job was for them. It allowed a discussion to be opened up, many of my colleagues who were struggling would feel more comfortable talking to me about their problems and the great thing for me was that I had acquired some really good advice.

But what did I actually do?

Relax, take a breath - If things get really bad and the only way out seems to be to leave your job, then do it, BUT after the elation dies down and the fear of needing to provide for yourself and your family starts to set in, take a minute.

Part of my issue was feeling trapped in my job, my salary was really good, but whatever I earned we spent. Interestingly sitting down, reworking the money removed a massive burden from me. We also realised we spent way too much money.

My point is that money isn’t everything, work out “how much do I actually need to live?”, not luxuries, not going out, not buying the latest gadget, “how much do I need for the next 6 months?”. If you can take 6 months to reflect, try some things, relax your brain, enjoy things again, you’re on the way to recovery. People will talk about relaxation and mindfulness, hey its your choice, do what makes you happy.

That leads the next point Do what makes you happy. If you are anything like me, when you are working away, head down, day-in, day-out, you miss opportunities. You forget to lift your head up, have a look around and thing about what makes you happy. You forget to spend time thinking about what you want to do.

Time is spent working, sleeping, missing your family and feeling guilty. The greatest opportunities could literally smack you in the face and that cynical, unhappy part of your brain just misses it. So, the job is to find what makes you happy, because you’ve probably forgot. If you search online about ‘finding your passion’ or ‘love work’ or ‘find the work you love’, you read about lots of examples of how to find that one thing you were meant to do. For me that didn’t work, it just created so much unnecessary pressure to find that ‘one thing’.

Forget that, do things you’ve done before, do things you haven’t done before. When you find something you like, do it some more and don’t do the things you don’t like. But think “why didn’t I like that”.

Give yourself a break from social media. Give yourself 30 minutes, an hour, a week if you are feeling strong. Disconnect from the world around a little bit and focus on the things around. Part of the problem for me was I started to read articles about the state of the NHS in mainstream media. To be honest it wasn’t the stories, but the comments that people left, many of which were personal attacks against their healthcare provider. I’m guessing you can see how this kind of activity is not conducive to a healthy brain.

We now live in a society of comparison. Social medial provides a great vehicle to compare our social lives. However, our online persona can be incredibly different to our real life persona. The online persona can be a rockstar, but unless you are a rockstar, reality will never live up. And as each of us strives to show how amazing everything is, you create unobtainable goals.

Medicine provides an excellent environment for comparison, we compare our knowledge, our ability, whether we work fast enough, are we caring enough etc, etc. The problem is, we may have been the best at Primary School, Secondary School, even University, but eventually there comes a point where, there can only be one person at the top.

But take a break from it, stop, Be happy with what you have. If you really aren’t happy with what you have, think about what you can reasonably do about it…

…and do it!

And Sleep Zzzzz. Want to be healthy? Get more than six hours of restful sleep. That means forget the blue light from your phone, TV, laptop at least an hour before you go to bed. Put your phone in another room and buy an alarm clock. Do you know a significant number of people check their phone in the morning before saying good morning to their partner - don’t be that person.

Poor sleep negatively effects job performance and productivity, motivation and mental function. Fatigue makes you more sensitive to stressful events, and unable to deal with decisions.

I love it when a plan comes together. Planning your week is a great way to feel back in control. “What do I need to achieve this week?”, but balance this with “what can I achieve this week?”. Don’t beat yourself up if you don’t do everything, your list was too long, it takes time to learn how long things take, and if you are a true overachiever, you will start of with an insanely long list. Give it time, reflect at the end of the week, just before you plan the next week.

Be aware. If your recovering from burnout, near burnout, or have made changes early and have stopped the slide to burnout, it is important to understand the precursors and signs that suggest things aren’t quite right. When you see these signs, talk to people, make a change, talk to your boss or colleagues; I guarantee that you will find people who are or have been where you are now.

And if you want to read a book, read The Chimp Paradox and control that inner chimp. It gives a great insight to whats going on inside your brain in a way that is easy to understand and act upon.

Can burnout be eradicated?

It can, our understanding of it and knowledge of ourselves will help, but its not all down to us. There are organisational changes, societal changes and changes in leadership that need to happen to eradicate burnout. We can influence those, but it will take longer to change.

So, I suppose the answer to ‘how do we eradicate burnout?’ is…