Burnout: The Signs of Onset, Methods of Prevention

Burnout is a systemic problem in healthcare and a test of resilience for the individual worker. In a new book1 on a problem that has become epidemic, a physician draws on his own experience with burnout and interviews those who are susceptible to the condition or are surprisingly resilient.

Hospital Employee Health spoke with book author Rajeev Kurapati, MD, MBA, a clinician at St. Elizabeth Healthcare in Edgewood, KY, in the following interview, which has been edited for length and clarity.

HEH: Why did you decide to take this approach in your book? Is it something that has worked for you personally or has demonstrated efficacy in others?

Kurapati: A combination of both. I’m a hospitalist and I do critical care. I’ve been doing this for over a decade. I have noticed in myself some of the signs of burnout, before I termed it “burnout.” That term for this condition or state of mind is actually not quite accurate. It is very difficult to find a suitable word or term for that. Burnout [implies that] the individual is weak, incompetent, and unable to deal with the stress the medical profession is imposing on him or her. The word “burnout” almost signifies an individual weakness. Some of the medical doctors detest that and they don’t like the word. They have come up with different names for it. One that kind of describes what it is like is “job-related distress.” Some call it a “system-induced” distress. But if it is an institutional problem, it is almost like it is not my problem. It is difficult to define along the spectrum between the individual and the system because it is both. The medical industrial complex has created so many rules, regulations, policies, and job requirements that take away the passion and joy of medicine. The individual can succumb to this. But the solution has to be from both a system and individual standpoint.

HEH: Can you describe your personal experience with feelings of burnout or job-related distress?

Kurapati: I started picking up some of these signs in myself. For instance, after about five or six hours working on a given day, I would get really irritable. I see about 20 to 25 patients a day, and by the evening I was irritable. My mind says “Enough — I can’t deal with this anymore.” Maybe I promised my children I would do something with them, but it is difficult to keep those promises to your family members and friends. Medical professionals are overachievers. We feel like we are invincible and can do anything. This is how we see ourselves when we go through medical school. We see ourselves with superhuman capacity.

Sometimes you have to push the pause button, slow down, and ask yourself “What is going on?” That is exactly what I did. I went to the Mayo Clinic and interviewed some of the burnout specialists and some of the doctors going through job-related distress. I also interviewed doctors who are resilient, who are doing very well despite the stressors that the job imposes upon them. I started journaling and researching how pervasive this problem is. I found I was not the only one. It’s personal, but I have seen these signs in my colleagues and the people I interviewed.

HEH: Your book includes some specific approaches to a problem that often is generalized. For example, to self-assess burnout, you recommend people ask themselves three questions: Do you feel burdened by your next work task? Do work tasks seem to lack purpose? Do you have a persistent feeling of aversion toward the people around you? Can you elaborate on these three areas?

Kurapati: If you cannot stand other people, it means you are depersonalized. In the medical profession, connection is important. If you say, “I cannot deal with people,” then something is really wrong. It is not necessarily something wrong with you, but you have to figure out why this is happening. Are you depersonalized, emotionally exhausted, or poorly functioning despite adequate training? Those questions target three areas, but you don’t have to have all three. If you answer yes to one of the questions, you are probably in the early phases of burnout. You don’t want to wait until you are completely exhausted. If you answer yes for one, it is time to do something about it.

HEH: You note that some people seem to be naturally resilient, while for many of us it is an acquired skill.

Kurapati: Resilience is, by definition, the ability to bounce back in the face of adversity. How quickly are you able to bounce back? If you are not able to bounce back, why not? Some people can take on change and still function really well. Those are the type of people, if you observe them, whose egos are not so strong. They go with the flow, saying, “This works for everybody, so let me change,” instead of, “This doesn’t work for me, so I am not going to change.” They change themselves for the welfare and the greater good of others. It helps the patients and the organization. For some people, this is innate, although there is breaking point to everything. At that point, they have to have the wisdom to say, “This is out of control, and I’m going to work someplace else.” But resilience is an acquired skill for most of us. People who see the big picture become more resilient. Again, we are talking about personal resilience here, but organization resilience also is important.

HEH: Can you comment further on this concept of “shadow work,” which you say can be daunting if you do not acknowledge it?

Kurapati: We have all been told if you love your job, you never really work a single day. The statement doesn’t work anymore. No matter how much you love your job, there are aspects that are not pleasant. For example, my passion as a doctor is two things. One is intellectual reasoning. I am faced with a problem when a patient comes to me. My brain kicks into intellectual mode and starts doing the detective work. How do I diagnose this problem? What tests should I order? The other part is the connection with the patient. If I make a good connection with the patient and I am able to intellectually use my skills that I learned in medical school, that completes the picture. That is what excites me in my job.

But the job doesn’t stop there. I have to fill out the charts and paperwork. I am accountable to insurance companies and the institution where I work. This is the “shadow work.” These are the necessary compromises I have to make to be in this profession. When I went to med school, I didn’t expect that one-third of my life would be spent doing chart work. I didn’t expect I would take chart work home. But all of these things are necessary and you have to acknowledge it. It is not what I am passionate about, but it is something I have to deal with.

Find creative solutions and list them. Say a new requirement is put in place by policymakers. Find a way to deal with it that is most efficient and that works for you. List solutions to your shadow work and find one that works for you.

HEH: Can you speak a little bit to this idea of “bringing order to the content of your mind?”

Kurapati: Most people run away from spending time with themselves. You look for some distraction to your mind. The usual attitude is that it is a scary place and you don’t want to go there. But it is the content of your mind that determines the kind of person you are. It is the narrator of your story; it tells you what kind of life you are living. If the content of your mind is disorganized or you don’t have control over it, you have lost it. People who are successful — and I don’t mean wealth, but people who have contentment in their life — are happy with what they have and find passion in what they do. These people have mastered the content of their mind.

The best way to examine this is to take a walk with no distractions. Observe the dialogue that goes on in your mind. That will tell you what kind of life you are living. Are you constantly complaining and playing the victim? Listen to the inner dialogue that goes on in your mind. If your mind is saying, “Despite the ups and downs, I am content with my life,” then you are in reasonable control of the content of your mind. But if the dialogue says you are unable to deal with the stresses of your life, you have to reorganize the content of your mind. The way you do that is start with what is important in your life, what you are passionate about, and work toward that.

HEH: After someone begins to recognize and tries to prevent burnout, you recommend a follow-up self-assessment. This includes determining how frequently you feel emotionally upset, the intensity of those feelings, and your resilience in overcoming the experience and returning to a steady state.

Kurapati: No matter what techniques, strategies, and interventions that you do, you need to know if they are working. This is more or less a performance evaluation of the changes that you made. How frequently are you getting disturbed? Imagine you are calm and in a state of equilibrium, then life throws you a curve ball. You may be faced with adversity and change. Your mind gets comfortable in a certain stream of workflow. When a change happens, your mind sees that as a threat. It sees it as adversity. In that emotional state, how frequently are you getting disturbed or losing your cool? How intensely are you reacting to this adversity? Are you reacting to the point where you are becoming depersonalized and dysfunctional? Or, are you able to manage it and still function well? Intensity is important. No matter how hard the adversity is, [the key] is how you react to it.

The final one is recovery. When faced with change and adversity, are you able to recover and bring yourself back to a state of equilibrium? This is where you need to calm your mind. Rather than saying, “I am a victim of this change,” say, “I am going to use this change to make my life enriching.” You must find solutions to get around it, and turn it in a way that actually works for you. If it doesn’t work for you and you are in distress, then you have to make the hard decision whether this is the right thing to continue.

(Sources: 1. Kurapati R. Burnout in Healthcare: A Guide to Addressing the Epidemic. Sajjana Publishing; 2019.)

This article was originally published by Relias Media 

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Gary Evans

Medical Writer

I am currently a medical writer for two publications by Relias Media, Hospital Infection Control & Prevention; and Hospital Employee Health. Over my 30 years as a medical writer, I written numerous articles on infectious disease outbreaks and threats to both patients and healthcare workers. These include HIV/AIDS, tuberculosis, bioterrorism agents like anthrax, SARS, H1N1 pandemic flu, MERS, Ebola, Zika, and now SARS-CoV-2 (COVID-19). My writing has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC. I have a B.A. in English from the Christopher Newport College of the College of William & Mary. I received an M.A. at the Henry Grady School of Journalism at the University of Georgia.

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