However, burnout is more elusive. Even though academically we may know it manifests as symptoms of apathy, depersonalization, fatigue, detachment, isolation, and is associated with medical errors, anxiety, depression and 400-plus physician suicides per year, when we are in the middle of it, we can’t pinpoint it.
Sometimes, it is like when we have cilantro in our teeth: someone has to point out the obvious. I wish I could say I was no different. After all, I have been burnt out twice in my short career and yet each time, I had no insight until it really hit me in the face (or was pointed out by my physician or my husband).
The thing is, physicians are a group of highly trained and intelligent people. We can critically analyze and debate very complicated subject matter, algorithms, data, and charts. We’re no strangers to critical thinking — after all, it’s what allows us to sift through large quantities of information and arrive at an assessment, usually in a short amount of time.
However, the ability to critically analyze our internal state (our thoughts, emotions, how our body is signaling to us that something has gone awry) is something that is lacking in our education system and our medical training. In fact, it’s been estimated that only 15% of people have an awareness of their internal state. Becoming aware is a practice — akin to when we practiced ad nauseam how to critique journal articles during our training.
This awareness about our internal state is defined as mindfulness: a careful attention to what’s going on emotionally. It is through this awareness that we are able to critically “observe” the data of the thousands of thoughts and emotions we cycle through daily.
Why would this mindful awareness be a crucial skill we clinicians must develop? Because it can reveal to us not just when something is off, but when it is likely to become off. Lest we forget, the human body is amazing. Not only does it coordinate millions of activities, processes, and functions unconsciously, but it also signals when things have begun to deviate from a calm internal state. If we nurture our body and maintain its health with mindful behaviors, we can do our jobs for longer and with greater freedom from worry, hospitalizations, and complications from illness.
So how can our body signal that something has gone wrong and that we are shifting into burnout? By physical symptoms. Burnout has been identified as the end stage manifestation of chronic stress — which in turn has been linked to many diseases, such as migraines, fibromyalgia, heart attacks, asthma, GERD, IBS, pelvic pain, autoimmune diseases, and decreased immunity.
That burnout reveals itself often only when we start to get physically sick is something I know all too well. During a recent round of burnout, I ground my teeth to the point of destroying two molars, needing root canals and crowns. I also suffered from an agonizing tooth abscess; lost 10 pounds; and endured insomnia, GERD, asthma, debilitating chest pain, and joint pain that led to an elevation of my rheumatoid factor.
As it turned out, my symptoms did not have a physical, but rather a mental, explanation. After a slew of tests and appointments with multiple specialists, all I was told was, “Your tests are normal. I can’t explain your symptoms or that your pulmonary function tests are showing asthma or rheumatoid elevation without rheumatoid arthritis.” In other words, my disease states and symptoms were confounding. And coincidentally, I was also experiencing extreme stress at work.
We probably have all seen many patients in similar scenarios. I know with COVID-19 I have had a flood of patients with pelvic pain and testicle pain or unexplained abdominal or back pain after exhaustive workups. I’ve found that when you address the stress in these patients’ lives and find ways to reduce it, as well as reassure them that they’re not experiencing cancer or another pathology, it is as if magically the physical symptoms improve or disappear.
I know for me, once I learned the power of mindfulness and awareness and began to tap into my creative side, the shift was seismic. This didn’t happen all at once, however; it took determination and an investment in myself to work with a certified coach and eventually become one too. I also deepened my spiritual development, started a daily practice of meditation and gratitude journaling, wrote frequently as a way of healing, practiced conscious breathing, and danced to release absorbed energy. Finally, I made a point to exercise, eat healthy foods, prioritize sleep, and set and maintain boundaries (saying no to things I didn’t want to do and yes to things I did). After a while of this internal work, I was no longer on a proton-pump inhibitor, my chest pain and joint pain disappeared, I stopped experiencing wheezing and chest pain, and I slept through the night like a (sleep trained) baby. The mind-body connection is powerful.
In order to accept the signals our body is sending us about our stress, we must be willing to listen. It is usually only when we have pain (a tooth abscess is a pretty LOUD signal) that we will stop and find out the cause. But I urge you not to wait for your sleep to be fragmented, to have a heart attack, or to experience unexplainable symptoms, before you wake up and tap into awareness.
Start today. Learn the skill of awareness, mindfulness, and self-care. This may be a foreign concept and make you feel uncomfortable in the beginning. But I know from experience that it is worth it. My fellow clinicians, I urge you to take care of your mind and body so that you can continue your life’s work to the fullest. You and your patients will thank you.
Have you ever experienced a round of burnout? What precipitated it, and how did you come out the other side? Share in the comments below!
Diana Londoño, MD is one of the 10% of urologists in the U.S. that are women and 0.5% that are women and Latinx. She can be reached at www.dianalondonomd.com where she writes a blog on topics she is passionate about, or followed on Twitter @DianaLondonoMD.
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