Background     Fast Facts #167 and 168 described burnout, its risk factors, symptoms, and consequences.  This Fast Fact will address strategies to avoid burnout while sustaining personal and professional health, integrity, and growth.  Fast Fact #170 will describe assessment tools validated for burnout.

I. Individual Strategies

• Reflection upon work:  journaling, discussion with colleagues.
  • Am I burned-out/healthy?
  • Why do I do this/continue to do this?
  • What inspired/moved/surprised me today?
• Attend to health: diet, exercise, rest, regular health care.
• Plan activities that rejuvenate:  Play!
• Professional supervision:  Regular interaction with a mental health professional with the express purpose of exploring dynamics of the provider/patient relationship.
• Make time for yourself
  • Plan vacations at regular intervals.
  • Allow for “time-out” when stressors increase.

II. Interpersonal Strategies

• Give important relationships priority – strengthen existing relationships with family and friends.
• Expand your community beyond existing relationships through activism or spiritual engagement.

III. Professional  Strategies

• Debrief emotional events:
  • Reach out to colleagues.
  • Seek out or strengthen a mentor relationship.
  • Write about your work for a larger audience.
  • Utilize your institution’s Critical Incident Response Team if available.
  • Psychosocial rounds with colleagues to explore these issues.
  • Schwartz Center Rounds: interdisciplinary hospital rounds to explore emotions surrounding provider/patient interactions.
• Advocate for change in your job, organization, or profession.

Triggers for Professional Counseling

• Persistent feelings of sadness, exhaustion, anger, worthlessness, hopelessness, suicidal ideation, or anxiety interfering with work or interpersonal relationships.
• Self-prescribing sedative/hypnotic medication.
• Substance abuse: alcohol, prescription, or non-prescription drugs.
• Other ‘addictions’ interfering with work/relationships:  gambling, exercise. 
• Persistent sleep disturbance: nightmares, difficulty initiating or staying asleep, early morning awakening.
• Loss of professional boundaries:
  • Inappropriate relationships with patients, families, or trainees.
  • Lack of attention to patients’ rights, safety, or autonomy.

If, after careful attention to the variables within your control, you still feel burned-out and at risk for serious consequences, it may be necessary to temporarily or permanently leave your current job to regain your health.

References 

1. Gundersen L. Physician burnout.  Ann Int Med.  2001; 135:145-148.
2. Kuehn Kelly C. Strategies to Balance Training, Your Personal Life. ACP-ASIM Observer. 2001.
3. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001; 286:3007-3014.
4. Remen RN. The doctor’s dilemma: returning service, grace, and meaning to the art of healing. Whole Earth. Summer 2000: 4-10.
5. The Kenneth B Schwartz Center. Available at: http://www.theschwartzcenter.org/.

Version History:  This Fast Fact was originally edited by David E Weissman MD and published in November 2006.  Version copy-edited in April 2009; then again July 2015.