Do you feel like you are running on empty? Dragging yourself through the day with feelings of exhaustion coupled with frustration? If so, you may have burnout.
The General Medical Council National Training Survey for 2022 found that two-thirds of trainee doctors were 'always' or 'often' worn out at the end of their working day, and suggested that 63% of junior doctors were at moderate or high risk of burnout.
How do you know if you're actually burnt out? And if you are, what can you do about it?
What is Burnout?
The dictionary definition of burnout is physical or mental exhaustion. It may be caused by overwork or stress, but that doesn't tell the full story.
"Burnout happens when the emotional and physical demands of a job become too much, and we don't have the resources within ourselves to deal with them anymore," said Joe Meredith from the Royal Medical Benevolent Fund.
It's often the result of a long, sustained period of work stress. It can happen to anyone, across all types of jobs and careers. But, he added, "it’s true that it is a major problem among doctors. And not just since the pandemic: burnout in the medical profession has been a serious issue for a long time".
Burnout usually happens when there's an imbalance between workload and the resources needed to do your work in a meaningful way.
Dr Julie Hannan, is a counselling psychologist who runs online courses for doctors to overcome and prevent burnout. She said burnout does not appear all of a sudden, it develops slowly and gradually.
"It is different to workplace stress, as that is a harmful reaction to undue pressures and demands placed on employees at work at some point temporarily, from which people have an opportunity to bounce back. Burnout occurs after increasing and unremitting stress without relief, and eventually our systems give up," she explained.
Signs and Symptoms
Burnout can manifest itself in a variety of ways, physically, psychologically and behaviourally.
"There are some early warning signs. On a practical level, doctors who are suffering burnout, or close to burning out, may be less effective at work. They might be slow to get through clinical procedures or admin work, be frequently late or ill, or struggle with exams and CPD. There are also emotional signs: being bad-tempered with colleagues, inflexible or defensive, and overall feeling disillusioned," explained Mr Meredith.
Burnout is different from just being overworked, but they do overlap and it can be hard to separate the two. One of the differences is that burnout is often accompanied by demoralisation and cynicism.
"One of the hallmarks of burnout is how it can blunt a doctors' passion for the job. It can make doctors doubt their own competence, introduce uncertainty around their career choices, or leave them feeling empty and unfulfilled by a job they previously loved," said Mr Meredith.
Symptoms of burnout are different in different people and may occur in all parts of life, not just while at work.
Dr Hannan said: "Behavioural signs include self-regulation issues such as anger and flying off the handle, alcohol or drug increase, change in diet, obsessive behaviours to try to keep control, or being increasingly distracted."
Symptoms of burn out may be more physical, she said. "These may include chronic fatigue, stomach complaints, diarrhoea, IBS, indigestion, weight gain or loss, insomnia, loss of libido or erectile dysfunction. Whereas personal and psychological signs could include wanting to engage less socially, the sense of not doing a good job at work or home (double whammy), withdrawal from friends, family or partner, loss of humour, tearfulness, sensitivity to criticism and even paranoia and suicidal ideation."
Why are Doctors at High Risk?
There are plenty of stressful occupations and situations in which burn out can develop, but doctors do appear to be at a higher risk.
"There are risk factors for burnout that are simply inherent to being a doctor. Medical practice involves dealing with patients who are seriously ill. They can be scared, agitated, or even abusive. Almost all doctors will experience the death of a patient, usually before they’ve finished their training. Even for doctors who see their career as a calling, this adds up to a very emotionally demanding job," said Mr Meredith.
As burnout has a physical component as well as an emotional one, this is where doctors' working conditions are not helping.
He added: "Long hours and back-to-back shifts are just the start of it. Doctors face large admin loads on top of their clinical work. Junior doctors have to move from placement to placement in their early years, often adding long commutes to their working day. Break and refreshment facilities are seriously lacking. In the middle of a hard shift, not being able to sit somewhere comfortably and have some nourishing food really puts a strain on the body."
Many of the signs of burnout for doctors are the same as for other healthcare professionals and those in non-healthcare-related roles, but there are some signs that are more common among doctors.
Dr Hannan said: "If you work within the NHS or a similar setting, you are likely to have noticed many colleagues leaving their roles due to working conditions, which are leading to stress and burnout. If you are spending time while at work thinking about escaping your current role, then it may be worth considering if you are experiencing the early stages of burnout."
She said as a doctor there are signs to be aware of:
- Skipping tasks that feel overwhelming or lacking in value. The number of tasks, especially administrative tasks, that doctors must complete can often contribute to burnout. New initiatives and changes in processes and procedures can make such tasks feel meaningless
- Noticing you are making more mistakes. When you are stressed, you are more likely to rush through tasks or to multitask. Doctors report that they make more mistakes when they feel burnt out than when they are feeling supported and calm about their role
- Becoming cynical about your role, patients or colleagues or being less compassionate about clients or colleagues. If you notice yourself becoming cynical about the treatments that you offer, frustrated with patients or venting to your colleagues, then you may be experiencing burnout
- Moral distress. When a doctor cannot meet patients' needs to the appropriate standard, it is common to experience moral distress. This is an emotional state that can arise from a work situation when you can feel ethically compromised because you believe the ethically correct action you want to take is different from the action you have had to take, whether this is due to limited time, lack of support or resources, or the task you have been instructed to carry out
Show Yourself Compassion
If you feel as though you are probably on the verge of burnout, there are steps to take yourself to prevent things getting really serious.
"Many will have said these things to their patients over and over again, but it has been noted that doctors often fail to follow their own advice," said Mr Meredith.
"A healthy diet, regular exercise and good sleep hygiene are vital starting points. Time outside work to recharge is important as well. In both cases, planning ahead can be helpful, for example, preparing some healthy lunches ahead of time, or rescheduling an event outside work to ensure you have some downtime. Of course, the nature of doctors’ working conditions can make these things more difficult: night shifts are not very conducive to a healthy sleep pattern, for example. But we shouldn’t lose sight of their effectiveness, and it helps to make good choices where we can."
He said emotional self-care is important too: "Avoid negative self-talk, and try to be aware of what is realistic to achieve – don't hold yourself to impossible standards. Doctors have to treat patients with compassion, but they often forget to save enough for themselves."
Dr Hannan agreed that prioritising self-care is crucial: looking after your physical health, getting enough sleep, eating well and exercising.
She said: "Creating balance in your life is essential, especially the balance between home and work life. Prioritise leaving work on time, taking lunch breaks, and limit overtime you take.
"Talk to a trusted colleague about it, or create time with your colleagues or team over coffee for a 30-minute de-brief. Create a narrative and recognition about the situation to express how you feel, and help to gain perspective on the situation," she advised.
Getting Outside Help
There are multiple sources of help for doctors suffering with burnout.
"Ultimately, every doctor faces different challenges and needs different kinds of support. The important thing is to recognise when you need that support, and to reach out," advised Mr Meredith.
"We know there is a stigma among doctors that makes it hard to admit they are struggling –especially with mental health. Look out for your colleagues, offer them time to talk if they need to, and know where to point them for help – those are some good first steps in overcoming that stigma."
- BMA wellbeing support services - open to all doctors whether BMA members or not and staffed by professional telephone counsellors 24 hours a day, 7 days a week
- Royal Medical Benevolent Fund - If burnout has affected your ability to work, and you are facing hardship as a result, the RMBF may be able to give you financial help
- DocHealth - is a joint project from the RBMF and the BMA, and offers confidential psychotherapy to every UK doctor. It is accessed on a self-referral basis, with no reports to GPs or Trusts
- NHS Practitioner Health is a free and confidential place for doctors to help with a mental health problem or addiction
- Burnout UK - founded by Dr Julie Hannan. It provides online courses for doctors to overcome and prevent burnout