Tackling Burnout with Hard-Won Wisdom

Modern life is complex. Unfortunately, it has also become difficult, with increasing levels of cynicism and disillusionment both towards and within healthcare. The recent RCOphth survey shows serious staff shortages and we know we have an increasingly aging population – a combination that places higher demand on ophthalmologists than ever (1). It is clear that we need to ensure those who enter our worthy profession have every chance of building not just a successful career, but also remaining physically and mentally healthy at the same time. Worryingly, rates of burnout are on the rise in ophthalmology post-COVID – and, as with so many things, prevention is better than cure (2).

Hard-won wisdom
 

There’s so much to love about being an ophthalmologist, but we shouldn’t be naive. No matter where in the world you work – and no matter the healthcare system, huge stresses and pressures are placed on ophthalmologists.

Stress doesn’t just come from the responsibility of patient care, but also from our situations – let me offer a personal example. In 2007, there was an attempt to modernize specialist medical training posts in the UK, summed up with the phrase: “geography or specialty.” In short, if junior doctors wanted to stay in a specific region, they had to accept whatever specialty was available. Alternatively, if you wanted to be an ophthalmologist (for example) you might have to move across the entire country, regardless of your family situation – and with 48 hours to decide. That was my experience with an infant daughter – and it really made me consider both the motivation and the cost of doing what we do.

Whatever the source of your stress, I’ve gathered some hard-won pearls of wisdom to steer you away from burnout.

Protect your time and autonomy
 

My experience highlights one of the important triggers for burnout: A lack of autonomy. We doctors are generally high achieving; we value the freedom to make choices on our own terms. However, systems can often take our autonomy away, and so my first tip is to effectively time manage your schedule – on your own terms where possible. To do this we have to recognize our own limitations and identify what motivates us. The solution to a lack of autonomy is not greater effort, but better protection of our time and energy. A pet hate of mine is the ideal of giving 110 percent to something; even if you give 100 percent of yourself to work, that leaves 0 percent for anything else. And let’s face it, there is much more to life than work – we only need to think of Maslow’s hierarchy of needs to know this. At the very top are self-actualization and esteem – the desire to become the best we can be and to be treated with respect and dignity. When those concepts are absent, you’ll get resentment and, ultimately, burnout.

Given this fundamental need, should the waves of strike action by junior doctors in the UK really take us by surprise?

Diversify and engage
 

There is great deal of talk in healthcare about the importance of resilience – an ability to respond and grow despite adversity and stress. Remember life as a junior medic? The stresses of learning decision making as a junior doctor promoted greater confidence as a senior, through previous exposure to complex clinical scenarios. A great way of building resilience is through teamwork and mentoring – including reverse mentoring, where all members of the team are valued, and seniors can gain unexpected insights from their juniors. Ask yourself these questions: Who are you mentoring? And who is mentoring you? Engaging in these relationships will reduce isolation attitudes, allowing us to thrive rather then simply survive.

Diversification can help you thrive too – if you only do the same thing day in, day out you can get ground down by workplace dramas. If you develop a range of different interests, you are less likely to get bored, and more capable of compartmentalizing issues when they arise. So, get involved! This can be through engaging with professional societies, giving tutorials or writing talks – developing these interests and relationships will also make you a much better doctor. As a medical professional, you are likely highly skilled at more academic pursuits, so maybe you could think about getting involved in research, opening avenues for further study. Strange as it may seem, I find academic writing therapeutic – and it recently culminated in achieving a higher degree! Whatever enables you to develop new skills and gain new experiences is liable to help you love your job for longer.

Don’t forget the ice cream
 

One of my greatest joys is protected time with my family. We shouldn’t just schedule our work time day to day, but also our leisure (including exercise!). Planning time and space away from the stresses of work will make you much better able to deal with it on your return, and it can help us work more effectively. This approach is clearly better than over-working and becoming resentful of your work schedule. Look out for symptoms of work encroachment causing anxiety – and be proactive in addressing them as soon as possible. And if some of it appears to be self-inflicted? Perhaps high achievers like ophthalmologists need to learn to say one of the hardest words – enough! Prioritizing the source of your joy will enable you to maintain a positive attitude in all aspects of your life.

Ancient wisdom still applies
 

Most of these concepts are not new. There is great deal of evidence that having a higher calling and purpose in life promotes resilience (consider those who endure despite persecution). Similarly, timeless principles, such as ensuring a day of rest, not being jealous of others’ achievements or finances, and accepting we can’t do everything all at the same time can only help us reach a greater level of contentment.

Originally, I gave this article a different title – “How to love your job forever” – but, if I’m being honest, I don’t love it every day. I’m trying to do the best I can with the gifts I’ve been given to support my family and do the best for each specific patient in front of me. I’m sure those concepts are feelings to which many of you can relate.

In short, be yourself – that’s all you can be! Make every effort to protect your time and energy. Diversify where you can to keep your passions engaged. Remember your purpose and that work should be just one aspect of your life. Learn to be content. And, perhaps most importantly, don’t forget the ice cream!