BECAUSE PATIENTS JUDGE YOUR SKILLS BY YOUR BEDSIDE MANNER
Top Five Signs You’re Suffering Burnout
5. You’re so tired you answer the phone “hell” instead of “hello.”
4. Your mom calls and you yell, “Get off my back, bitch.”
3. You’re so stressed you can’t remember how to pee.
2. You wake up and your bed is on fire, but you’re so tired you go back to sleep.
1. You think how relaxing it would be if you were in jail right now.
Everyone is entitled to have a bad day, except people in service industries. How many times have you experienced a service provider having a bad day, causing you to say, “I’ll never go back to that place again”? We all have bad days; the problem is that no one wants to know about your bad day. When you meet a miserable service provider for the first and only time you may have no idea how wonderful they are on all other days and you really don’t care. It’s today that most people are concerned about.
For the doctor with the great bedside manner it is important to avoid showing the effects of the bad day, and even more imperative is the need to stay focused and avoid becoming burned out.
In essence, burnout is physical or emotional exhaustion, especially as a result of long-term stress. It doesn’t take a lot of years to become a victim of burnout when trying to seek perfection in an imperfect world, dealing with difficult patients, lackluster staff, demanding colleagues, and insurance carriers denying payments, all the while worrying about being sued and losing your home. Just about this time you should consider a career change. Yes, you should go ahead and open that candy store.
Much burnout comes from a practice that is too busy. Trying to see too many patients is physically demanding, and deep down inside there is the mental anguish of knowing you aren’t performing the type of care you are capable of providing. Rationalization often surfaces, and you tell yourself the way the HMO pays you, the patients are lucky you have time to say hello. You worry about maintaining your income and you cut corners even further. Try to work toward a practice that is balanced and don’t let your practice run your life.
A busy neurosurgeon gives this advice to new doctors to prevent burnout:
“Make sure they are associated with a group so they can have a life. Make sure they know the emergency room docs; who’s good and experienced and who’s not. Then you will be better able to know when something is a true emergency.”
Diagnostic challenges, personal physical decline, dealing with difficult people and staff, as well as forces external to your practice (like family issues or even the classic midlife crisis) are strong catalysts for burnout.
At the opposite end of the spectrum is the practice that can barely pay the bills because the practitioner is lacking in business skills or people skills (poor bedside manner), or the location of the office is not ready for a fulltime practitioner. Not being busy enough can be just as bad as being too busy.
It’s easy to criticize the system and make excuses, but you really have to step back and see if you are burning out. Not only will stress cause your practice to suffer, it is implicated in so many health issues that you may die young.
Once you establish that you are having problems dealing with stress, you have to remedy the situation. The best suggestion is to try to work toward a practice that is balanced. Don’t try to treat everyone in the world. Depending upon your type of practice, consider getting a partner, or at least an associate, to allow you to take a vacation and have some time off to rejuvenate.
Health-care providers have some unique issues that can result in burnout. Some of them are difficult to identify and can lie beneath the surface resulting in generalized feelings of depression. Stress and burnout are universal and affect most everyone.
“I just decided ‘no more surgery.’ The risks were too great. I didn’t want to worry about losing my house to some lawsuit. Now I am happy to treat allergy and hearing problems. I work less and make out better without all of the stress.”
It is important to recognize that failure is a fact of life in every health-care endeavor. Not every procedure is successful and not every patient survives. While having high ego strength helps you ignore the feelings of failure, beneath the surface it may take a toll on your psyche. It may help to have contact with fellow practitioners to share war stories and common experiences to ward off feelings of isolation and failure. Vacation time allows you to unwind and regenerate.
Maintaining a teaching affiliation and going to professional society meetings are ways for the solo practitioner to have professional contacts. Joining a group practice provides built-in professional relations that can ward off feelings of isolation and failure.
Diagnostic challenges can make you doubt your abilities, and while no one can make every diagnosis, you can take failure personally if you dwell on difficult cases. The affect on your confidence can be daunting. Fortunately, most practitioners become so busy they won’t remember each failure or each diagnostic nightmare.
It should be noted that with advancing age it is not uncommon for practitioners to lose their sight or dexterity. Trying to accomplish procedures with the same level of expertise they had in earlier years may become impossible. It is extremely difficult to admit physical decline, and if practitioners don’t plan for retirement, they could be forced to continue working beyond the time that they should have stopped. While still young, make sure you plan ahead so you don’t have to practice when you should be enjoying the fruits of your labor.
Dealing with difficult people and staff is a strong catalyst for burnout. Learning interpersonal skills and taking courses on how to deal with difficult people may be helpful. Consider taking these courses and you will not only learn some good skills, you will be reminded that the human experience is common to all of us or there wouldn’t be a need for all those courses.
Patients don’t know or care what causes your coldness or rude behavior, or even that you may have cut them off while they were asking you the same question for the tenth time. They only know you aren’t that doctor with the great bedside manner. If your patients know how great you usually are, they will forgive you, and because they actually feel close to you, they will often ask if something is wrong as they would a good friend. In that case you may get away with being moody on occasion. But it won’t take long to use up your goodwill capital if you don’t get your act together.
Doctors with good bedside manner can usually tell when they aren’t themselves. If you are the oblivious type, you must learn to recognize the signs. It may be that you snap at your coworkers or employees. Perhaps a caring patient who knows this isn’t you will say something. If your staff asks if something’s wrong, that is a sure sign you aren’t being yourself. They will often notice your bad day before you do by something as subtle as you not saying good morning.
Vacation is a great way to unwind and regenerate. Taking several shorter vacations may provide you with more relief than waiting all year to get away for one treat. The anticipation of respite helps make the days go by faster, and the more good things you have to look forward to the better you will feel.
Consider getaway weekends if you can’t schedule full weeks. Anytime away from the practice is recuperative.
Altered hours are a fabulous way to defeat the monotony of your routine. If you know that every Monday is a long hectic day, you begin to dread Monday. If surgery days are stressful, and Tuesday is surgery day… you get the idea. By having altered days and weeks, you can avoid preconceived anxiety. Consider making an A week and a B week with enough variety to keep you out of a rut.
Avoid high-stress, time-consuming, expensive hobbies. Sports, meditation, Yoga and maintaining a regular fitness program will do wonders for dealing with stress and provide you with a healthy outlet. All too often, health-care providers have so little time for themselves that they neglect their own health. Don’t let high school gym be the last time you had a cardiovascular workout.
Consider avoiding dangerous hobbies and sports like motorcycling, mountain climbing, and full contact football. While some of you require intensity in your lives, the injuries from high-risk hobbies can ruin your career.
You can get much relief from stress on the racquetball, tennis, or basketball court, or by playing hockey or softball. Develop hobbies and sports skills you can continue with advancing age. You aren’t going to be playing rough touch forever. A round of golf may be there for you once your knees no longer tolerate tennis. Golf can be so time consuming that it may not be right for you early on while you begin practice, but as you consider slowing down, it can offer a great getaway from the stresses of practice.
Learning some simple techniques and taking the time to relax could be the difference between an extended or shortened career. You don’t have to take a formal course to learn meditation. You do have to take the time to utilize the techniques.
Yoga offers both physical and mental benefits. By taking time to relax and go into the various poses you rest your mind and the poses themselves stretch the muscles and joints to keep you flexible and fit. Like meditation, you don’t have to take formal courses, but some introductory lessons would be helpful. Unless you really get into Yoga, you don’t have to strive for the exotic poses that take much practice and guidance. It may be best to learn a few simple poses that help with your particular physical stresses. If you have a bad back, learn poses that stretch the back.
Besides formal Yoga postures, you can consider utilizing some basic physical therapy stretches. Anyone who has had physical therapy knows they teach many stretches that help with rehabilitation. Keep doing those that let you maintain flexibility and relieve pain.
Psychotherapy is needed when you recognize you no longer deal effectively with your stresses. While the techniques noted should keep you from getting to this point, there may come a time in your life that you need to talk with a professional. One of the biggest problems is denial or an inability to see that you need psychotherapy.
Health-care practitioners have some of the highest rates of alcohol and drug abuse, and a high suicide rate, which shows that dealing with sick people may take a toll you didn’t expect when you chose this profession. Don’t let yourself fall into substance abuse or succumb to untreated depression. You’d never ignore the signs in your patients and you shouldn’t ignore the signs in yourself. Self-destructive behavior should not be an option.
• Craig C
• A. Vo
• Andrew V
• Craig C