Emotional exhaustion, not excessive work, leads to burnout: Another misconception about burnout is that it is caused by excessive work. That’s simply not true. People can be extraordinarily productive when they are in settings that are supportive and conducive to personal satisfaction. At the same time, when physicians feel stuck in places where they can’t do as much as they would like to do or are performing tasks that they really do not want to do, it leads to emotional exhaustion.
Among physicians, there is an additional danger: moral injury, when we incorporate the pain of others into our own lives. For rheumatologists, who treat chronic disease, this can be debilitating.
Burnout doesn’t just hurt physicians. It hurts patients, too: Physicians who continue to trudge along, burning themselves out in the process, don’t just hurt themselves. They hurt patients, because they are unable to do the things that patients rely on them for. Even the most basic obligations, such as establishing rapport, become so difficult once physicians are burned out. And, in our field, where creativity and thinking outside the guidelines are so vital for successful outcomes, burnout can lead to incredible harm. Therefore, the need to look after ourselves and our colleagues is a vital aspect of professionalism.
Personal satisfaction protects against burnout: Unfortunately, there is no quick-and-easy antidote for burnout. In the quest to keep burnout at bay, physicians have to look at what brings them satisfaction, both at work and at home. Rheumatologists have a built-in advantage in this regard, because we can see the fruits of our labor in decreased joint swelling and less disability, but it requires that we actively observe these successes. Just as important, in order to prevent burnout, or even reverse it, we have to invest our time in doing enjoyable activities far removed from the clinic and the hospital. It may sound like a very technical way to say “get a hobby,” but it is exactly that: an investment in one’s own happiness. The bottom line is that we have to maintain a passion for something, regardless of what it is, in order to stay motivated.
Recognize signs of abuse, and formulate an exit plan: Burnout is serious, and sometimes an environment can be simply so toxic that there is no other option but to get out. Unfortunately, there is no clear line that differentiates an unsupportive environment from a hostile one, but once an environment crosses into overt hostility, and its workers are subject to abuse, there simply is no return. Signs of abuse, including depersonalization, a lack of respect for boundaries, and predatory deprecating practices by supervisors, should not be overlooked. Instead, they should be noted carefully, and strategies should be implemented to counter the abuse. At its extreme, an exit plan may need to be formulated.
