Burn Out and Resilience – 13 January 2025
Response to Montgomery A, Panagopoulo E, Esmail A et al. Burnout in Healthcare: The Case for Organisational Change; British Medical Journal; 2019; 366; 193-195.
I appreciate that I wrote this article several years ago, before Covid times and that there is far greater knowledge and support now, but there is still lots that is relevant. I wanted to share these thoughts prior to writing a more general up to date article about burnout relative to my current role as a counsellor / psychotherapist including its recognition and management.
Burnout is "mental, physical and emotional exhaustion, cynicism, increased detachment and a decline in professional satisfaction caused by multiple factors."(1)
Why Self-Care Matters
In 2014, the Journal of General Internal Medicine recommended "Ten Bold Steps to Prevent Burnout".(2) These include steps in institutional metrics, work conditions, career development, and self-care. I cannot help but wonder why self-care sits in bottom place at ten. Safety warnings on aircraft comes to mind "put on your own oxygen mask before helping others", because you are not going to be able to help others if you do not ensure your own wellbeing.
The Scale of the Problem
In February 2018, an article in the Canadian Medical Association Journal "Addressing physician burnout at the systems level"(3) reported that 42% of physicians reported feeling burnout. Recommendations were made to "prevent burnout".
"Physicians aren't burning out: they're suffering from moral injury" was published in 2018.(4) The authors use the metaphor of medics "going to battle". That description probably rings resonance with many medics, whatever their speciality. It also describes doctors facing "moral injury". It acknowledges that burnout is a term hard for medics to identify with, as it suggests a failure of resourcefulness and resilience, which in fact is quite the opposite of what medical training strives to achieve. By nature, medics are resilient characters, so it is no wonder that people struggle on.
Beyond Resilience Training
Continuing the analogy "battling", an article "The Army's Flawed Resilience Training Study"(5) addresses the US Army's Comprehensive Soldier Fitness Programme, which incorporates "Master Resilience Training". It became apparent that there is little evidence to suggest it works. Whilst clearly, medicine is vastly different, there is a lot to learn from this reflective article. Primarily, resilience training may be part of the solution, but the issue is far broader.
A Call for Organisational Change
A BMJ article "Burn Out in Healthcare: The Case for Organisational Change"(6) acknowledges the issues, and that organisations need to focus on developing healthy workplaces and preventing burnout, rather than being reactive. Pulse published an alarming article "Top GP issues mental health warning as 400 doctors died by suicide"(7) and in Canada, an article about suicide in GP trainees.(8)
These headlines show a growing awareness of the problem. There are also numerous articles online from medics sharing their personal experiences. However, this is the tip of the iceberg.
The Path Forward
A huge amount of work is needed to address this problem, and increased awareness is the first very small step in the right direction. Change is required at organisational, team and individual levels. Measures are being put into place, such as the Practitioner Health Programme, and resilience training.
It is reassuring that organisations are taking the issue seriously. The MPS issued a statement on 30th September 2019, "Urgent action needed to tackle burnout endemic in healthcare."(1) It contains alarming statistics about the percentages of doctors with personal wellbeing concerns, and dissatisfaction with their work/life balance.
The MPS is calling for every NHS organisation to have a named wellbeing guardian who is trained to recognise and support professionals in difficulty, by 2022. This is admirable, but will be a challenge financially, culturally, timewise and manpowerwise.
Individuals need to be able to reach out for support, be encouraged to do so, and recognise that the work they do on a daily basis, is phenomenal. I believe every individual has a part to play in change.
One of my questions is what can I myself do to contribute?
Personally, on my own journey through depression as a doctor, I made use of journal therapy. I plan to share this journal in the form of a book as my next step, in the hope it can help, but that is just the first step.
Dr Victoria Froome
References
1. MPS Casebook Connect – Breaking the Burnout Cycle
2. Linzer M, Levine R, Meltzer D et al. Ten Bold Steps to Prevent Burnout in General Internal Medicine; Journal of General Internal Medicine; 2014; 29(1); 18-20.
3. Collier R. Addressing Physician Burnout at the Systems Level; Canadian Medical Association Journal; 2018; 190(6); 174.
4. Talbot S, Dean W. Physicians aren't "burning out." They are Suffering from Moral Injury; satnavenews.com; 26.07.2018.
5. Eildenson R, Soldz S. The Army's Flawed Resilience Training Study: A Call for Retraction
6. Montgomery A, Panagopoulo E, Esmail A et al. Burnout in Healthcare: The Case for Organisational Change; British Medical Journal; 2019; 366; 193-195.
7. Wickware C. Top GP Issues Mental Health Warning as 400 Doctors Die by Suicide; www.pulsetoday.co.uk; 2019.
8. Laramee J, Kuhl D. Suicidal Ideation among Family Practice Residents at the University of British Columbia; Canadian Family Physician; 2019; 65; 731-734.