Work-life balance
Prefer to listen to the podcast? Subscribe and listen free:
If you're a clinician who's only interested in medicine, this message is especially important to you.
Having this base (work-life balance) in place correctly will allow you to learn more, retain more, and play the long game. Let's start with the concept of work-life balance.
I’ll be blunt. I don’t believe in work-life balance as it’s traditionally depicted.
The concept of work-life balance has two fundamental flaws. It implies there are only two parts to your life and that everything must be distributed equally at all times.
This terminology also implies one is good and the other bad; therefore, they must live on opposite ends of the spectrum.
But this is neither practical nor realistic.
Simon Sinek says, "Balance is achieved with two opposing forces. Why should work and life be in opposition?"
Instead, I like to think that you have one life. Nothing more. Nothing less.
Separating the two is much more complicated because the two always intersect. We've been taught that work shouldn’t be enjoyable because it’s “work,” if you enjoy it, then you’re the exception.
My question to you is: why do we accept this as truth?
Just because something is common doesn’t mean it’s normal. Diabetes and obesity are common, but it’s not how things should be. The goal isn’t to be miserable at work so you can enjoy your personal life.
You should not be waking up with dread.
Anxiety should not creep its ugly head whenever the alarm clock goes off. Have you noticed any of the following as you drive to work?
Exhaustion
Unappreciation
Boredom
Anger
Sadness
If so, you may be approaching burnout. It's time to take control before things spiral too far.
What is burnout?
We talk a lot about burnout, but we should define terms to be on the same page. But before I do, I want to say many variables are at play here (many of which are outside our control). It’s tough to change an institution and probably not the best use of your energy (unless that is your mission in life).
With that said, there are things we can control. We need to be proactive about this, not reactive. Preventive lifestyle changes are always better than pharmacotherapy; the same rule applies here.
The term burnout was introduced in the early 1970s by psychoanalyst Freudenberger. Maslach et al. later defined it as a syndrome consisting of the following:
Exhaustion (emotional/ mental/ physical)
Exhaustion is the most common of the three signs listed here, as it’s probably the easiest for someone to pinpoint.
Feeling unaccomplished
Here, you begin to question whether there is any point in doing the job that you're doing.
Self-doubt might creep in, and you’ll think a mistake is inevitable unless something changes.
Depersonalization / Cynicism
There is a lack of empathy towards your patients, colleagues, and staff.
You start to have negative emotions towards patients and coworkers, which turn into complaints and stereotypes.
Here are a few thoughts that are common among individuals at this stage:
“My patients are non-compliant.”
“It’s ridiculous that I care more about my patient’s health than they do.”
“Patients never listen.”
“My coworkers don’t help.”
“I must pick up the slack to make things run more efficiently.”
Depending on the source you look at, 40 to 60 percent of clinicians will burn out at some point in their careers. This is a big deal. The effects of burnout (to name a few):
Decreased quality of care
Poor patient satisfaction
Decreased trust from the patient also increases the chance that they don’t adhere to a plan. I know I wouldn’t listen to someone I don’t trust
Medical errors
High clinician turnover
Relationship difficulties
Colleagues, patients, admin, spouse, children, parents, and friends
Substance abuse
Suicidal ideation
Many feel they can just tough it out. But when you zoom out, you’ll realize you’re not the only person involved. The way you feel affects performance regardless of what you think.
Burnout affects you and your patient. Patients aren't just a random group of people, either. They consist of every single human being on the planet.
You are a patient
Your spouse is a patient
Your child is a patient
Your attending is a patient
Your colleague is a patient
Everyone is a patient at some point in their life. Therefore, every human being suffers when a clinician isn’t putting their best foot forward.
The Misconception
If you were to do some research for the root cause of burnout, you would find article after article stating that it’s due to chronic stress secondary to your work environment. But, I believe that paints an incomplete picture.
The only way your work environment leads to burnout is by doing nothing about the work environment. There are only three reasons why you do nothing about an environment that makes you unhappy:
You aren’t aware of the problem. Perhaps you feel something isn’t right and something needs to change, but you’re not exactly sure what that is.
You’re aware of the problem but don’t know the solution. You know your work environment makes you unhappy, but you’re unsure what will fix it.
You know the problem and have a solution in mind, but you don’t execute it. You either don’t know how to execute the solution, or you’ll come up with excuses as to why now isn’t the right time. But, if you dig deep, you’ll realize many excuses are grounded in fear and insecurity.
If you quit a "bad" job, any of this would be impossible. If you understand why you quit this job and put a system in place to prevent this from happening in the future, then it would be really difficult for any of this to recur.
This requires self-awareness of standards, boundaries, and tolerance levels.
With all that in mind, everything discussed thus far is still confined to only one thing: your career. Most articles fail to consider the other aspects that make up your life.
The Problem with WHO & ICD-11
I’ll discuss what I believe to be the best approach to managing this “syndrome.” Before I do, please read what the World Health Organization has to say regarding burnout:
“Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition.”
Burn-out is defined in ICD-11 as follows: “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
Feelings of energy depletion or exhaustion;
Increased mental distance from one’s job, feelings of negativism or cynicism related to one's job, and
Reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
The danger of calling it a syndrome downplays the severity of burnout.
Question: what is one of the most important things we must identify when looking to “treat” a patient (especially in mental health)?
Answer: Whether or not the condition is affecting the patient's quality of life and well-being.
After all, it’s well-documented that burnout has contributed to suicide in many cases. So, don’t let the word “syndrome” fool you.
While the ICD-11 asserts that burnout results from chronic workplace stress, I argue it can’t be the only identifying factor. By definition, a syndrome cannot have a single identifiable cause or a defined cure. Based on that, how can one confidently say it must be occupational?
We can also apply logic here…
If the job was fully to blame, how can two clinicians work in the same system but have two different experiences? How does the same job induce stress for one person but not the other?
If it were strictly an issue with the job (workload, system, and resources), 100% of the staff would burn out. But we know that’s not the case.
I believe occupation plays a major role but is not the only component. Thinking that one area of a person's life doesn’t affect another is short-sighted. A person's state of mind, feelings, and/or emotions cannot be confined in this way.
Imagine if I said that a syndrome of sadness, fatigue, and decreased motivation refers specifically to one's relationships and should not be applied to describe experiences in other areas of life.
This definition doesn’t acknowledge the complexity of the human mind.
Because burnout wasn’t even considered a “syndrome” until 2019, it’s clear that, in many ways, mental health is a profession that stands apart from medicine (although it shouldn’t).
Why does this matter as we discuss management?
Because of the adopted definition, most resources paint an incomplete picture regarding how we should address burnout. These resources assume that there's only one thing to fix (your job).
But if it were that easy, why is burnout at an all-time high?
To treat, we must first understand the following:
How your system (life) is supposed to work when healthy (ideal life)
How your system works when it’s unhealthy (burnout)
The management here will be different for everyone and depends on what their system (life) is supposed to look like when it’s healthy.
Your baseline is not the same as mine, so one blanket answer won’t suffice. We need to treat the underlying cause(s).
If you remember, we previously discussed the unique stressors and beliefs that were built into us during our medical training. Some were necessary evils to survive the education needed to care for human life.
The problem is this approach stops serving you once you leave school. After you graduate, you have to start thinking differently. You have to start putting yourself first.
At this point, we’ve had hundreds of 1:1 conversations with clinicians. In the first session, we always ask, “What do you want from your life and career?”
Mostly, we hear an “it would be nice if...” type of response. However, it’s often difficult to get a more concrete answer.
While I understand this is very hard, it’s worth putting the time and energy into answering this question for yourself.