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  • Valerie Brooke, MD

Physician burnout - Part 4

I am just finishing a fantastic book, Burnout: The Secret to Unlocking the Stress Cycle, by sisters Emily and Amelia Negoski. I picked up this book recently after recognizing I was feeling burned out at work. I was looking for answers about how not to feel this way, other than quitting my job and moving into a little cabin in the woods far away from the stresses of modern living, something my “prepper” husband (someone who prepares for a disaster or emergency by stockpiling food and supplies) would absolutely love to do!


Well, that’s obviously not a desirable option as we need community, so what to do? So many nuggets of wisdom in this book! First, I was reminded that my response to the stressors at work during the COVID-19 pandemic are to be expected. It’s normal to feel stress, normal to get the surge of adrenaline and cortisol when faced with sick patients and so much fear associated with the SARS-CoV2 virus. As the Negoski sisters explain so clearly, our bodies and brains are hard wired to chemically respond to the lion we see in the distance, to get ready to release the fight-or-flight mechanism in us. Every day at work I am confronted with many situations that trigger this automatic response in my body.


The key is what I do after I have either successfully killed or run away from the lion. How do I “complete the stress cycle” or release those chemicals in my body and blood? How do I turn off my sympathetic fight-or-flight system and turn on the parasympathetic rest-and-relaxation system? How do I release the stress so that I can get up the next day and go back to work? How do I not accumulate months and years of stress that will push me toward physician burnout?


There are many ways to accomplish this, but the most effective way for me is to move my body. This I understand on a deep level. There is nothing in my self-care armament that makes me feel better than exercise. When I go several days without moving my body in some way, whether it’s walking, running, biking, weightlifting, or high intensity exercises, I literally feel as though I could crawl out of my own skin. After a good, hard workout that raises my heart rate, I finally feel that I have reset my nervous system.


This, of course, is not the way to relieve stress for everyone. Others may get the same sense of relief from deep breathing, meditation, yoga, connection with loved ones, laughing (or crying!) or doing something creative. I do enjoy those things, but more as an adjunct to anything else that moves my body.


The other secrets I have learned from this book include ways to deal with the inevitable external stressors which are never going away, ones I have no control over. There will always be lions to run away from or to fight. It’s part of being human. Some of the strategies include reframing your experience to see the external stressors as a way to grow, uncomfortably of course, which comes with growth of any sort. You can also redefine what it means to “win” or “lose” and can set achievable goals. It’s easier and much less stress producing to focus on taking one step, then the next, rather than trying to climb that ten-thousand-foot mountain tomorrow. And the most important strategy is to know when to walk away, when to let go of the goal, or the job, or the relationship, whatever it is that is causing a perpetual stress response.


But probably the best reminder of how to avoid burnout is to have a sense of purpose in your life: the reason you get out of bed in the morning; the reason you continue to deal with the external stressors day after day. I myself have known what my purpose was for a very long time although it took me many years to find the best outlet.


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