Today’s post is in the form of a vlog, or video blog. View the video and refer to my notes below.
Notes from Video
- Stress leads to more stress through positive feedback mechanisms. By “positive” I do NOT mean desired and beneficial. Rather positive means that increase in the value of one variable leads to increases in value of that same variable and other related variables, irrespective of whether the consequence is beneficial (virtuous circles) or detrimental (vicious circles). Thus, wealth begets wealth, aggression begets aggression, and burnout begets burnout.
- To summarize from an example I gave in a previous post: When you feel emotionally exhausted, overwhelmed, and drained you are more likely to make medical mistakes. But even small mistakes, ones without negative consequence for the patient, undermine your confidence in your work, and your sense of competence and professional achievement. Thus, increasing burnout by another notch and likely leading to increased emotional exhaustion and propensity to make a mistake.
- Today I wish to focus on the positive (and this time I do mean beneficial) steps a clinician can take to optimize work performance and satisfaction. They both entail a change in mindset.
- One way is to maintain or re-establish a sense of commitment to one’s profession. Of course, uncommonly a clinician may learn that patient care truly is not their calling and they face the hard decision to pursue a different career direction. More often, however, is that the unhappy clinician is unhappy due to circumstances at their particular job in the particular setting they work in. Once burnout sets in, with its undermining of one’s sense of purpose and competency, it is a small step to move towards an undermining of one’s commitment to one’s profession. The affected clinician can then live chronically with that “one-foot-in-and-one-foot-out” approach. This is really the worst of both worlds: the clinician undermines any remaining satisfaction from their work while not effectively pursuing an alternative. Most often (I believe) it is most beneficial to recommit oneself with conscious intent towards one’s chosen profession. This willful re-establishing of commitment then leaves the clinician with two remaining possibilities: either find a way to make it work or stay miserable. When one removes the possibility of getting away from one’s career, the making-it-work approach may be the only viable one left. And that can be a good thing. There is a motto for such circumstances: “The only way out of this is through it.”
- So, if you tell yourself that you WILL be a clinician for the rest of your working days, then you are forced to confront what exactly is contributing to your unhappiness, stress, and burnout. If it is the EHR, then you are forced to do something about it – perhaps learn it better. If your stress is from inefficient charting, then make a commitment to make your notes more efficient and effective.
- A second beneficial change in mindset is to react to work-related events with a certain emotional distance. This can be done by maintaining a sense of curiosity about why patients act the way they do or events take the turn they do. For instance, consider the situation of the patient you keep telling to take their meds as prescribed because their poor adherence can lead to an early death, who continues to remain poorly adherent. For clinicians it’s often hard to be emotionally neutral and much easier to get irritated and act in accordance to that irritation. (Of course, such behavior can lead to self-recrimination for “unprofessional” behavior.) But a more emotionally neutral stance can open up the clinician into considering, “Maybe I should try something different. Clearly, my current approach is not working. What other avenues can I consider? Maybe I’ll ask the patient’s advice rather than giving voice to my own?”
- Notice that what I’ve said about commitment and curiosity are equally beneficial mindsets for personal relationships. Rather than asking, “How do I get out of this relationship, sometimes it’s worth asking, “What can I do to make this work?”
Until next time,