Speak up or burn out

Physician Executive, Nov-Dec, 2006 by Joseph Grenny

A little over 50 years ago, the experience of some U.S. Forest Service smokejumpers showed that in certain circumstances, the best way to save their lives was to do something outrageously contrary to their natural tendencies.

In August of 1949, 15 men parachuted into a mountainous area of Montana to put out a growing fire. Within minutes the fire exploded out of control spreading at 660 feet per minute and threatening to consume the firefighters. They started running pell-mell toward a ridge, but when the crew foreman realized they couldn't outrun the blaze, he turned toward the approaching inferno and set the grass in front of him on fire.

As the grass finished burning he yelled for his comrades to drop onto the ashes to save their lives, but they kept running. In the end, the foreman threw himself into the burned out area and survived as the fire skipped over and around it, but 10 of his crew were killed before they could reach the safety of the ridge.

Unfortunately, like the Montana smokejumpers who were overcome, when people are placed in overwhelmingly stressful circumstances they frequently "run for the ridge." In other words, they tend to do things that actually put them at risk of greater harm.

Doctors are no different. The 2006 Physician Morale Survey by the American College of Physician Executives points to a growing combination of stressors that are overwhelming a disturbingly high number of doctors and physician leaders.

Challenges like patient overload, loss of autonomy, loss of respect, lower reimbursements, and bureaucratic red tape create a hostile environment for medical professionals that is so intense that three-fourths of doctors report having experienced stress-related problems.

Symptoms like fatigue, emotional burnout, marital and family discord, and even clinical depression regularly afflict more than half of doctors. The problems are so pervasive that 60 percent of doctors report having considered leaving the medical profession.

According to Christina Maslach, a professor of psychology at University of California Berkeley, and the leading researcher in the area of burnout, people cross the line from simple exhaustion to burnout when two things happen:

* Their relationships become increasingly depersonalized.

* They become chronically pessimistic.

When people withdraw from their relationships and become increasingly convinced of their own powerlessness, they enter a downward spiral of pessimism that can feel impossible to escape.

Like the smokejumpers facing fire, people become convinced that running away is the only available option. However, when physicians under stress take this route, they retreat from the only options that enable them to master their complex and stressful environment.

Stress becomes burnout

According to Maslach, when physicians' stress turns into burnout they experience depleted energy, lowered resistance to illness, increased absenteeism and decreased effectiveness on the job. Everyone suffers when doctors are trapped in this cycle of stress, withdrawal and burnout.

But not all doctors who experience stress are consumed in this cycle. Some cope well and remain resilient in the same environments that overwhelm others. Our research suggests that one significant key to coping with stress is akin to running toward the fire rather than running away.

Specifically, the best way to fight the creeping depersonalization and pessimism that underlie burnout is to take active steps to strengthen our relationships and increase our circle of influence. And the path toward both begins with investing time and effort in six "crucial conversations."

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It turns out that physicians who handle stress better engage more consistently and more effectively in six kinds of conversations that strengthen their social support systems and give them a greater sense of efficacy.

Here's a look at the six conversations that provide both inoculation and remediation against burnout.

1. Ask for support from your physician team.

Doctors who avoid burnout take the time to discuss creative ways of supporting and assisting each other so that the team deals with stress together rather than asking each to handle it alone. Often, they are able to find small adjustments that make big differences in lightening each others' burdens.

For example, one doctor reported that just getting a Friday off to attend an important family gathering was enormously helpful--even though her regular long workdays continued unabated afterward.

As doctors invest time in understanding the needs and concerns of their physician team, they develop creative solutions that help them cope better with unrelenting demands. Equally important, they build connections with others that reduce stress while avoiding the isolation that turns stress into burnout.

2. Step up to peer performance problems.

It isn't just unreasonable patient workloads that create stress. When peers fail to do their share--or are incompetent to do their share--it can pile resentment on top of stress. Too many physicians fail to confront and resolve concerns they have with their partners and peers.