Today, we're talking about burnout which is something very personal and very important in the grand scheme of the medical world and the premed world. Allison joins us to talk about her experience with burnout during residency and we talk about how you can hopefully cope during a stressful time.
I've talked to a burnout expert before back on Episode 47 and we went through some free dance exercises and some other things. But I wanted to talk about burnout from a personal standpoint; so I have Allison on the show to talk about her experience, what we experienced together going through that, and then how we can transition this and help the student though whatever they may be going through.
[02:02] A Personal Experience: Allison's Residency
Allison was going through a neurology residency – which wasn't very easy – at Massachusetts General Hospital, a big, academic medical center. Even though we were married, at that time we were living apart. She was working 80 hours a week, had to do her one-year internship, the following year was her first year of neurosurgery residency, and she was on call every fourth night for about 32 hours. She describes it as a crazy and very intense experience with very sick people.
Days off would be spent on sleeping and eating and not much “me time”, which is apparently important. She realized something wasn't right once she noticed she had trouble concentrating. It was very disturbing for her, since she always had to rely on her brain and she felt like she couldn't rely on it anymore. This bothered her. For example, she would be at work and she'd have trouble getting her work done. It wasn't bad enough that it was apparent to everybody else, but to her, who used to be very efficient and was used to getting things done quickly, she felt like she was moving like a tortoise. Fortunately, she wasn't on a busy rotation at that point and it was further into the year.
This happened during her first year of neurology residency and second year of residency as a whole. Again, first year was the prelim internship year. But Allison says her first year of neurology was 100 times busier. Month 7 and she just felt like it was starting to eat at her. She was just tired. She was living in cold Boston and she was practically working all the time. She had no work-life balance. She was back living with her parents after she recently got married and she found it very hard. I was back in the Air Force and busy and was doing my own stuff too.
[07:05] No Outlet and Losing Focus on Your Health
Allison and I would get on the phone and Allison would just say she was fine because she also didn't want to burden me. Her friends in residency were all going through the same thing and her friends outside medicine couldn't actually relate to what she was going through, so she felt there were not any people she could talk to about it. They would sit around together but they really didn't talk about burnout. The residency program talked about it but it was also a well-known fact that first year was brutal. There was a light at the end of the tunnel and you just had to get there, because the second and third years were much more manageable.
Allison didn't know what was happening except that she felt bad. She didn't have time to sit around and feel sorry for herself. She was dealing with trying to take care of really sick people and didn't have time to focus on herself.
[10:02] Premed Burnout and How to Avoid It
As a premed, you may not be taking care of patients, but you're studying organic chemistry, physics and biology, chemistry, and MCAT prep and biochem. It's kind of the same as you're trying to power through that. You're sacrificing sleep, exercise, and eating right. So students go through this as well and not just physicians. There's also that possibility of rejection and that's very stressful for many people.
Allison recommends “decreasing the dose” is an important thing. It means decreasing the amount of work. Although you can't necessarily do this, you can structure your breaks so that you don't hit a wall and feel like you have to push through that wall and then hit another wall. So it's like breaking the cycle. Exercise is another important thing. Allison wasn't doing it other than running around the hospital. Sleep is also huge. People can get nervous, stressed, and burned out and they don't sleep well and that's terrible for your brain. Not sleeping won't help you in terms of studying or learning and it makes you feel more depressed.
Allison also cites the importance of talking to somebody and sometimes that may not be your friends or family but a professional who can help you though that with different strategies.
[13:14] Breaking the Stigma
Acknowledgment is the first thing. Burnout, as rampant as it is, is almost stigmatized. Nobody really wants to have a medical student or a physician hanging around a resident who's burned out, since you have to be able to function and do your job. So, as much as we say “it's common” if you start advertising that you're really burned out, Allison thinks it's not a welcomed discussion for a lot of people. Going outside of where you are to get help is important too. But I disagree with Allison here because I think we need to break this stigma and going outside is just continuing it. But if you feel you can't get the help you need or you're embarrassed, don't let that get in the way of you getting help.
[14:20] The Constant Need for Doing More
As a premed, there's this constant need for doing more and getting great grades, doing the extra curriculars, clinical experience, shadowing, and whatever else you need to do to get into medical school.
In residency, there was always a lot to do and that you're also expected to be reading and you won't have time to do that when you're working 80 plus hours a week. Allison didn't have the bandwidth to do this when she had time off because she only wanted to sleep.
The important piece here is that you're really going through burnout, take a couple days off. If you're a premed, give yourself some respite. Take a two to three days off or one week if that's possible for you. Give yourself a breath of fresh air.
[16:05] Decreasing the Dose
As a premed too, you can “decrease your dose” by dropping your classes or taking a semester off or a year off. This is okay. I would rather see a premed on the verge of going through burnout and going through these issues take a semester off, than see a a full semester with classes that have C's and D's because they were burnt out and couldn't handle it. If you're in that spot, take the time off. Volunteer somewhere and go work with a hospice or get a scribe job. Do something out of academics for a little bit for you to recuperate and fix yourself.
Also, as a premed, getting that time with patients reminds you of why you're doing this in the first place. This can help you feel refreshed. If you're feeling burned out, you're not alone. It's a huge problem for physicians and if you're dealing with it as a premed, it's still there. So it's something to practice learning to prevent yourself from falling down the rabbit hole. Learn the skills very early on, so that when get to be a physician you're able to better manage it. Neurology has one of the highest rates of burnout and biggest job dissatisfaction. As a physician, Allison had a recent burst of burnout and she had to do all these things – decrease the dose, get help, talk to me, lean on friends and family.
The demands in medicine just grow more and more all the time and that's not going to change. You need to figure out how you can withstand all that.
[19:45] Final Thoughts
If you are feeling signs and symptoms of burnout, if you're not happy with what you're doing, it's okay to take a break. Make sure you're eating right. Make sure you're exercising. Exercise has been shown over and over again to be a cure for everything. Eat well. Exercise. Get sleep. And go talk to somebody if you need to. Stress can lead to autoimmune problems; so protect your physical health, take care of your mental and emotional health.
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