Avoiding burnout and promoting self-compassion

By Dr Suzy Jordache on the 3 May 2018

Burnout among GPs is increasingly common. Dr Suzy Jordache, senior medical educator at Medical Protection explains what 'burnout' is and offers some advice on how to avoid it.

Studies from across the world quote rates of burnout within the medical profession as 12-80% depending on the dimension of burnout studied.¹ Prevalence varies according to specialty, gender, age or career stage and practice setting.

The impact this has on physician wellbeing, patient safety and patient satisfaction is now a recognised challenge for all who work in healthcare.

General practice in the UK is a high pressure, high expectation environment. Determination and dedication to meet the demand and fulfil expectations can lead individuals into a very unhealthy relationship with work that spills over into family life and personal health.

As Professor David Peters, head of the Centre for Resilience in London, states: 'Long term drowning in high levels of adrenaline and cortisol eventually makes you ill. But before that, it makes you stupid and unfriendly.'²

Litigation and complaints are often seen to arise against the background of a burnt-out, unhealthy doctor - diagnoses are missed, errors occur and patients and families experience unempathic, dismissive care.^3,4

What is burnout?

Burnout is an occupational hazard. The well-recognised Maslach Burnout Inventory (MBI)⁵ proposes three domains:

Emotional exhaustion
Depersonalisation – a cynical attitude with distancing behaviours
Low sense of personal accomplishment

A survey of 500 GPs in the UK in 2012 found 46% were emotionally exhausted, 42% were depersonalised and 34% felt they were not achieving a great deal.⁶ It is unlikely that if these surveys were repeated today the numbers would reflect an improved picture given the current tensions and difficulties.

Avoiding or reversing burnout

Avoiding or reversing burnout requires careful attention to developing good individual coping strategies in the workplace. Organisational policies and procedures must ensure these coping strategies are respected and enforced.

For healthcare workers, evidence suggests this requires renewed focus on physical and emotional wellbeing and ensuring a sense of calling is not eroded. This focus on self is an uncomfortable shift for many doctors. The concept of self-compassion is new and unsettling for a profession who pride themselves on caring for others and are driven by a moral obligation to serve.

In 2015, Minford and Manning looked at the current status and attitudes to self-care training in UK medical schools. Of the 15 medical schools that replied to the survey (44% response rate) self-care training is currently mandatory for all students in 40% and available to some extent in 93%.⁷

This is encouraging for our future medical workforce, but what about the current workforce? How well is self-care practised? Many would argue that it has never been needed more.

How can GPs practise self-compassion?

Physical wellbeing
Unfortunately many doctors find that the existing culture requires them to have considerable courage to ‘say no’ to skipping breaks and taking on extra work. Prioritising personal wellbeing can be a significant challenge for many.

Often doctors give much of their energy to their work and arrive home exhausted and unable to enjoy or participate fully in time with family and friends; fail to exercise or eat healthy food; or relax into restorative sleep. Developing rituals and routines that promote regular healthy eating, hydration and sleep underpins all other more sophisticated strategies.

Emotional wellbeing
Coping with the stress of working with suffering patients day after day requires attention to emotional wellbeing to avoid secondary traumatic stress disorder or compassion fatigue. Moral distress is a further occupational hazard that may need addressing. The frustrations of working in a limited resource setting can generate huge discomfort in clinicians. Mindfulness, reflective journaling, and attending Balint groups⁸ are evidence-based techniques that promote self-awareness and resilience.

Sense of calling
A sense of mission and purpose can also be important. Remembering why an individual chose medicine and celebrating achievements that align with these values can be a powerful way to bounce back in an environment that constantly challenges and surprises. Organisations and teams can support this by collecting evidence and stories of good practice and rewarding, thanking and celebrating.

Dr Kirsten Neff, associate professor at the University of Texas and a researcher in self-compassion and creator of the Self-Compassion Scales,9 says: 'Some people think that self-compassion is self-indulgent or selfish. It is not. The more we can keep our hearts open to ourselves the more we have available to give to others.'¹⁰

Medical Protection members can attend the free ‘Building resilience and avoiding burnout’ workshop available throughout the year at various locations. Non-members can attend the workshop at a fee. Additionally, the ‘Clinical Communication Programme’ (CCP) addresses workload and other professional issues that may predispose members to burnout. One-to-one coaching sessions around avoiding burnout and building resilience can be arranged too.