Is it time to change the way we think about burnout and the way we train medical professionals to prevent burnout? Is it time to rethink resilience and resilience training, and to fully recognize that resilience training is only one part of preventing burnout in health care? This article is a call for those who see the potential of changing that paradigm.
Burnout in health care is essentially the result of an inadequate approach to solving an old problem. How would health care training change if we consider that the current approach to health care itself is flawed? This could reset the starting point of training and thus the outlook of preventing burnout.
Yoga and cupcakes will not solve the burnout issues of health care professionals. The health care system is deeply dysfunctional and in dire need of resuscitation. In the face of economic pressures, legal threats, societal disruption and other challenges, providing care from human to human is increasingly difficult. Any training generally promoting individual resilience without adequately, openly and frankly addressing systemic deficiencies is implicitly increasing the burden on health care professionals to keep performing under increasingly adverse conditions. This has created a downward spiral with a poor prognosis.
The unspoken message is: “If you are burning out, you are not good enough for today’s health care. But do not worry, we can help you survive.” This promotes a mental health stigma that does not land well with professionals used to working at the highest standards and with the trained self-image of being strong in times of crisis. This is why too many health care professionals are still not utilizing the available and valuable burnout prevention resources.
So, what are the alternatives?
Understanding the Signs
Step one might be to clearly differentiate three areas driving burnout, and to recognize that each requires an entirely different approach to prevention.
First, there are issues that are inherent with the medical profession — issues that must be addressed from both a human and professional perspective. Changing this paradigm will require a fundamental change in perspective, from treating disease to promoting health; otherwise, health care professionals will continue the Sisyphean task of curing signs and symptoms. Until health care professionals see their patients as fully human and understand the cause of their suffering, they will remain on the hamster wheel driving burnout.
In today’s health care system, the professional has great technical knowledge and skills for addressing disease, but hardly any personal authority on understanding health or conducting a healthy life. From a patient’s perspective, it may look similar to signing up for a violin class with a teacher who knows everything about violins but has never actually mastered playing the instrument.
Training in this area needs to focus on the essence of resilience: Bouncing back or recoiling is the result of first accepting an impact fully to leverage the energy as fuel for the countermovement. Personal resilience is not about harnessing a bulletproof armor to shield against adversity or increasing adaptability. It is also not about running at high speed, non-stop, giving 100% with maximum efficiency around the clock, day after day, regardless of circumstance, to maintain the profit margin. It is about training medical professionals how they may fully allow real human suffering to affect their hearts deeply to fuel a therapeutic alliance with compassionate resonance on a shared journey of healing. This is what yields a heartfelt sense of purpose and meaning. This is what energizes and ultimately keeps health care professionals thriving.
Address the Big Picture
There are systemic deficiencies that must be changed in the interest of everyone. But these can only be changed through concerted action by a critical mass of health care professionals leading to change of policy or change of culture. Burnout prevention training in the face of systemic deficiency must be based on the most sustainable business model available: training personal sovereignty in organizations. It is about enabling health care professionals to question norms and daring to consider a change of paradigm rather than crafting solutions within the old paradigm. Saying “no” to the current paradigm may protect and nurture the bigger “yes” that motivates people to enter this profession. This may be one of the hardest things to coach in medical leadership and professionals as it elicits fear in those with vested interest in the status quo. This is probably one of the strongest obstacles to real resilience and better health for health care professionals
Balancing Personal Experiences and Professional Approaches
Third, there are personal issues that trainees can address individually. Most of these are not hardwired in DNA, but either acquired during early childhood or even medical training. The classic paradigm holds that maintaining energy is based on professional distance and objectification. Both are integral to standard medical training, yet interestingly both are signs of burnout. Here’s an extreme example: A pediatrician reduces the overwhelming experience of child abuse to the medical task list of taking a structured history, examining the child for physical injury, taking photo documentation and pertinent samples, summoning gynecological and psychiatric support and writing a report. This may keep the pediatrician from crying with the victim, swallowing a broken heart, vomiting in disgust or engaging in thoughts of killing the perpetrator. The pediatrician clicks the save button on the medical report and moves on to the next patient, an adolescent with acute asthma.
However, distance and objectification also shield the pediatrician from nourishing experiences. They can still feel positive emotions, but their bandwidth for seeing the world through the eyes of patients or colleagues is small. Without authentic interest, medical professionals lose the ability to truly connect, to engage with heartfelt compassion, and thus to resonate in loving compassion, the source of life and the condition for true healing.
The path to healing health care professionals needs to go beyond acquiring the skills of an oak tree or a willow in handling a storm. Adaptability training focusing on adversities and offering solutions is a similarly limited approach, as is the one taken by medicine with a focus on combating disease rather than promoting health.
Even adaptability training that focuses on positive emotions or positive intelligence is in a way putting the cart before the horse. It is evidenced that practicing positivity and creating a track record of positive experiences builds something like a bank account that can be drawn upon in times of stress. Like any sage advice, this is a useful approach that, when practiced, will allow for a more peaceful and fulfilled life. Yet, this approach will turn into freedoms naturally lived and expressed when we are one with the source of life. From here we see clearly that we are all expressions of this one sacred life, and we naturally feel compassionate connection.
A sense of separation between health care providers and their patients is a fundamental driver of burnout. An expanded understanding of health, personal sovereignty and compassionate love removes that sense of separation. This kind of health care training can complement technical training and change our concept of resilience and preventing burnout.