The work of Dr Tait Shanafeldt is gaining traction across the world. He has hypothesised that approximately 80% of the issues contributing to clinician burnout stem from system level issues, rather than individual clinician factors.
System change is coming, momentum is building and little by little things are shifting. But, changing systems is like turning cruise ships – slow and cumbersome. Speed boats on the other hand can be speedy and nimble, rapidly changing direction at the side of the ship. In this analogy, YOU are the speed boat, and the cruise ship is our healthcare system. Read on to learn how to start using your agility and begin paving the way for change.
As doctors, we are trained to be adaptable. We change jobs every two minutes (or so it feels) as juniors and become skilled at rapid integration in teams. When working with our patients we are constantly dealing with changing information, often building the jigsaw puzzle without any idea of the finished picture.
But, when dropped into dysfunctional systems we become the canary in the coal mine. No matter how strong the canary is, it won’t survive in the coalmine if the conditions are unsafe. This analogy, with clinicians being the canaries and healthcare systems being the coal mines, was popularised by Dr Christina Maslach – co-author of the Maslach Burnout Inventory. It paints a vivid picture and can be helpful to keep in mind when thinking about clinician burnout.
By giving the canary personal protective equipment (PPE) and an oxygen mask (as long as he actually puts it on), we can buy extra time to sort out the massive issues in the coal mine itself.
Here are 5 things you can do as part of your own PPE.
#1 Look after your basic needs.
Stop accepting that you won’t have time for a lunch break and that you can’t get to the toilet. As a human, and as an employee, you have rights to these things every single day. Working whilst hungry or busting to pee affects your concentration, decreases your decision making capacity and increases your risk of making errors. So if you won’t prioritise it for yourself, prioritise it for your patients. They deserve to have a doctor firing on all cylinders, not sputtering over the finish line.
I can think back to many shifts in the emergency department or on the wards where I didn’t get lunch and I went for hours with a full bladder. Nobody gave me a medal, in fact nobody really noticed. The place was overflowing then and it is still overflowing now. So stop, have a break, and then carry on with refilled energy and compassion. And remember, if you don’t stop to have a break, that is a you problem. If you truly cannot stop to have a break, that is a system problem and needs to be escalated, fast.
#2 Go home on time as much as possible.
When you decide to embark upon a career in healthcare you need to understand that there is going to be overtime and antisocial hours. People don’t only get sick between 9-5 on weekdays. You will work evenings, you will work nights, and you will work weekends. Get used to that early.
Leaving work on time is important because hopefully you will have things to do when you “clock off”. Catching up with a friend, picking up your kids, playing sports… When you start missing these things it breeds frustration and eventually resentment. You may not feel it at first, but this silent stealing of your time can be the beginning of losing your identity to your job as well as placing you on the path to burnout.
In reality, there will be times when you are packed up and ready to walk out the door and there’s a MET call on a patient you know really well. You decide, or are needed, to stay and you do so willingly. We’ve all been there, and if you haven’t yet then you will be soon. These things happen, but thankfully not all the time.
So even if you have nowhere to be, make a date with yourself and make sure you get there. If not all the time, most of the time.
#3 Claim your overtime.
If you work overtime, you should be paid. It is quite simple. Safework.org says the
“historic reliance on ‘goodwill hours’ is now a legal and reputational hazard”,
meaning that the days of accepting un-rostered and unpaid overtime are gone. New South Wales Health and Victoria Health have recently agreed to a settlement payout of nearly $405 million between them for unpaid overtime and wage theft. Whilst money won’t protect against burnout, being paid appropriately for your work can help.
Excessive workloads and time pressure are number one on the list of psychosocial hazards at work and under the new legislation your employer has a legal responsibility to ensure that this is properly managed. So if you are consistently working in an environment with these risks, speak up.
Remember, if you work late and don’t tell anyone then the health service will continue to function on unacceptable altruism.
#4 Get a non medical hobby.
You may feel work is all consuming and you might tell yourself that there is no time, but it is mission critical to make the time for life outside of work. Identity loss during your medical training (and beyond) is real and can be a risk factor for burnout. So, find something you like and commit to doing it regularly. Your future self will thank you. (It also means that you will have something to talk about other medicine which is always a win!).
If you can’t actually remember what to do for fun outside of work, that is a problem. I have been there, and it sucks. The pull of Netflix and doomscrolling is real when you don’t actually know what you enjoy. So if this is you, seek help immediately and figure out what floats your non medical boat.
#5 Prioritise sleep.
Yeah yeah, we all know that sleep is good. But do you know how good? Neuroscientific research highlights that even one poor night sleep can negatively affect cognitive decision making and increase emotional lability. If this happens on repeat then it can really cause problems. As a shift worker, this is a high risk area which means that you need to be even more aware of controlling the things you can control. Dark room, cool temperature, opportunity for at least eight hours. And you already know the deal about alcohol (sorry about that!).
Now that you’ve read all of this, grab a pen or open the notes on your phone and write down your own 5 pieces of your PPE. Setting a goal to achieve one of these each week is a fantastic place to start.
If you would like further information about your rights as a doctors in Australia, please check out http://www.safedr.org.
