In my first book, a chapter entitled Workplace Burnout, chronicles the life of a surgical colleague who prided himself on his nickname “Rambo.”

I wanted to be that go-to guy….  If you had told me during residency that in 15 years I would be writing about my own experience with burnout, I would have laughed in your face.  Burnout was for the weak.

However, almost without realizing it, the pace of my solo practice continued to pick up speed… everything became a rush…. I even rushed to spend time with my family because I never knew when the pager would go off.  I was on an electronic leash complete with choke collar.

Patients and their families did not matter anymore; in fact, they were often obstacles, even enemies….I wondered, ‘What have I become?’ I had been breaking the speed limit of life, and the law was catching up with me.  I had no breathing room, no margin, no reserve.  I was physically and emotionally exhausted.

Now, four years later, I am a much happier member of a three-person group of hospital-employed thoracic surgeons…. The journey from where I was to where I am now required a huge pushback against a system that rewards producers and turns a blind eye to the consequences until they get out of hand and patients and families suffer…. Only rarely do healthcare professionals connect the dots between their personal philosophy and their daily activities.

What is burnout?

Burnout occurs when work and/or personal demands exceed one’s ability to cope.  It involves a continuum of responses ranging from acute exhaustion after being up all night on call to mood swings, impaired performance, or suboptimal coping strategies, such as disruptive behavior and/or substance abuse.

The Maslach Burnout Inventory defines three components: emotional exhaustion, decreased empathy, and lack of personal accomplishment.

Tools for reflection

Physicians can benefit from  periodically taking stock of where they are and how they are feeling, what my surgical colleague referred to as “connecting the dots.”  The following are ways that leaders can invest in improving their situation (Boyatzis R, McKee A, Goleman D. Reawakening your passion for work. Harvard Business Review, April 2002: 86-94):

• Define your core values regarding your career, family, health, finances, and spirituality
• Finish the sentence, “In my life, I have done …, and now I …”
• Envision the future 5-15 years from now and ask yourself what a typical day, week, or month might look like
• Review the above answers with a formal or informal coach who gives you permission to think creatively

In Tip of the Iceberg? New perspectives on disgruntled doctors, I described the difference that just a 15-minute co-mentoring discussion made re: the following questions.  Connecting the dots gave physicians clarity on their niche:

• What are you really good at (expertise)?
• What do people pay you for (market)?
• When was the last time you felt really alive (passion)?

What do you think?

• Like my surgical colleague, have you wondered, “What have I become?”
• Have you experienced forces that required pushback to reestablish your personal boundaries
• What has helped you or hindered you in your own journey

I welcome your input.

Kenneth H. Cohn

© 2009, all rights reserved