Part 2: Burnout

[to learn the beginning of the story, be sure to read the first post – Part 1: Time for Change] 

Burnout has many definitions, but it’s commonly defined as the loss of enthusiasm for work, depersonalization (increasingly negative and cynical mindset), and a low sense of personal accomplishment. 

Physicians have one of the highest burnout rates amongst all professionals. Additionally, those who, like myself, do primary care work typically experience higher rates of severe burnout than other types of physicians. 

I was quite aware of the phenomenon of physician burnout throughout my career, so I always worked hard to eliminate the factors that can cause it. So while classic burnout wasn’t the problem — even though I did identify with some of the classic symptoms — the single determining factor for closing down my practice was that of happiness. Specifically, my own. 

We all have baggage we’ve acquired throughout our lives. That baggage shapes how we feel, how we respond to different situations, and how we interact with others. Although the term “baggage” has acquired a negative connotation, it isn’t actually negative in and of itself. 

By “baggage,” I simply mean everything we carry with us. In my opinion, defining experiences as “good” or “bad,” or labeling influences as “positive” or “negative” is not productive. We are who we are at any given moment.   

We, as humans, live in a fluid state, constantly shifting and reacting to our environment. Our baggage might be physical, such as when someone with an intestinal bacterial imbalance responds negatively anytime they’re exposed to otherwise healthy probiotic foods and supplements. In another instance, our baggage might be emotional. A fairly severe example is post-traumatic stress disorder (PTSD), where very minor stimuli (i.e. sounds or smells) recreate a traumatic experience. 

No matter what the situation, your day-to-day experiences interact with your baggage to impact your overall well-being. 

In my case,  many aspects of owning and running a practice in addition to being a primary care physician with personal, ongoing relationships interacted negatively with my baggage. Every day there were dozens of events (both actual and anticipated) that pulled my psychological strings and triggered negative emotions. 

Part of my baggage is that the expectations I place on myself, and often others, are never achievable. Even when I get close to a goal, my brain moves the expectation further away, almost ensuring it will never be reached. 

For those of us that are wired this way, there is often significant anxiety leading up to events (Am I going to reach these expectations?), as well as depression afterwards (I’m a bad person for not reaching these expectations). 

In medicine, there are few absolutes. In a primary care and chronic disease practice, there are almost none. An individual’s health changes over time, so each person has their own goals and expectations. As a physician, I inquire what  those goals are, but I also subconsciously add my own. 

Let’s take someone dealing with insomnia and depression. Their health care goals might be to a) learn the root causes of these symptoms, b) have a doctor listen and empathize, and c) find treatment options that maximize benefit and minimize side effects. Those are realistic expectations. In theory, that should be it. My patient and I are both content to seek and complete these clear-cut goals. 

Unfortunately, my brain adds extra expectations. In the example above, my brain would decide the only goal would be complete resolution of all symptoms, immediately. As you can imagine, this second version of the goal is not realistic. 

So within the context of my practice, even though patients were happy with their care, I was never satisfied. And it’s hard to be happy with your job when you feel like a failure. 

Expectations are a major factor in overall happiness, and giving yourself unrealistic expectations is a recipe for trouble. I’ve been well aware of this type of my personal baggage, but it was only in the past year that I realized it was a tremendous impediment to me feeling satisfied in my work. 

There wasn’t one single aspect of my job causing my feelings of unhappiness; nor was it just the one piece of my personal baggage described. Instead, it was the combination of all of my small, daily issues that led me to realize I needed to leave the world of private practice at this time. 

[to keep following the story, be sure to read the next post – Part 3: the Future]