Three years ago, if one had asked me what I would do if I "won the lottery", I would have wanted to continue to practice Neonatology. 

 

Over the past three years, my career has been increasingly about administrative duties. I still maintain the same clinical time which is 1.5 FTEs (full time equivalents). 

 

October of this year, we added a new EMR/CPOE. 

 

And...of course, the pandemic. 

 

I am ashamed to write this, but hopefully my experience will help others. 

 

I have burn out. I wasn't even aware of it. I needed a sort of "intervention" by other physicians to point out that I was in fact suffering from, and exhibiting a lot of symptoms of burn out. These "symptoms" resulted in a very passive/aggressive behavior pattern over the past 2-3 months, culminating in me telling a set of nurses walking through the NICU without masks, "Please put on your masks. I am not f*cking around anymore." That little comment resulted in a meeting with the hospital CMO. 

 

After we discussed my behavior, the CMO basically just called me out. He said I was suffering burnout. He said I am one of many good physicians locally whose professional behavior has deteriorated during the last few months. He was good enough to point out that my bad behavior was at least motivated by concern for patient and staff safety, but that any further bad behavior, regardless of the motivation, could result in loss of hospital privileges. He pointed out that my behavior mirrored most of the physicians that he needed to counsel, and that thankfully I had not deteriorated into other more harmful symptoms like substance abuse, etc. Just some bad words said in anger. Regardless, it made the staff feel uncomfortable, and I need to be better. 

 

In discussing the issues with the CMO, then spending the evening (and this morning) researching physician burnout, I must admit, I am a little disheartened. The research suggests burnout is only getting worse, and unfortunately, the best research on the subject suggests that the biggest contributor to burnout, is also the thing that is least in a physician's control - essentially working within complicated systems that do not always make sense scientifically or clinically. A second large contributor was EMR/CPOE. 

 

Here are the personal issues I have identified:

1. I do not feel like I am being heard by administrators/managers. This has always been an issue, wherever I have been. However, during the pandemic, it has felt more acute and more urgent. 

2. I do not feel supported by the community I serve. There seems to be not only a viral pandemic, but also a pandemic of scientific illiteracy in the general public and many healthcare workers. 

3. I need to understand that we have all been living in a heightened state of awareness over the past few months. It is as if our sympathetic nervous systems have been in overdrive for months. I need to recognize that the sense of urgency I feel is likely exacerbated by this chronic fight/flight reaction and may in fact, be unwarranted. 

4. My support system is not what it used to be. Prior to the pandemic, three close friends and their families moved away. These were friends and colleagues with whom I could vent my frustrations without causing offense. During the pandemic, it has been very difficult to replace these confidants because social interaction has been very limited, even when we are in the same area. 

5. I actually have adapted to EMR and CPOE better than most. Likely this is because I have been through at least three "go live" episodes at big hospitals, thus I have come to accept that I need to just embrace the suck and do the best with the tools I have. 

6. It is not the things I say, but the way I say it. This is not just in the face-to-face conversations, but also in how I interact with others within the system. I need to remember that although I may supervise NNPs, RNs, RTs, etc., I am not their employer. When I note they are doing something wrong, many times, it is best just to bring it to the attention of their manager, rather than point it out to them face-to-face. Like it or not, I am working within a complicated system, and if their is no immediate danger in someone's actions, it is best just to use the chain of command. Also, I need to remember #3 above. 

7. I need to stop watching the news. Prior to the pandemic, I might skim through a daily news feed. Once the pandemic hit, it seemed news sources were just as aware of new developments as the scientific community. I found it useful to hear about a new study on the news, then search for and read the actual article(s) to increase my knowledge. The problem is, I got sucked into all the other nonsense. I do not think I am unique in this behavior, but I do need to recognize that I need as little exposure to "news" as possible right now; it fuels my frustration and heightens the fight/flight response. It is difficult to watch the daily death count, then walk into a complicated medical system, and accept hospital policies that are as much about consumer satisfaction and legal maneuvering as they are about patient, staff, and/or public safety.

8. I need to accept that many healthcare workers are not going to act in the interest of public health in their personal lives (see #2 above). 

 

I am one that believes the stages of grieving apply to many things other than death. As I have pondered it over the past couple days, I can see clearly how I went through stages of denial, anger, bargaining, and even sought treatment for depression this summer.

 

I have struggled with situational depression, off and on, through my life. Meds don't help me. The best thing for me is realizing depression is anger unrealized. 

 

I am grieving the loss of ideals that turned out to be false beliefs. I am stuck in the anger stage. Most of my anger is focused on the poorly managed pandemic in my homeland and within the walls where I work. I do not believe that I am alone amongst scientists and healthcare providers in feeling this anger. The problem is my reaction to that anger over the past couple of months. 

 

Another issue is that I do not want to sink into a depression about the injustices I see, but cannot change. One way that has helped me in the past is just to talk about it - not complain and accuse, but rather a real gut-wrenching discussion about how these injustices (real or perceived) affect me internally. 

 

Anyway, if this topic is not germane to this forum, and needs to get deleted, I understand. 

Thanks for sharing your experiences, will share my own thoughts and experiences later (getting late here). This is the most relevant topic IMHO

Just this first: since first day in our education/training, we have been ”raised” to sustain in a work environment that creates a malignant  combo of long hours under high pressure, unlimited load (there is always more work to do) and some lack of self-control. Not really sustainable... and its hard to navigate in such a landscspe. 

Hi again, new day and off-call at the home desk (and Nick Caves latest album in the background, link below).

@HickOnACrick Thanks again for sharing your story. First of all, I wish you the best getting out of your tunnel soon. I read in-between your lines that you seem to have some support from work but also have your own strategy to get through.

Burnout in the NICU is a real thing, it has happened to staff in my closer network. I am myself coming "close to the wall" from time to time, but have so far been pulled back, foremost by my wife. She has a great temperament, so she tells me (off) clearly when it is time to shape up. Which has been a lifeline for me, I have very little self-insight into how to handle a workload / work situation that is getting monstrous. Before last summer, she did this exercise with me, that I had to write down all "threads" going on in my head on separate postit-notes, and prioritise them. A good learning experience to see all different things I tried to keep up, with clincial work, research projects, 99nicu.org, previously ebneo.org, a startup, QI-projects etc-etc.

My own (bad) excuse is that hard work is part of my DNA. I am a first-generation academic in my family (a real rural Swede!), and the working-class messages I grew up with and impregnated me was much like "hard work is rewarded", "you work for your next job", "get up at 5:00 to get going". So, working like crazy has always been the norm for me, and it has also taken me from rural Sweden to the capital of Stockholm  . And, I feel a special satisfaction from the physical exhaustion from hard work (like night shifting). I principally, I am clearly better at working than having time off. That's just how it is.

Interestingly, none of my superiors (like heads of departments etc) has ever discussed those things with me. It is rather the way that - the more one delivers, the more a superior may ask you to get involved and deliver even more. I have never been advised around a more healthy work-life-balance. From a HR perspective, there are many examples of Epic fails when it comes to those questions.

In many ways I love neonatology, and think it is a specialty that has suited me well. But it also takes on me. During the last few months, I have been more stressed and grumpy. The pandemic is clearly part of this, and my work with a startup (Neobiomics / ProPrems®) is another reason for my slippery slope... (this experience is a longer separate story...) But in the NICU I feel frustrated about the discrepancy / gap between our self-images/-confidence (as "know-how-driven professionals") and the daily practise that keeps moving on, as it is so hard to change/revise old practises no matter how strong evidence for an alternative approach.

Sorry for just writing without too much structure... lets see if/what others share here.

 

 

Thank you for your openness and honesty. I think you will not be alone at all in feeling like this, particularly at the moment. I do not know what it is like in the US, and I can only share my perspective as an ANNP, but the first step is to be able to reflect and recognise and it sounds like you have had the insight to do just that. 

In fact, in a way, it is good you have colleagues around you who feel able to raise such difficult conversations with you. 

Personally, the complex systems we work in do make this hard, and I agree that pressures have become "normalised"- this is a great article for considering how healthcare professionals adapt constantly to prevent errors, but the constant staying late, skipping meals, working overtime e.t.c that we do to adapt for the system can take its toll: https://qualitysafety.bmj.com/content/28/8/667 There is an increasing amount of literature about physician and nursing burnout.  I also think 'we' that make policies and guidelines and monitor safety etc need to think more about how we help our staff to do the job they want to do, rather than just "fire-fighting".  

I also really like this infographic- some on Twitter have suggested putting this in staff rooms for people to put stickers (anonymously) next to how they are feeling.  I have fluctuated between "surviving" and "struggling". I found opening up and being honest to those that could help,  instantly made me feel better even though nothing had changed. Instead of staying off social media, I found re-engaging with others helped. 

You are not alone. And you have insight, which is the first step in recovering 🙂 

I hope you get to take some time to rest

@Stefan JohanssonI am also better at working than relaxing! I think the culture of "being busy" or equating success with being busy, is also problematic. I also come from a "strong work ethic" background 😉