October 1, 2024 • 22 mins
HALF of all healthcare workers are Burned Out. But most of us typically power through without recognizing the classic signs. How can you tell when you're going through burnout? And more importantly, what is it about the culture of medicine and healthcare that increases our risk of experiencing burnout?
To help us sort through these issues and RECOGNIZE signs of burnout, we talk with Dr. Jessi Gold, Psychiatrist and Chief Wellness Officer of the University of Tennessee Health System. She is the author of a memoir called How Do You Feel? One Doctor's Search for Humanity in Medicine. This book highlights her experience taking care of healthcare workers during the pandemic, and emphasizes the *emotional toll that it is involved when we're taking care of others*.
** What are the signs of burnout?
** Why is it so hard to recognize burnout?
** How can we start to notice when we are going down the path of burnout?
Dr. Jessi Gold is an Associate Professor of Psychiatry at UT Health Science Center. Dr. Gold is not only a psychiatrist, but she is a mental health advocate and fantastic writer whose work has appeared in the New York Times, The Atlantic, InStyle, Slate, and Self.
https://www.drjessigold.com/
Her new memoir is called
How Do You Feel? One Doctor's Search for Humanity in Medicine available on Amazon at
https://www.amazon.com/exec/obidos/ASIN/1982199776?tag=simonsayscom
Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Elise Fallucco (00:21):
Welcome back to Psyched4Peds, the child
mental health podcast forpediatric clinicians, helping
you help kids.
I'm your host, Dr.
Elise Fallucco, childpsychiatrist and mom.
Today, we're going to be talkingabout burnout in healthcare.
Now you may know that half of usin healthcare have experienced
(00:41):
burnout at some point in time.
But how can you tell when you'regoing through it?
And more importantly, what is itabout the culture of medicine
and healthcare that increasesour risk of experiencing
burnout?
To help us sort through theseissues.
We have a special guest, dr.
Jessi Gold Chief WellnessOfficer of the University of
(01:04):
Tennessee Health System and anAssociate Professor of
Psychiatry at UT Health ScienceCenter.
Dr.
Gold is not only a psychiatrist,but she is a mental health
advocate and fantastic writerwhose work has appeared in the
New York Times, The Atlantic,InStyle, Slate, and Self.
Her clinical practice largelyinvolves taking care of
(01:26):
healthcare workers, includingtrainees, as well as college
students.
And today we are going to talkabout her new book, which is
called How Do You Feel?
One Doctor's Search for Humanityin Medicine.
And this book is a memoir thathighlights her experience taking
care of healthcare workersduring the pandemic, and really
(01:46):
emphasizes the emotional tollthat it is involved when we're
taking care of others.
I'm so excited and I just wantto welcome and say thank you to
Dr.
Jessie Gold.
Dr. Jess Gold (01:59):
Hi, thank you for having me and thank you, back
for the kind words and thereading of my book.
It's great.
I really appreciate it.
Dr. Elise Fallucco (02:07):
I think our listeners are going to be really
excited to, to hear about, whatyou've experienced and what
you've written and I cannotrecommend this book enough.
I think we don't talk enoughabout the emotional toll
involved then when we take careof other people and how it
impacts us when we go home atthe end of the day.
So glad to highlight this on thepod.
(02:27):
In your book, one of the maintopics that you cover is
burnout.
And we know that about half ofus in health care have
experienced significant burnout.
But there's a lot of confusionabout what that really is.
Can you give us your workingdefinition of burnout?
Dr. Jess Gold (02:42):
For sure.
So I think the confusion comesfrom the fact that mental health
words tend to be like co optedcolloquially.
So we'll say I'm depressed, butwe don't mean I have diagnosed
like major depressive disorder.
We'll say I'm anxious, but wedon't mean we have an anxiety
disorder, right?
Burnout's very similar.
I think people have started touse it like work is hard, I'm
(03:03):
burnt out, or I'm tired fromwork, I'm burnt out.
And that degree to which it isactually an issue gets minimized
in that conversation.
And I think that it becomesharder for people to actually
know what's going on or know ifthey're burnt out.
So the definition I use is theone that you probably see for
the most part in studies wherethe numbers you pulled came
(03:23):
from.
It's a workplace associatedcondition, which is something
that is really important to sayup front, meaning that It's not
considered a behavioral healthdisorder.
It's considered in the ICD codesto be a workplace associated
condition.
I'll just clarify that when wesay workplace, if you're a stay
at home, mom, your workplace ishome, if you're a college
student, your workplace isschool, right?
(03:44):
It's a kind of loosely appliedworkplace, but then it's a
constellation of three things.
The first one is emotionalexhaustion.
I think in a lot of people thatlooks like physical exhaustion,
but I just describe it as by theend of the day, you're just
like, I've got nothing left.
I'm spent.
The second one, depends on whoyou ask, can either be cynicism
(04:05):
or depersonalization.
Depersonalization is really likedisconnecting.
from the work that you're doingin the workplace.
So in some ways, we do that as aprotective mechanism in medicine
to go through patients and notbe affected.
But it's if you did that to anextreme and you were never
really connected.
So you're viewing patients sortof like objects.
(04:26):
And the cynicism part is morelike anger, frustration in the
workplace with colleagues, withthe work you're doing, that sort
of thing.
We often neglect anger as asymptom of anything, but it is
something to pay attention to.
And the last one is a reducedsense of personal
accomplishment.
In most people you notice thisone because you care when you
(04:47):
get work done or you care ifsomeone else tells you if you
are getting work done.
And so the last one tends to bethe one that I see people like
show up in my office aboutbecause someone pointed out
something at work about them notgetting things done or they felt
like they were becoming lessproductive and that made them
anxious.
It's not the other two.
The other two, I feel like we gowork is hard.
(05:08):
I'm supposed to.
To be tired from it.
Work is like emotionallyinvesting in patients and their
lives.
And of course I'm emotionallyexhausted.
And then I'm just protectingmyself from the content by
depersonalizing.
And then it's not really untilit starts to affect our work or
someone else starts to noticethat we go, Hey, like maybe this
is something I should worryabout.
Dr. Elise Fallucco (05:29):
That's an excellent recap using normal
human words and getting awayfrom dSM bullet points and
psych, psychiatry jargon.
And I just want to go over justto recap for our listeners.
Burnout is environment specific,like specifically it has to do
with how you feel related toyour workplace and, symptoms
that occur in the context ofwherever you work and then
(05:52):
number one of the three symptomsis emotional exhaustion.
And as soon as you said feelingtired every day or most days
when you come home from work,not physically tired and just
spent.
And I can completely relate tothat.
My kids can tell you that forsure.
And then the second one iscynicism or depersonalization.
(06:13):
I think when people hear wordslike depersonalization, they're
like, that sounds psychotic.
Like what does that really mean?
But I like how you recapped itand just talked about instead
of.
Putting your heart in your workand enjoying what you're doing,
you're to the point where you'regoing through the motions, but
you're not as connected to yourpatients connected to the work
that you're doing.
And I think that is can bereally subtle.
(06:35):
It's not necessarily like youcare so much and then the next
day you don't care at all.
I think it's a slippery slopeYeah,
Dr. Jess Gold (06:41):
I'll just add sometimes people will say like
the thing that makes them whothey are, the thing that like
you would pick going to me as apsychiatrist or going to you
would be the thing that might bemissing, right?
Like you're not making errors.
You're just not you.
And so that part, like maybeyou're still really good at your
job and maybe you're still anawesome diagnostician and maybe
(07:04):
you're still not going to hurtanybody as a patient, but you're
not you and you're not theperson that they like chose to
see because you're just not asinvested and probably you are a
person who would be.
Dr. Elise Fallucco (07:17):
And it's something that it's probably
more obvious to you and whichreminds me of something you said
in the book about, for those ofus who are very type a and
hardworking, oftentimes we cancontinue to go through the
motions and get things done andachieve.
And work is like the last placewhere you start to see problems
and errors.
(07:38):
And then that brings us to thethird symptom of burnout, which
is a lack of a sense of personalaccomplishment.
Or as you put it really nicely,it's almost like you've stopped
caring as much about things atwork that you would typically
care about like showing up earlyor making sure that your notes
are really high quality.
And this could be a really hardthing for us to figure out in
(08:00):
ourselves or to recognize whenit's happening in our own lives,
because it's not like our gradesare failing.
Or the hospital dictationservice is calling us because we
owe them a thousand notes.
It's more of a subtle, emotionalswitch and a change in how we're
showing up at work.
And I imagine that our listenersat this point are wondering how
(08:20):
then do you distinguish betweenburnout and depression given
that.
Some of these symptoms seem tooverlap.
Dr. Jess Gold (08:28):
I think about the difference between depression
and burnout as Burnout being asort of precursor or step to
depression.
So we know that burnout iscorrelated with depression.
It's correlated with suicidalthoughts, but they are not the
same thing.
That's in part because Burnoutis workplace associated and that
(08:51):
is where it stems from anddepression doesn't have a
location or a circumstance thatis the direct cause of it.
Depression's main symptoms arealso depressed mood and change
in interest or we use the wordanhedonia to mean that.
You might see that in burnout asa sort of after effect, but it
(09:12):
is not a key symptom of burnout.
With depression, you also seethings like change in appetite,
change in sleep, suicidalthoughts, change in
concentration.
A lot of those symptoms, again,might be something you could see
with emotional exhaustion, butthey're not.
the same that you would see indepression in the same sort of
cluster you would see indepression.
(09:33):
Depression also has a timeframe.
We say two weeks, at least twoweeks of symptoms.
Burnout doesn't currently have atime frame associated with it,
if that makes sense and ishelpful.
Dr. Elise Fallucco (09:44):
So typically with burnout, we wouldn't expect
to see changes in sleep orappetite or concentration.
But as you pointed out, it doesseem like it's a little tricky
to disentangle.
The differences.
And I would say, regardless ofwhether we're experiencing
symptoms of burnout ordepression, I think this is
definitely time to see somebody.
To help us sort out what's goingon and figure out next steps.
(10:08):
Without giving things away inyour book, you talk about About
your own personal journey andmoments or a moment when you
recognized, Huh, I may be goingthrough burnout.
What do you think are ways thatwe as clinicians might recognize
when we're beginning to tip overinto burnout?
Dr. Jess Gold (10:27):
Yeah, what I would tell people and I tell
patients is we tend not tonotice this until it's really
bad.
We blow past.
like the sort of subtle signsand symptoms that we might
experience.
I did this myself veryobviously.
I still do it sometimes.
I would say in that sense tooI'm a burnout expert and I'm not
really great at applying burnoutto myself, so like, why should
(10:49):
you be good at it, right?
In our lives because we pay somuch attention to other people,
we don't notice subtle things inourselves and we don't stop to
ask ourselves how we're doing.
by the time you're super angryin the workplace and really
disconnected from people, you'veblown past that.
By the time that someone mightmention that you are not doing
your work, you've blown way pastthat.
By the time you're like me andare sleeping every day after
(11:12):
work uncontrollably and wake upseven hours later.
That's a problem.
You skip some stuff.
And I think the subtle stuff is,for me, something as simple as
like email or like inbox makesme so mad, like not, Oh, look, I
have another email.
It's if somebody sends meanother email, I'm going to pick
(11:33):
up my computer and launch itacross the room.
And that reaction.
Is not normal, I've been told,but also it is as a result of me
knowing that email or my patientinbox is someone asking me for
something and I don't have thecapacity to give it, right?
And so I never really stoppedand thought about it.
I was like, so what?
Sometimes emails make me angry.
(11:55):
And it wasn't a thing that I wasreally thinking about.
And I realized, in reflection ofwhat are my subtle signs and
symptoms, which I wouldrecommend anybody do, because as
much as I can rattle off signsand symptoms, what it looks like
in you might be super differentand paying attention to some of
the early signs for you mightmake you better able to go, Oh,
I'm shifting towards somewhere Idon't want to be.
If someone sends me an email,it's here's this other thing
(12:17):
that I would want you to do.
Cause email tends to be like atransactional thing or a
question or something you haveto answer.
Same with patient inbox.
And so my reaction is very muchabout that.
I'll say other people have justanger more generally.
Other common things would belike, Subtle schedule changes,
so if you're a person who superlikes to cook, and then all of a
sudden you just start orderingtakeout, or you like exercise
(12:40):
and you pull back on it, or youlike hanging out with your
friends and you just don't havecapacity for that anymore, I
think those are signs thatthings are not going in the way
that you want to be going.
That a lot of people mentionedto me as patients or that I've
experienced myself.
We tend to just go I'm having abad day, but that bad day turns
into a bad week, turns into abad month, turns into you're
burnt out.
Dr. Elise Fallucco (13:01):
Yeah.
And I think it's sometimes it'shelpful to have people like
loved ones, colleagues, whoeveraround us who can who we trust
and who can call it out for usor maybe it's helpful if we
listen to them when they saythings like I think you need to
take a deep breath or, iseverything okay?
Dr. Jess Gold (13:21):
Yeah, in the workplace, people tend to point
out a flaw instead of reallychecking in on someone so that
the reaction tends to to be howdare you say I'm not doing my
work as opposed to, yeah, you'reright.
I'm not doing okay.
And so I often tell supervisorsor people that like, maybe
starting a little later and notpointing out the flaw would have
gotten a little more buy in, Ididn't know I was burnt out
(13:43):
until my therapist told me,right?
So like sometimes external eyescan make a big difference, but
even earlier I was havingfriends and family say what's
the deal with your texting?
You're not texting back.
And I just was like yeah, I'mover it right now.
But I'm a really efficienttexter.
If I could get an award forthat, I might and so having
friends or family say what's thedeal?
(14:05):
This isn't right For you.
Are you fine?
I just was like why are youtalking about my text messaging?
But it really is a sign if Ididn't take it as like an
affront to my texting ability.
Dr. Elise Fallucco (14:17):
No, but it's it's such a great example too,
about how, when people point outsomething that is different
about us, like your familysaying you're not texting back
or the medical records officesaying, where are those notes
or, whatever it is that you getdefensive and you're like, I'm
busy.
I remember feeling this thisimage of there were all these
vultures pecking at me from alldifferent directions can you do
(14:38):
this?
Or we want you to do this talkand we also need you to write
this thing and we need you tohelp out with that.
And, so and so called out sick,can you cover this shift and
that shift?
And of course, when you'recarrying a lot and when you're
working really hard, any extraask is really challenging, but I
think at some point The pointwhere you, it just makes you
angry and that's your body'sway.
(14:59):
I'm saying this in hindsight, Ididn't recognize it at the time,
but I guess of us don't, I thinkthat's the truth, like it's your
body's way of saying this isn'tright.
Something needs to go like redalarms are going off all over.
And I think we're used to justpushing through the red alarms.
You said this beautiful quote inyour book.
You said, mental health outcomesare an occupational hazard in
(15:21):
healthcare.
Wow.
And, you talked about howthere's lots of literature
showing that we as healthcareworkers have alarmingly high
rates of depression, of posttraumatic stress disorder, of
suicide, certainly anxiety.
Let's talk about how does theculture of medicine
inadvertently increase our riskfor negative mental health
(15:42):
problems?
Dr. Jess Gold (15:44):
It's a hundred percent an occupational
phenomenon and for a long timewe didn't want to talk about it
I think the pandemic sort ofcompounded these really deep
existing bad problems and peoplefinally started to pay
attention, right?
For me, writing the bookreestablishes that conversation
(16:05):
to say it's not going to getbetter.
It was only going to get worse.
So we need to talk about it.
In our culture, Stoicism isvalued, and so is um,
perfectionism.
And both of those arechallenging for things like
emotions and paying attention toyourself.
We also have a culture that weput other people before
(16:26):
ourselves because We areselfless humans who were like
that probably before we wentinto medicine.
And then it was repeatedlyemphasized to us that we needed
to do that.
So we learned through what wewould call the hidden
curriculum, really to focus onothers way before ourselves,
that our own problems areinterfering, and we're not
(16:47):
allowed to express them or dealwith them.
And then at the same time, wesee modeled, People who are not
emotional, who get good feedbackfor being not emotional, and
people who show up to work sickas a dog and get praised for it.
So we have a big culture ofpresenteeism, which is the
opposite, opposite ofabsenteeism.
(17:09):
We're going to go to work sickand data would show that too.
Even if we're seeing likeimmunocompromised people and
everybody I know can give youthis bonkers story of someone
who did something in theworkplace that they saw because
they were sick.
Oh, I remember this time whenthis resident came in and they
were throwing up, but they putan IV in their arm and dragged
(17:30):
it around and saw patients.
How cool was that?
And they say it like that.
They're
Dr. Elise Fallucco (17:34):
tough.
This is what you should bedoing.
And there's judgment who callsin sick to work?
Are you kidding me?
When I was in residency I did X,Y, and Z.
Yeah.
And we're, in some ways we'reperpetuating the culture.
This is what we grew up in, inthe culture of medicine.
And then, working with youngertrainees and younger people, I
commonly hear my colleagues sayOh, they're so ridiculous.
(17:58):
Look at them going home before 6p.
m.
Cause they want to be with theirfamily.
Dr. Jess Gold (18:04):
How dare they.
And so then we get called weakand we can't cut it and all this
kind of stuff, or the person whodoes choose to stay home sick,
they get joked about them thewhole day on the wards.
We would do it with Jenny, butJenny's not here.
And so that's, we learned that.
That is bad, that we show up nomatter what, and so we show up,
(18:24):
we can't feel, we can't putourselves into the equation, and
so we really stop payingattention to our cues, because
we even stop physical cues.
We're not allowed to be hungry,not allowed to go to the
bathroom, so we can't pee and wecan't eat, we definitely can't
cry.
And if we can't skip work unlesswe're, like, hemorrhaging, we
definitely can't skip work forburnout, right?
(18:45):
We're, like, it's justimpossible.
So the culture makes it.
Emotions don't even get a blipon the chart of what is an
acceptable reason to not besomewhere.
And all of the stuff inmedicine, we burden a lot of
people with our choices.
So if we don't show up for work,it burdens patients, it burdens
the team, maybe someone has tobe called in instead of us.
(19:06):
All of that, Also contributesbecause we have a complete lack
of redundancy in our culture.
So if we're not there, it's abig problem.
And we feel that despite thefact that we know we probably
shouldn't be there.
And so we show up and it'sprobably not good for anybody
that we do, but the culture is aculture of showing up way before
(19:28):
you show up for yourself.
Dr. Elise Fallucco (19:29):
Yes, I can think every single time that me
or my husband, who's also inhealthcare gets sick or have
some reason where we probablyshouldn't go to work, the first
thing that comes to your mindis, I have a clinic full of
patients.
Or who's going to reschedule?
Who's going to see them?
How is this going to work?
There is not a big backupsystem.
And I
Dr. Jess Gold (19:47):
look at who the patients are and I'm like, can
these people wait?
If I cancel, I can't invent newdays.
So you might not get back in formonths so it's do I need to go
to my 10?
Because my 10 can't afford menot to come.
And is that a thing?
And that's also hard.
I think.
Dr. Elise Fallucco (20:03):
Yeah, and this feeling that there, there's
not a buffer, there's not a lotof backup, there's not a lot of
other places where we can go andtake care of these kids, take
care of these patients, It'sdefinitely a reality and it's
not something that we're goingto be able to change overnight.
And so the hard part is justtrying to figure out like, how
do you move within that?
And how do you honestlyacknowledge, yes, this is really
(20:25):
hard.
This is something that you needto do for yourself and you'll
show up better the next day orthe next week or whenever it is
for the patients.
So for our psyched for Pedslisteners, I'm going to recap
some of the highlights from ourconversation.
We talked about how commonburnout is in healthcare
affecting about half of us andthat the very things that make
(20:47):
us excellent clinicians like ourselflessness and our desire to
help people and our caringnature may actually increase our
risk for experiencing burnout.
And that part of our job is totry to pay attention to the
subtle signs of burnout in ourown lives so that we can do what
(21:07):
we need to do.
To get healthy.
And so when you get a moment toreflect, maybe ask yourself some
of these questions to see.
If you're experiencing anysymptoms of burnout.
Do I feel exhausted at the endof work most days?
Have I noticed that I'm morecynical or angry when I'm at
work?
Have I noticed that I'm notreally putting my heart into
(21:28):
work as much as I typicallymight?
Do I feel less connected to mypatients?
Am I showing up at work the waythat I want to?
And I know for me personally, Ihave definitely answered yes to
a lot of these questions.
And so our next step is to joinus next week, where we're going
to really talk about what do wedo about burnout?
(21:50):
How do we as individuals survivein this culture of health care
and take care of ourselves andhelp our colleagues and so that
we can all help our patients.
So please tune in next week topsych for paeds.
As we continue this discussionwith Dr.
Jessi gold.
Thanks for listening.
Welcome back to Psyched4Peds, the child
mental health podcast forpediatric clinicians, helping
you help kids.
I'm your host, Dr.
Elise Fallucco, childpsychiatrist and mom.
Today, we're going to be talkingabout burnout in healthcare.
Now you may know that half of usin healthcare have experienced
(00:41):
burnout at some point in time.
But how can you tell when you'regoing through it?
And more importantly, what is itabout the culture of medicine
and healthcare that increasesour risk of experiencing
burnout?
To help us sort through theseissues.
We have a special guest, dr.
Jessi Gold Chief WellnessOfficer of the University of
(01:04):
Tennessee Health System and anAssociate Professor of
Psychiatry at UT Health ScienceCenter.
Dr.
Gold is not only a psychiatrist,but she is a mental health
advocate and fantastic writerwhose work has appeared in the
New York Times, The Atlantic,InStyle, Slate, and Self.
Her clinical practice largelyinvolves taking care of
(01:26):
healthcare workers, includingtrainees, as well as college
students.
And today we are going to talkabout her new book, which is
called How Do You Feel?
One Doctor's Search for Humanityin Medicine.
And this book is a memoir thathighlights her experience taking
care of healthcare workersduring the pandemic, and really
(01:46):
emphasizes the emotional tollthat it is involved when we're
taking care of others.
I'm so excited and I just wantto welcome and say thank you to
Dr.
Jessie Gold.
Dr. Jess Gold (01:59):
Hi, thank you for having me and thank you, back
for the kind words and thereading of my book.
It's great.
I really appreciate it.
Dr. Elise Fallucco (02:07):
I think our listeners are going to be really
excited to, to hear about, whatyou've experienced and what
you've written and I cannotrecommend this book enough.
I think we don't talk enoughabout the emotional toll
involved then when we take careof other people and how it
impacts us when we go home atthe end of the day.
So glad to highlight this on thepod.
(02:27):
In your book, one of the maintopics that you cover is
burnout.
And we know that about half ofus in health care have
experienced significant burnout.
But there's a lot of confusionabout what that really is.
Can you give us your workingdefinition of burnout?
Dr. Jess Gold (02:42):
For sure.
So I think the confusion comesfrom the fact that mental health
words tend to be like co optedcolloquially.
So we'll say I'm depressed, butwe don't mean I have diagnosed
like major depressive disorder.
We'll say I'm anxious, but wedon't mean we have an anxiety
disorder, right?
Burnout's very similar.
I think people have started touse it like work is hard, I'm
(03:03):
burnt out, or I'm tired fromwork, I'm burnt out.
And that degree to which it isactually an issue gets minimized
in that conversation.
And I think that it becomesharder for people to actually
know what's going on or know ifthey're burnt out.
So the definition I use is theone that you probably see for
the most part in studies wherethe numbers you pulled came
(03:23):
from.
It's a workplace associatedcondition, which is something
that is really important to sayup front, meaning that It's not
considered a behavioral healthdisorder.
It's considered in the ICD codesto be a workplace associated
condition.
I'll just clarify that when wesay workplace, if you're a stay
at home, mom, your workplace ishome, if you're a college
student, your workplace isschool, right?
(03:44):
It's a kind of loosely appliedworkplace, but then it's a
constellation of three things.
The first one is emotionalexhaustion.
I think in a lot of people thatlooks like physical exhaustion,
but I just describe it as by theend of the day, you're just
like, I've got nothing left.
I'm spent.
The second one, depends on whoyou ask, can either be cynicism
(04:05):
or depersonalization.
Depersonalization is really likedisconnecting.
from the work that you're doingin the workplace.
So in some ways, we do that as aprotective mechanism in medicine
to go through patients and notbe affected.
But it's if you did that to anextreme and you were never
really connected.
So you're viewing patients sortof like objects.
(04:26):
And the cynicism part is morelike anger, frustration in the
workplace with colleagues, withthe work you're doing, that sort
of thing.
We often neglect anger as asymptom of anything, but it is
something to pay attention to.
And the last one is a reducedsense of personal
accomplishment.
In most people you notice thisone because you care when you
(04:47):
get work done or you care ifsomeone else tells you if you
are getting work done.
And so the last one tends to bethe one that I see people like
show up in my office aboutbecause someone pointed out
something at work about them notgetting things done or they felt
like they were becoming lessproductive and that made them
anxious.
It's not the other two.
The other two, I feel like we gowork is hard.
(05:08):
I'm supposed to.
To be tired from it.
Work is like emotionallyinvesting in patients and their
lives.
And of course I'm emotionallyexhausted.
And then I'm just protectingmyself from the content by
depersonalizing.
And then it's not really untilit starts to affect our work or
someone else starts to noticethat we go, Hey, like maybe this
is something I should worryabout.
Dr. Elise Fallucco (05:29):
That's an excellent recap using normal
human words and getting awayfrom dSM bullet points and
psych, psychiatry jargon.
And I just want to go over justto recap for our listeners.
Burnout is environment specific,like specifically it has to do
with how you feel related toyour workplace and, symptoms
that occur in the context ofwherever you work and then
(05:52):
number one of the three symptomsis emotional exhaustion.
And as soon as you said feelingtired every day or most days
when you come home from work,not physically tired and just
spent.
And I can completely relate tothat.
My kids can tell you that forsure.
And then the second one iscynicism or depersonalization.
(06:13):
I think when people hear wordslike depersonalization, they're
like, that sounds psychotic.
Like what does that really mean?
But I like how you recapped itand just talked about instead
of.
Putting your heart in your workand enjoying what you're doing,
you're to the point where you'regoing through the motions, but
you're not as connected to yourpatients connected to the work
that you're doing.
And I think that is can bereally subtle.
(06:35):
It's not necessarily like youcare so much and then the next
day you don't care at all.
I think it's a slippery slopeYeah,
Dr. Jess Gold (06:41):
I'll just add sometimes people will say like
the thing that makes them whothey are, the thing that like
you would pick going to me as apsychiatrist or going to you
would be the thing that might bemissing, right?
Like you're not making errors.
You're just not you.
And so that part, like maybeyou're still really good at your
job and maybe you're still anawesome diagnostician and maybe
(07:04):
you're still not going to hurtanybody as a patient, but you're
not you and you're not theperson that they like chose to
see because you're just not asinvested and probably you are a
person who would be.
Dr. Elise Fallucco (07:17):
And it's something that it's probably
more obvious to you and whichreminds me of something you said
in the book about, for those ofus who are very type a and
hardworking, oftentimes we cancontinue to go through the
motions and get things done andachieve.
And work is like the last placewhere you start to see problems
and errors.
(07:38):
And then that brings us to thethird symptom of burnout, which
is a lack of a sense of personalaccomplishment.
Or as you put it really nicely,it's almost like you've stopped
caring as much about things atwork that you would typically
care about like showing up earlyor making sure that your notes
are really high quality.
And this could be a really hardthing for us to figure out in
(08:00):
ourselves or to recognize whenit's happening in our own lives,
because it's not like our gradesare failing.
Or the hospital dictationservice is calling us because we
owe them a thousand notes.
It's more of a subtle, emotionalswitch and a change in how we're
showing up at work.
And I imagine that our listenersat this point are wondering how
(08:20):
then do you distinguish betweenburnout and depression given
that.
Some of these symptoms seem tooverlap.
Dr. Jess Gold (08:28):
I think about the difference between depression
and burnout as Burnout being asort of precursor or step to
depression.
So we know that burnout iscorrelated with depression.
It's correlated with suicidalthoughts, but they are not the
same thing.
That's in part because Burnoutis workplace associated and that
(08:51):
is where it stems from anddepression doesn't have a
location or a circumstance thatis the direct cause of it.
Depression's main symptoms arealso depressed mood and change
in interest or we use the wordanhedonia to mean that.
You might see that in burnout asa sort of after effect, but it
(09:12):
is not a key symptom of burnout.
With depression, you also seethings like change in appetite,
change in sleep, suicidalthoughts, change in
concentration.
A lot of those symptoms, again,might be something you could see
with emotional exhaustion, butthey're not.
the same that you would see indepression in the same sort of
cluster you would see indepression.
(09:33):
Depression also has a timeframe.
We say two weeks, at least twoweeks of symptoms.
Burnout doesn't currently have atime frame associated with it,
if that makes sense and ishelpful.
Dr. Elise Fallucco (09:44):
So typically with burnout, we wouldn't expect
to see changes in sleep orappetite or concentration.
But as you pointed out, it doesseem like it's a little tricky
to disentangle.
The differences.
And I would say, regardless ofwhether we're experiencing
symptoms of burnout ordepression, I think this is
definitely time to see somebody.
To help us sort out what's goingon and figure out next steps.
(10:08):
Without giving things away inyour book, you talk about About
your own personal journey andmoments or a moment when you
recognized, Huh, I may be goingthrough burnout.
What do you think are ways thatwe as clinicians might recognize
when we're beginning to tip overinto burnout?
Dr. Jess Gold (10:27):
Yeah, what I would tell people and I tell
patients is we tend not tonotice this until it's really
bad.
We blow past.
like the sort of subtle signsand symptoms that we might
experience.
I did this myself veryobviously.
I still do it sometimes.
I would say in that sense tooI'm a burnout expert and I'm not
really great at applying burnoutto myself, so like, why should
(10:49):
you be good at it, right?
In our lives because we pay somuch attention to other people,
we don't notice subtle things inourselves and we don't stop to
ask ourselves how we're doing.
by the time you're super angryin the workplace and really
disconnected from people, you'veblown past that.
By the time that someone mightmention that you are not doing
your work, you've blown way pastthat.
By the time you're like me andare sleeping every day after
(11:12):
work uncontrollably and wake upseven hours later.
That's a problem.
You skip some stuff.
And I think the subtle stuff is,for me, something as simple as
like email or like inbox makesme so mad, like not, Oh, look, I
have another email.
It's if somebody sends meanother email, I'm going to pick
(11:33):
up my computer and launch itacross the room.
And that reaction.
Is not normal, I've been told,but also it is as a result of me
knowing that email or my patientinbox is someone asking me for
something and I don't have thecapacity to give it, right?
And so I never really stoppedand thought about it.
I was like, so what?
Sometimes emails make me angry.
(11:55):
And it wasn't a thing that I wasreally thinking about.
And I realized, in reflection ofwhat are my subtle signs and
symptoms, which I wouldrecommend anybody do, because as
much as I can rattle off signsand symptoms, what it looks like
in you might be super differentand paying attention to some of
the early signs for you mightmake you better able to go, Oh,
I'm shifting towards somewhere Idon't want to be.
If someone sends me an email,it's here's this other thing
(12:17):
that I would want you to do.
Cause email tends to be like atransactional thing or a
question or something you haveto answer.
Same with patient inbox.
And so my reaction is very muchabout that.
I'll say other people have justanger more generally.
Other common things would belike, Subtle schedule changes,
so if you're a person who superlikes to cook, and then all of a
sudden you just start orderingtakeout, or you like exercise
(12:40):
and you pull back on it, or youlike hanging out with your
friends and you just don't havecapacity for that anymore, I
think those are signs thatthings are not going in the way
that you want to be going.
That a lot of people mentionedto me as patients or that I've
experienced myself.
We tend to just go I'm having abad day, but that bad day turns
into a bad week, turns into abad month, turns into you're
burnt out.
Dr. Elise Fallucco (13:01):
Yeah.
And I think it's sometimes it'shelpful to have people like
loved ones, colleagues, whoeveraround us who can who we trust
and who can call it out for usor maybe it's helpful if we
listen to them when they saythings like I think you need to
take a deep breath or, iseverything okay?
Dr. Jess Gold (13:21):
Yeah, in the workplace, people tend to point
out a flaw instead of reallychecking in on someone so that
the reaction tends to to be howdare you say I'm not doing my
work as opposed to, yeah, you'reright.
I'm not doing okay.
And so I often tell supervisorsor people that like, maybe
starting a little later and notpointing out the flaw would have
gotten a little more buy in, Ididn't know I was burnt out
(13:43):
until my therapist told me,right?
So like sometimes external eyescan make a big difference, but
even earlier I was havingfriends and family say what's
the deal with your texting?
You're not texting back.
And I just was like yeah, I'mover it right now.
But I'm a really efficienttexter.
If I could get an award forthat, I might and so having
friends or family say what's thedeal?
(14:05):
This isn't right For you.
Are you fine?
I just was like why are youtalking about my text messaging?
But it really is a sign if Ididn't take it as like an
affront to my texting ability.
Dr. Elise Fallucco (14:17):
No, but it's it's such a great example too,
about how, when people point outsomething that is different
about us, like your familysaying you're not texting back
or the medical records officesaying, where are those notes
or, whatever it is that you getdefensive and you're like, I'm
busy.
I remember feeling this thisimage of there were all these
vultures pecking at me from alldifferent directions can you do
(14:38):
this?
Or we want you to do this talkand we also need you to write
this thing and we need you tohelp out with that.
And, so and so called out sick,can you cover this shift and
that shift?
And of course, when you'recarrying a lot and when you're
working really hard, any extraask is really challenging, but I
think at some point The pointwhere you, it just makes you
angry and that's your body'sway.
(14:59):
I'm saying this in hindsight, Ididn't recognize it at the time,
but I guess of us don't, I thinkthat's the truth, like it's your
body's way of saying this isn'tright.
Something needs to go like redalarms are going off all over.
And I think we're used to justpushing through the red alarms.
You said this beautiful quote inyour book.
You said, mental health outcomesare an occupational hazard in
(15:21):
healthcare.
Wow.
And, you talked about howthere's lots of literature
showing that we as healthcareworkers have alarmingly high
rates of depression, of posttraumatic stress disorder, of
suicide, certainly anxiety.
Let's talk about how does theculture of medicine
inadvertently increase our riskfor negative mental health
(15:42):
problems?
Dr. Jess Gold (15:44):
It's a hundred percent an occupational
phenomenon and for a long timewe didn't want to talk about it
I think the pandemic sort ofcompounded these really deep
existing bad problems and peoplefinally started to pay
attention, right?
For me, writing the bookreestablishes that conversation
(16:05):
to say it's not going to getbetter.
It was only going to get worse.
So we need to talk about it.
In our culture, Stoicism isvalued, and so is um,
perfectionism.
And both of those arechallenging for things like
emotions and paying attention toyourself.
We also have a culture that weput other people before
(16:26):
ourselves because We areselfless humans who were like
that probably before we wentinto medicine.
And then it was repeatedlyemphasized to us that we needed
to do that.
So we learned through what wewould call the hidden
curriculum, really to focus onothers way before ourselves,
that our own problems areinterfering, and we're not
(16:47):
allowed to express them or dealwith them.
And then at the same time, wesee modeled, People who are not
emotional, who get good feedbackfor being not emotional, and
people who show up to work sickas a dog and get praised for it.
So we have a big culture ofpresenteeism, which is the
opposite, opposite ofabsenteeism.
(17:09):
We're going to go to work sickand data would show that too.
Even if we're seeing likeimmunocompromised people and
everybody I know can give youthis bonkers story of someone
who did something in theworkplace that they saw because
they were sick.
Oh, I remember this time whenthis resident came in and they
were throwing up, but they putan IV in their arm and dragged
(17:30):
it around and saw patients.
How cool was that?
And they say it like that.
They're
Dr. Elise Fallucco (17:34):
tough.
This is what you should bedoing.
And there's judgment who callsin sick to work?
Are you kidding me?
When I was in residency I did X,Y, and Z.
Yeah.
And we're, in some ways we'reperpetuating the culture.
This is what we grew up in, inthe culture of medicine.
And then, working with youngertrainees and younger people, I
commonly hear my colleagues sayOh, they're so ridiculous.
(17:58):
Look at them going home before 6p.
m.
Cause they want to be with theirfamily.
Dr. Jess Gold (18:04):
How dare they.
And so then we get called weakand we can't cut it and all this
kind of stuff, or the person whodoes choose to stay home sick,
they get joked about them thewhole day on the wards.
We would do it with Jenny, butJenny's not here.
And so that's, we learned that.
That is bad, that we show up nomatter what, and so we show up,
(18:24):
we can't feel, we can't putourselves into the equation, and
so we really stop payingattention to our cues, because
we even stop physical cues.
We're not allowed to be hungry,not allowed to go to the
bathroom, so we can't pee and wecan't eat, we definitely can't
cry.
And if we can't skip work unlesswe're, like, hemorrhaging, we
definitely can't skip work forburnout, right?
(18:45):
We're, like, it's justimpossible.
So the culture makes it.
Emotions don't even get a blipon the chart of what is an
acceptable reason to not besomewhere.
And all of the stuff inmedicine, we burden a lot of
people with our choices.
So if we don't show up for work,it burdens patients, it burdens
the team, maybe someone has tobe called in instead of us.
(19:06):
All of that, Also contributesbecause we have a complete lack
of redundancy in our culture.
So if we're not there, it's abig problem.
And we feel that despite thefact that we know we probably
shouldn't be there.
And so we show up and it'sprobably not good for anybody
that we do, but the culture is aculture of showing up way before
(19:28):
you show up for yourself.
Dr. Elise Fallucco (19:29):
Yes, I can think every single time that me
or my husband, who's also inhealthcare gets sick or have
some reason where we probablyshouldn't go to work, the first
thing that comes to your mindis, I have a clinic full of
patients.
Or who's going to reschedule?
Who's going to see them?
How is this going to work?
There is not a big backupsystem.
And I
Dr. Jess Gold (19:47):
look at who the patients are and I'm like, can
these people wait?
If I cancel, I can't invent newdays.
So you might not get back in formonths so it's do I need to go
to my 10?
Because my 10 can't afford menot to come.
And is that a thing?
And that's also hard.
I think.
Dr. Elise Fallucco (20:03):
Yeah, and this feeling that there, there's
not a buffer, there's not a lotof backup, there's not a lot of
other places where we can go andtake care of these kids, take
care of these patients, It'sdefinitely a reality and it's
not something that we're goingto be able to change overnight.
And so the hard part is justtrying to figure out like, how
do you move within that?
And how do you honestlyacknowledge, yes, this is really
(20:25):
hard.
This is something that you needto do for yourself and you'll
show up better the next day orthe next week or whenever it is
for the patients.
So for our psyched for Pedslisteners, I'm going to recap
some of the highlights from ourconversation.
We talked about how commonburnout is in healthcare
affecting about half of us andthat the very things that make
(20:47):
us excellent clinicians like ourselflessness and our desire to
help people and our caringnature may actually increase our
risk for experiencing burnout.
And that part of our job is totry to pay attention to the
subtle signs of burnout in ourown lives so that we can do what
(21:07):
we need to do.
To get healthy.
And so when you get a moment toreflect, maybe ask yourself some
of these questions to see.
If you're experiencing anysymptoms of burnout.
Do I feel exhausted at the endof work most days?
Have I noticed that I'm morecynical or angry when I'm at
work?
Have I noticed that I'm notreally putting my heart into
(21:28):
work as much as I typicallymight?
Do I feel less connected to mypatients?
Am I showing up at work the waythat I want to?
And I know for me personally, Ihave definitely answered yes to
a lot of these questions.
And so our next step is to joinus next week, where we're going
to really talk about what do wedo about burnout?
(21:50):
How do we as individuals survivein this culture of health care
and take care of ourselves andhelp our colleagues and so that
we can all help our patients.
So please tune in next week topsych for paeds.
As we continue this discussionwith Dr.
Jessi gold.
Thanks for listening.
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