Provider Burnout Revisited

I wrote an article about burnout just shy of 9 months ago from my temporary office in a back yard at a picnic table on the North Shore of Oahu, where I found myself after coming dangerously close to an emotional point of no return…a negative outlook on life, the fear of impending illness or injury, and questions about my own worth drowning out my voice of reason and my truth. I meant to follow it with a Part 2. What happened when I returned to the mainland and “got back to real life”? Did I follow my advice? Did I learn from my lessons? Did I incorporate changes into my life that translated to “burnout prevention”…or better yet, not even the need to worry about its presence in my life?

The simple answer? Well, if it is a Yes or No box to check, then it’s a no. But, it’s not a simple answer.

If you are interested in an unscientific story without references, about real life, that’s fairly uncensored, may make the reader uncomfortable, and doesn’t end in rainbows and butterflies, I invite you to read on.

I returned to my office. I set clear boundaries for the work I was willing to do. Namely, I was willing to do my work (seeing patients and developing complex treatment plans, answering calls, writing appeal and prior authorization letters, filling out disability papers, doing peer-to-peer calls for tests), but I was no longer willing to do the work for the other providers in my office if the information was not readily accessible. So, if dictations weren’t complete, the information I needed was not in the note, or I had never seen the patient and did not clearly understand the plan of care, the work was passed onto its rightful owner. The best part about being gone for a month is that new behaviors were created in my office. In the past, after a week away from the office, I would return to, “Oh, wow, we really missed you while you were gone. You really DO do a lot around here! Thank goodness we can get back to our old behavior now!” When I returned after a month, behaviors had changed. And I have stuck to my guns to reinforce those behaviors. It has worked, and frankly, I don’t think anyone is upset about it. In fact, there seems to be greater mutual respect. Lesson 1 learned and imprinted.

I also set limits on my encounters with patients. I stopped taking them home with me. I stopped carrying them in my heart and soul. I developed the following system: I give the client information. She takes it home and either implements it or doesn’t. If she implements it and it doesn’t work, we develop a different plan. If she doesn’t even try to implement it, I ask WHY?, and we develop a different plan based on the answer. If she doesn’t try, can’t answer the question WHY?, and returns time after time in misery, I suggest that perhaps something else underlies the problem. Does she want to get better? Does she enjoy the sick role? Does she need to see another provider? Does she need to see a counselor? I believe that problems that root in the heart and soul show up in the body as dis-ease. I share that belief with patients. For many of them, I have become a deliverer of information, no longer an investment banker. This does not mean that I hold back on hope and care and empowerment. Rather, I give them tools to find those things, a pat on the back, and encourage them to do the digging. I am no longer the excavator. Lesson 2 learned and implemented.

It did help that exactly a month after I returned to work from Hawaii, I went to Europe for 2 weeks. One of those weeks was for an annual meeting that just so happened to correspond to a milestone birthday. I took the time to travel with my best friend. While my month in Hawaii was a rather urgent call for help, this trip had been planned for a year. Had I not been to Hawaii, I would have felt guilty. But, I no longer felt guilty. It’s pretty simple to others. “You shouldn't feel guilty,” they say. “You work so hard!” I challenge you to say that to yourself, and to believe it. Is it even possible to believe that you are worthy of being treated as a human being by your staff, your clients, your supervisors…and to create an environment that supports your worthiness? I believe so. I think. Right? See…it’s not simple. That self-care that prevents burnout? Not always pretty.

I had a little conversation with myself, summarized here with some “oh my goodness are you really writing THAT” emotion. Do you know that I work hard? That I care for patients and their families, and sometimes too much (refer to Lesson 2)? Do you know that you do, too? That for every patient you see who makes a request, you have another thousand (or more) patients making the same request, or a more difficult one? But they don’t see that. That one patient is “The One”. That can drain the blood right out of your body unless you know how to manage it…how to transfuse. We are in a service profession, whether we like it or not. We are well-educated waiters and waitresses, well-educated sales people. After all, we “sell” our plans of care. We give options, we convince patients what we know is best, they pay for services (and many of them are in debt because of these services…even I have put co-pays for physical therapy on a credit card), and we ask them to come back and see us again, in spite of the fact that sometimes what we do makes them feel worse…and we can’t even give them a good answer about what might happen to them in 20 years because we may not know ourselves.

Most people don’t willingly choose to be waiters and waitresses for the rest of their lives. The restaurant business is hard. Well, we chose. We chose to be in a service profession. We chose to serve. It is a huge choice. It is a noble choice, but one to be embraced with humility. Hopefully for you, as is true for me, you believe you were put here to do what you do.

Which brings me to the next point.

It is awfully hard to say no when you love what you do, and when you believe you are living your purpose. I am living my purpose and unfortunately close to burnout again. The climb off the cliff takes a lot of energy when your soul is happily tired. My month away was lovely, but I can’t expect that every year. I can expect the necessity of going to work everyday, and the equally as important necessity of improving my self-care. I call it bringing Hawaii into my everyday life. For me, it begins with an ugly two-letter word: NO. I ask you to think where it begins for you, and we will meet at the drawing board again.