Stress and Burnout: A New Approach

Before I retired from medicine, I was showing signs of burnout and did not know it. All I knew was that I was miserable. 

The morning started out fine. By one or two, however, I was ready to flee. My thought was always the same—get in my car and drive West. What I imagined was that seeing the open countryside would make me feel free of all responsibility. At that moment, and, that time in my life, it was a welcome thought.

Well, that drive into the sunset never happened. After trying to scale down my practice, I was still in pain. As every practitioner knows, it is difficult to support staff while deliberately seeing fewer patients to save one’s own soul. I retired.

What might have spared me was not available then. But, fortunately for the medical profession, it is now. Enter Dr. Jed Brewer M.D, Ph.D., a neuroscientist, and psychiatrist, who transforms recent research findings into programs to treat addictions and burnout. Since Dr. Brewer is a physician himself, he is particularly sensitive to the plight of the medical profession, who now are not only under the usual pressures, but those of COVID as well. 

The Dr. Jud Program

Dr. Brewer calls himself Dr. Jud, I assume to make himself more accessible. And, that he is, with his exceedingly calm demeaner and easy to understand instruction. 

His main message is that we humans are responsive to triggers which lead to an action that, in turn, precedes a reward. In its simplest terms, this is hunger (trigger), eat food (action), satisfaction and pleasure (reward). 

Of course, a nurse or physician’s response to a patient who is suffering is more complicated. When the medical caregiver identifies with the suffering herself (empathy), she hurts as well. This leads to burnout. Dr. Brewer refers to this as learned helplessness on the part of the medical caregivers.

On the other hand, he says that a different response to the same patient’s suffering can benefit both the medical professional and the patient. Instead of focusing on empathy, she places her energy into compassion. Then, even if the suffering on the part of the patient continues, she can feel as though she is contributing in the most effective way she can without a side effect of burnout or learned helplessness. She is not living the suffering, but a partner in obviating it.

Empathy and Compassion Explained

Now, for a word about the difference between empathy and compassion, two words with similar but different meanings that can easily be confused. 

Empathy suggests that the caregiver relates to another person’s pain vicariously, as though she is experiencing that pain herself. Compassion, on the other hand, refers to both an understanding of another’s pain and the desire to somehow mitigate it—a broader definition.

Dr. Brewer tells this story in his elegant way in videos which, at the present, can be accessed free of charge by the medical profession. The advantage is that watching them takes little time and there really is nothing to lose except an hour or so. Please see them for a deeper understanding which Dr. Jud explains far better than me. 

Module 4: How mindfulness decreases clinician burnout and builds resilience

Module 5: How to move from empathy fatigue to compassionate action (and build resilience)

Putting Dr. Jud’s Program in Perspective

In the past, I recommended making art and appreciating art as a relief from the intensity of the medical profession, i.e. combating burnout. That series, Physicians with Passion, chronicled four M.D.s who found relief and joy outside of their practices through collecting art, taking photographs, making sculptures, and painting. 

Dr. Brewer’s approach, to me, is different. He wants to nip stress-related burnout in the bud by teaching those who are vulnerable to understand it better so that their response to it is healthier right from the get-go. In this way, there may be fewer cases to begin with—a victory not only for those in medicine, but their patients as well.

The views expressed in this piece are those of the author, not necessarily those of the publication.

Shirley M. Mueller, MD, is author of Inside the Head of a Collector: Neuropsychological Forces at Play (Lucia Marquand: August, 2019).