LMS President’s Message, November 2021: Is it Burnout or PTSD
By James Borders, MD
On March 11, 2021, the United States congress passed the American Rescue Plan Act, also called the “COVID-19 Stimulus Package” or the “American Rescue Plan”, a $1.9 trillion economic stimulus bill of which Kentucky’s portion is $2.183 billion. Of Kentucky’s portion, Governor Beshear wants to give $400 million to essential workers, a move that will need approval during the 2022 session of the Kentucky legislature. A factor motivating this gesture is the belief that burnout, thought to be currently prevalent among essential workers, can be mitigated by financial rewards. Debate continues not only about which workers should be considered “essential” but also about what constitutes “burnout”.
Burnout is not considered to be a disease state but, instead, a syndrome caused by workplace stress that has not been managed successfully. It consists of three characteristics- physical exhaustion, dis-engagement and negative attitudes toward one’s occupation, and the feeling of ineffectiveness or lack of accomplishment. Before the pandemic, burnout was well recognized as a prevalent issue among physicians and other healthcare workers with many aggravating factors such as laborious electronic medical record data entry and rising consumerism in medicine, among many others.
To remedy burnout, physicians are advised to seek efficiencies and economies of scale in their workflows and to address work-life balance. They should seek outside interests and connect with colleagues and others who will listen and understand their struggles. Practical remedies may be quite effective and straight-forward, such as changes in work schedule or employing a scribe.
On the other hand, post-traumatic stress disorder (PTSD) is recognized as a disease state triggered by first-hand exposure to trauma, threat, or loss. This may be a more accurate description of the effect of the pandemic on many of our clinicians faced with seeing so many suffer for want of a readily available vaccine. Our ICU staff are also forced to witness the grief magnified by forced isolation of patients from their families. In addition, many of our staff choose to work through fear for one’s own safety for the sake of their patients, thus creating a mindset not unlike a soldier on the battlefield who accepts personal risk toward the goal of a greater good.
PTSD can increase the risk of suicide. Burnout is not thought to be a direct cause for suicide but can contribute to depression, which increases suicide risk. PTSD, however, is closely linked to depression and may respond to medication, psychotherapy, “exposure therapy”, and a novel therapy called “eye movement desensitization”. It is important that PTSD not be mislabeled as “burnout” which may result in ineffective responses from those in a position to be of help.
Whether the stressful experience of healthcare work during the pandemic can be appropriately considered as burnout or PTSD, it is clear that physicians suffer for lack of personal connection with one another. Zoom meetings provide a poor substitute for in person meetings which were in sharp decline before the pandemic. Online CME and colleague collaboration has replaced many in-person physician gatherings.
Counselling services from the Woodland Group are available to all LMS members for up to 8 free sessions each calendar year. These services are completely confidential. To make an appointment, call 1-800-350-6438. “Life groups” of small numbers of physicians who meet and discuss personal challenges are forming under the guidance of trained life coach organizations. One such organization is the Referent Group (TRG)- founded by retired army colonel (and physician), Dr. Tom Hustead. TRG builds upon the basic human need of collaboration with others facing similar struggles but also offers the opportunity to learn leadership skills the military teaches to mitigate the experience of battlefield-like conditions the pandemic has created.
The pandemic has taught us many lessons about our country’s priorities, intellectual objectivity, political environment, and moral compass. It has also forced us to explore ways to maintain operations at physical distance from one another. Many of these pandemic accommodations will remain long after the pandemic subsides. But, let us assure that we understand the importance of getting together in groups as soon as it is safe to do so.
James Borders, M.D.