Flameproof
Flameproof = Anti-burnout
The physician resilience template
As physicians, we have a massive tank of grit. We can push through, persevere, put our heads down, and show no weakness. That approach to work is heartily rewarded.
If we struggle, the inner (and sometimes outer) message is…work harder! Go faster! Be tougher! How do we add resilience? By sucking it up! In a crisis, this is a great tool to have. As an approach to career longevity, not so much.
Being flameproof is a type of resilience we weren’t taught in med school and is not yet the prevailing ethos of physician culture.
There are several components to building a flameproof career. We’re going to talk about just one.
Agency
What do Viktor Frankl, Holocaust Survivor, psychotherapist, author of Man’s Search for Meaning, and Ted lasso, fictional soccer coach and master motivator, have in common? Let me bring up a quote from each to illustrate.
“The one thing you can’t take away from me is the way I choose to respond.”
― Viktor E. Frankl
Soccer fan: “You’re a legend for doing something so stupid. They’re going to murder you.”
Ted lasso: “But here I am, still dancing.”
What’s the common thread here?
Agency – the capacity of an individual to actively and independently choose and effect change. When we think about agency, it hinges on this question: What is in your COMPLETE control? You control your judgments, opinions, values, and behaviors. That’s it. Everything else is outside your sphere of complete control.
Understanding where you do and don’t have agency is incredibly empowering and you can find it in some unexpected places.
How good is your job?
Four questions:
- If you had a genie who could snap its fingers and create your ideal job, what would that job look like?
- How much overlap is there between that genie job and your current job?
- Where do you have the agency to increase that overlap?
- Will it be enough?
Why is there discordance between our genie job and our current job?
There are many potential ingredients. Here is a small sampling:
- EMR
- Lack of recovery and recharging
- Moral injury you repeatedly see and are part of the system where people are treated worse than they deserve and you are working contrary to your values
- Collegiality decay
- Friction –it is increasingly harder to get things done
- Lack of autonomy
- Admin work that feels like such a waste of time
- Overwork
- Overwhelm
- Underappreciation by patients, leadership, and sometimes peers
The discordance recipe is unique to each individual, but the above examples are all ingredients that can lead to burnout.
Feeling the burn
Burnout ranges from “I’ve lost that loving feeling” to “This is no longer sustainable.” It’s a yes answer to one or both of these statements:
- “I feel burned out from my work” (emotional exhaustion)
- “I have become more callous toward people since I took this job” (depersonalization)
A yes answer is associated with increased work dissatisfaction, medical errors, being named in a malpractice suit, practicing suboptimal care, and clinicians getting out of medicine altogether. Burnout also increases the chance of alcohol abuse and suicidality.
So what do we do about it?
The three domains
There are three domains that we need to pay attention to and identify where in them we have agency: personal, professional, and systems.
Personal
What lives in this personal realm? Your relationships. Family, friends, and how you develop as a human being. One of the tragedies of modern medical practice is that the personal realm can become increasingly hard to not only support and build but frankly have time for.
If you want to know where to put boundaries here’s the easy answer: relationships. There is agency here in abundance. For example, if you want to increase throughput in your clinic, OR, or ED, you can do it, but there is only so much of that you can control. If you want to schedule a date night, the return on investment for you as a human being is probably a lot bigger and your agency is also orders of magnitude higher.
Here’s a question to use as a regular check-in: What are things that you can put into place to make sure that your relationships and family are both supported and a continuing source of joy?
Professional
When a doc who is feeling burnt out, frustrated, or stuck comes to me, one question I like to ask is, “What is it about your current work situation that needs to change?”
For many, it’s a lack of appreciation from patients and leadership.
What can you even do about that?!? Where is your agency here? It’s not in how others think and act. In a situation like this, our agency lies in our mindset and actions.
The only actions are to act in a way that is worthy of appreciation and to be open, receptive, and present when it happens. We too often let gratitude slide off our shoulders, ignore it, diminish it, or dismiss it.
A simple way to open the door of agency with this is an exercise I learned from my coaching mentor years ago.
Before each shift, write down or say out loud before you walk in the door, “I am open to accepting gratitude from my patients and staff.” That’s it. Don’t make this just a little openness. I want you to be like a 50-dish radio telescope turned up to maximum sensitivity. Anytime you pick up that gratitude is happening, pause and acknowledge it. Pause and really acknowledge it.
The return on investment is stratospheric.
Systems
When we get to the systems level, our agency generally lessens but it’s rarely zero or as close to zero as we might think.
Examples
- The hospital handshake is where the CEO comes to the ED every morning and meets with staff and boarded patients.
- The CMO who started a listening project where physicians were asked, as a hospital, what are we doing well and where can we improve?
The wrap
One of the challenges with the state of medicine is that we can feel powerless in all domains: personal, professional, and systems. The ability to make changes and have influence can be found in surprising places.
Where is your agency? When you have none, that can lead to despair and hopelessness. When there is some, when there is a spark, that is where we can thrive. Find the pain point, and ask yourself, “What can I do about this?” If the answer you get back is silence, keep asking, keep looking. Sometimes there truly is nothing, but often something is there. When you get ready to tackle it, don’t try to eat the whole buffet in one sitting, start with one thing, one step, one small action, and then build on that.
And if you want an easy place to start and build momentum, start here: Take care of yourselves and take care of each other.