John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania. He focuses his blog on helping surgeons reduce stress while achieving balance in their practices and families.

BLOG: Avoiding burnout is your choice

The burnout prevalence rates continue to increase with no apparent end to this disturbing trend. One recent study cited the prevalence of emotional exhaustion amongst orthopedic surgeons approached 60%.

The onset of burnout is not inevitable. Emotional depletion can be sidestepped. The answer lies in the power of decision. We have the power to choose what we direct our attention to and in these choices, lay our growth and happiness or lack thereof.

Our creator endowed us with free will, the ability to choose our response to any event or stimulus. In fact, life can be characterized as a continuum of events, each of which ask of us some form of response. The nature of our response will either bring us peace or stress. It is our choice.

Viktor Frankl, in his timeless classic Man’s Search for Meaning, summarized the power of decision best when he wrote: “Everything can be taken from a man but one thing; the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

We have the ability to make two consequential choices regarding work and life. We can decide to focus on all that is good in our lives or focus on the negative. Similarly, we can decide to reframe the meaning of our orthopedic vocation and recognize all the good services we render for humankind daily, or we can simply put in our time only to get our paycheck.

 Recall the words of Sir Winston Churchill, who stated: “We make a living by what we get; we make a life by what we give.”

Focus on all that is good

A decision to focus on all that is good and meaningful about work and home is a time-tested resiliency builder. Stress management guru Wayne M. Sotile, PhD, has written extensively on the truth that resilient physicians are those who can appreciate the value of their vocation as it relates to serving others and aligning with a higher purpose.

For example, a decision during a busy day in clinic to pause and reflect on the profound privilege of easing the joint pain of another human being will generate feelings of satisfaction and fulfillment that no paycheck can offer. A choice to regard patients as well-intending souls in pain who chose you to help them will energize even the most despondent caregiver. We will be confronted with many challenges and trials each day. However, each challenge holds within it an opportunity to exercise our free will and decide to focus on all that is good and meaningful.

Strong relationships safeguard against burnout

Sotile has steadily preached the value of good relationships, both at home and at work, as a safeguard against burnout. Strong relationships can be forged with a decision to look at all that is right about whom we live and work with. When we have healthy relationships at work, we will return home in good spirits. The mood we bring to our families has been shown to correlate more with family happiness than hours worked.

At home, a decision to dedicate energies directed toward all that is good about our spouse or partner will yield abundant resiliency dividends. For example, one’s spouse may have lost the physical luster of youth. However, when one focuses on the loyalty, kindness and sacrifices endured on behalf of the family, real intimacy will manifest. The daily “deposits” of kindness, forgiveness and encouragement we sow will come back to bless us and keep emotional exhaustion at bay.

In surgery, a choice to direct energies to the abundance and lavishness American ORs enjoy will generate gratitude and appreciation for the most endowed health care system in the world. An excursion to a developing nation, especially in the capacity of an orthopedic service trip, will prompt the most advanced malcontent to recognize how good we have it here in the United States.

 

Negativity is distorted thinking

How do we deal with negativity? Simply create space with negative thinking and merely observe it as if a melody was playing in the background. Negativity is essentially distorted thinking which arises without our command. Just like our heartbeat happens, so do negative thoughts.

The challenge is to let negative thinking run its course in the background of our lives and willfully return to the present moment. There, we are empowered to choose what we direct our attention to.

Resiliency takes courage and practice

Sotile does admonish that resiliency takes courage and practice and that it is not for sissies. It takes character and discipline. As surgeons, we spend our days looking for all that is wrong with the musculoskeletal system and it is difficult to refrain from this fault-finding perspective in our personal relationships. It takes real inner strength to reorient to look for all that is good.

Thankfully, resilient-yielding choices become easier in time as we reinforce healthy brain circuitry. The brain’s plasticity affords us all the capacity to become more positive and peaceful when we repeatedly choose a love-finding perspective.

Try this. Place blue dot stickers around your home and office. Every time you see one, decide to think of something to be grateful for. Take the lead in your relationships at work and home and dedicate your attention to all that is good about that person. Write one email every day to thank someone for a previous kindness or thoughtful gesture. Spend 1 minute every morning reflecting on the profound privilege of performing surgery. Decide to develop awareness whenever negativity descends. Stop, breathe and reorient to the positive.

 

References:

Frankl VE. Man's search for meaning: An introduction to logotherapy: A newly revised and enlarged edition of from death-camp to existentialism. 1962. Beacon press.

Sargent MC, et al. J Bone Joint Surg Am. 2011;doi:10.2106/JBJS.J.01252.

Shanafelt TD, et al. Mayo Clin Proc. 2015;doi:10.1016/j.mayocp.2015.08.023.

Sotile WM, et al. Bull Menninger Clin. 2004;68(1):39-59.

 

See more from Focus On: Physician Burnout