Burnout & Suicide: Detection and Intervention Strategies

Burnout can be difficult to diagnose because physicians often fail to recognize their own symptoms until the later stages. Complicating matters, burnout mirrors the symptoms of depression even though depression doesn’t always accompany burnout. Although not an absolute, physicians typically follow a four-stage buildup to burnout: fatigue, hindrance, frustration, and withdrawal. This progression might begin with increased fatigue and exhaustion resulting from seemingly endless to-do lists – especially if additional tasks hinder proper completion of a job. Eventually, these barriers can cause frustration, dissatisfaction and a sense of failure, leading to overwhelming feelings of helplessness, hopelessness, indifference, and withdrawal.

If you relate to any of these stages, you may be at risk of, or are currently dealing with, physician burnout. Appropriate courses of action for each respective stage can mitigate the effects of burnout and restore a sense of control.    

One way to identify burnout symptoms in others is to recognize those most susceptible to burnout and symptoms of suicide. Physicians who are going through transition – from graduating med students competing for residency slots to physicians preparing for retirement – are considered at highest risk for burnout and suicidal ideation. Other vulnerable populations within the health care community include specialists like anesthesiologists and psychiatrists; women; those with a history of physical and/or mental illness; those who identify as part of the LGBTQIA community; and current or former abusers of alcohol and drugs.

Because most physicians experience occasional fatigue and frustration without the full-blown effects of burnout, it’s most useful to monitor for signs of cynicism and lack of empathy in colleagues – signs that could signal a physician is in the late stages of burnout and needs help.

As a proactive or preventative strategy, you can also encourage team members take the Maslach Burnout Inventory, which measures the three components of burnout: emotional exhaustion, feelings of loss of personal accomplishment or ineffectiveness, and depersonalization.

Individual methods of combatting burnout aren’t a one-size-fits-all affair; sometimes you have to try multiple activities for a period of time to discover what’s most effective for you. Many physicians swear by mindfulness, the practice of being present in a moment and being nonjudgmental of your feelings – to build resilience and increase empathy. TED talks and guided exercises on mindfulness are excellent resources for physicians who can easily access them on YouTube and in app stores.

Other morale-building techniques to prevent burnout can be something as simple as a “brag book.” This can take on the form of a scrapbook full of thank you notes from patients and families – a tangible reminder during stressful periods of why you chose to pursue medicine.

When all other burnout-reducing methods are exhausted, it might be advisable to consider pivoting in your career. While we at the American Association for Physician Leadership firmly believe that all physicians are leaders at some level, there is always a need for physicians to enter formal leadership positions. Your knowledge of the unique stressors and impediments on the clinical side of health care could help you drive positive, life-saving change in the C-suite.

Burnout is best battled and conquered with a combination of individual efforts and institutional support that includes workplace wellness programs and organizational policy changes. For instance, electronic health records (EHRs) are known major contributors to burnout, so consider hiring clerics to manage EMR documentation or contracting information technology specialists to frequently provide in-clinic assistance and training. Doing so can reduce “pajama time” and allow physicians to truly disconnect at home while striking a healthier work-life balance and alleviating the symptoms of burnout.

Another coping mechanism for physician burnout is the establishment of peer-support programs for physicians who are dealing with stress stemming from medical errors, malpractice cases, and unintended outcomes. Events like these often stigmatize, isolate and prevent physicians from speaking out about their problems or admitting their struggles. On-site, facilitated support programs or a directory of peer supporters can give physicians a safe place to turn in an open, non-judgmental environment.