Emerging from burnout
How the size-inclusive medicine movement is giving me some fire back
Welcome to Chief Complaint! For those of you who are new, this newsletter features intermittent musings about medicine, gender, parenting, and body liberation — all from your friendly neighborhood primary care doc. I’m so happy you’re here.
A few weekends ago, I went to a medical humanities conference here in Philadelphia. It felt like being an undergrad again: We read poetry! We looked at art! It was lovely.
Although I was a bit grumbly when my alarm went off at 6:30 on a Saturday, once I arrived, I was energized to be there. I got to see and chat with colleagues I really do like. I went to some inspiring talks. I thought about some new ideas. I went home feeling excited about my work .
In other words, I was feeling the opposite of burned out. I left feeling good. And it couldn’t have been more different than a year ago.
See, last year when I went to this very same conference, I was feeling deeply burned out. So burned out that I didn’t even really have the language for what was going on.
I remember having dinner last fall with a friend and her friend, all of us primary care doctors, and I said something along the lines of: “Nothing we doctors do matters; we’re all just cogs in a corporate machine; I’m essentially a data entry clerk; my patients want me to provide Amazon-style customer service where I give them whatever they ask for within 24 hours…”
Cue deep breath, when I pause for two seconds, and my friend’s friend says, gently: “You sound like you’re experiencing some burnout.”
I was startled. I hadn’t thought that the term might apply to me. And yet it so obviously did. I spent my days talking with my patients about their mental health concerns, but when it came to my own wellbeing, I could barely even recognize my own distress.
I am so grateful to this friend-of-a-friend for helping me understand what was going on. Maybe it was the fact that I didn’t know her well that made me take her seriously when she suggested burnout might describe my mental state. When she pointed it out, it landed at exactly the right time. Eventually, having language for it helped me understand how to do something about it.
But last year at this time, I wasn’t there yet. I showed up at this very same medical humanities conference, and the whole thing felt like adding salt to my burnout wounds.
The conference was about using art to find meaning in our experiences working in health care. But it felt hard to find meaning — via art or otherwise — when I was in a burnout spiral, increasingly convinced that the U.S. health care system was irredeemably corrupt.
I said to a friend, at the conference lunch last year: “What makes us think we doctors are so special? It’s like we’re a bunch of hedge fund managers, sitting here writing poetry trying to convince ourselves our work has purpose.” (Sorry to the hedge fund managers. If you like poetry, that’s great! But my snark got at a deeper truth — if the work is inherently corporate, will writing poetry about it make it just?)
I left last year feeling panicked. Everyone else there seemed so happy and fulfilled, their days spent building deep relationships with their patients, using the power of science and medicine to improve their lives.
And I felt like a widget in a computer program, my death getting closer every second as I spent my precious hours on this earth clicking and clicking through vast swaths of the electronic medical record. Would this be the rest of my professional life, feeling bitter and cynical about the growing corporatization of medicine? Yikes.
I was telling myself a story about myself. I had constructed a narrative that I had come to believe: My work was meaningless, and I was stuck.
Where did my burnout come from? How did it start? What was it?
The World Health Organization says occupational burnout is “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy.” If you want to nerd out about it, most scholarly work about burnout uses a questionnaire called the Maslach Burnout Inventory, which has you rate how much you agree with statements like: “I feel like I’m at the end of my rope.” Womp womp.
It’s not clear to me if everyone everywhere is burned out, ‘cause, ya know, capitalism, or if something particular is going on in health care, but I do know that doctors are obsessed with studying and quantifying their own burnout. And apparently, it’s bad. There are thousands of scholarly papers about physician and nurse burnout, if you type the term into PubMed, a search engine for scientific research. Some pandemic-era estimates found that over 60% of U.S. physicians were experiencing burnout.
I take some comfort in knowing whatever I was going through, I wasn’t alone. Health care burnout is such a ubiquitous topic of workplace chatter that it’s become a cliche. I get invitations to 7pm webinars about how we should make time to watch evening webinars to prevent burnout. We have yoga sessions and “take the stairs” challenges. My students ask about it; my peers and I grumble about it. And I myself had reported (a lot!) on physician burnout for NPR.
Here’s what was going on: I felt a growing sense of dread about my work. Health care felt overwhelmingly profit-driven, far away from the values that had drawn me to the field. I felt rushed with my patients, pressured to cut corners, my clinical judgment constantly undermined by huge insurance companies that didn’t have my patients’ best interests at heart.
In other words: I felt like an American primary care doctor.
The medical humanities conference was a nice benchmark for me to see how far I’ve come. Because when I went to the conference just a few weeks ago, I couldn’t have felt more different. I felt excited, energized, and proud of both my colleagues’ and my own accomplishments. What a difference a year makes.
What changed? How did I get out of the burnout spiral?
There’s a lot of research out there on this topic, and there are plenty of scientific papers on specific strategies that really do seem to help. Here are a few things that have helped me, over the last few years:
Identifying burnout and “diagnosing” it appropriately.
Having clear boundaries about the start and the end of the workday.
Related: Not allowing e-mail or electronic medical record notifications show up on my smartphone! In fact, I (almost always) leave my phone charging in our home’s entryway and try not to look at it when I’m home for the night.
Working through lunch.
This one is a hot take! When I eat my sad desk salad in front of my computer and type furiously through lunch, it allows me to leave work earlier and hang out with my family and friends. Many people like taking a proper lunch break, and I totally respect that. And if I have time, I like to get outside and take a quick walk. But plowing through as much work as possible while I’m physically at the office is my top priority. I do not like to leave charting for my evenings.
Leaning in to meaningful connections with colleagues and patients
Primary care is full of emotional whiplash: within the span of 30 minutes, I might have a conversation about how a patient’s daughter recently died of brain cancer, and then I might have a conversation about a grandchild being the first in the family to graduate from college. So when my patients disclose either good or bad news, I try to do a brief mindfulness exercise. I turn away from the computer, remind myself of what a true honor it is to bear witness to these stories, and focus on what my patient is saying to me. It’s beautiful, but it also makes me run behind schedule. :/
This is absolutely, completely, 100% not a call to “yoga your way out of burnout.” The U.S. health care system has deep inequality and injustice at its core, and no amount of self-care practice will fix it. Only sustained, community-based activism will change things — and voting! Which is why I’ve been eagerly helping my patients get registered to vote.
So perhaps most importantly, my involvement in the size-inclusive medicine movement over the past year has renewed my sense of purpose at work.
About a year ago, I took a big risk, and wrote an essay for NPR about the rewards and the challenges of practicing weight-neutral medicine. It was a clinical philosophy I had been exploring for years, but this was the first time I had written publicly about it. I was worried I’d be attacked by fatphobic trolls; instead, the love poured in to my inbox. People were overjoyed to hear about doctors who didn’t yell at them for being fat.
Over the last year, it’s been amazing to build a community of health care workers who are committed to ending fatphobia in medicine and working to make our clinical spaces welcoming to people of all body sizes. I went on national TV and NPR and talked to Vogue and the Washington Post. I’ve given countless talks to students and colleagues. Everyone is ready for a change. And it feels great to be a part of a community working to get us there.
Being a part of the size-inclusive medicine movement is not only the right thing to do — working to dismantle the longstanding discrimination and inequality that exists in health care — but it has also totally cured my burnout.
I mean, sure, prior authorization requests still drive me bananas, but it’s been thrilling to realize I have a renewed sense of excitement and mission in my work. It helps me feel like I’m starting to mend one tiny piece of the deep problems I’m faced with every day.
That’s why I’m especially proud to announce the official launch of a new professional society for physicians and advanced practice providers: The Association for Weight and Size Inclusive Medicine. It’s a professional community with clinical and educational resources, and also just a really nice group of people.
And: If you’re a health care provider, we’d love to have you get involved! Check out our website to learn more.
Now, onwards to tackle all those insurance company denials of my patients’ medications!!!!!
Thanks so much for reading. If you’d like, I’d love to hear your perspective! What helps you find meaning in your work, paid or otherwise?
It feels good to feel good. Glad to learn that support and a real vacation can do wonders to heal from burnout.