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Maggie McKay (Host): Sometimes when we're feeling low or overwhelmed, we keep it to ourselves and brush it. But what if it's more serious? And what if you ignore your feelings? What if it's burnout? And how do you recognize and prevent burnout today. We'll find out with an expert from Prisma Health. Joining me is Dr. Rachel Brown, Medical Director of Prevention and Wellness and family physician at Prisma Health. This is Flourish, A podcast brought to you by Prisma Health. I'm Maggie McKay. Dr. Brown, thank you so much for being here today to share your knowledge about burnout. For starters, what is burnout and how do you know if you might be experiencing it?

Dr Rachel Brown: So thank you so much for having me today. I'm excited to talk with you all about burnout and ways to mitigate that. Your first question, what is burnout is obviously the most important. We generally characterize burnout with three different main characteristics. They are emotional burnout, or exhaustion, or not having anything left for anybody when you're done with your shift that day. The next is depersonalization or really starting to dehumanize the care that you give your patients, the interactions you may have with your colleagues.

And often this will show up initially as cynicism and then the third characteristics. Is a lack of sense of personal accomplishment. So really feeling like nothing you do matters. No one's really listening to you or taking your advice. And in for folks who have crisis burnout, they may experience something called imposter syndrome, where they really believe that they don't know what they're doing despite the fact that they have a lot of expertise and knowledge and skills, they may not feel that way.

Burnout, is a spectrum. It's very insidious, and often the folks who last know that they have burnout are those people themselves. And so you just have to keep checking in with yourself. Do you feel emotionally exhausted? Do you have cynicism? Do you feel like you're depersonalizing your work? Or do you feel like you have lack of impact? And if some of those things are bubbling up to the surface, then yes, you may be experiencing burnout.

Maggie McKay (Host): What causes burnout?

Dr Rachel Brown: So many things contribute to burnout. What we find in healthcare workers is that it's generally not patient care, and it's generally not necessarily the busyness of providing care for patients. It turns out that overall burnout, Is when the demands of your job are not met by the amount of resources that you have to fulfill your obligations, and that may be your own internal resources and coping skills. More likely in healthcare because healthcare workers are already highly resilient, it turns out that it's that they don't have the career resources to match the demands.

But what we find is that it's not generally the patient care demands that cause the burnout. We use it an expression desk by a thousand paper cuts. It's all of the other little things that happen throughout your day. Requirements, policies, procedures, policies. That keep you from providing that patient care, that tend to cause that burnout and that chronic stress of being in a healthcare, setting and having so many, responsibilities and boxes that need to be checked, that chronic stress can lead to burnout.

Maggie McKay (Host): Is burnout the same thing as depress?

Dr Rachel Brown: Such a great question, and there's a lot of overlap for sure. However, burnout is different from depression in a couple of ways. First, we do describe burnout as a career phenomenon, and so we're really talking about that emotional exhaustion, depersonalization, and lack of accomplishment as related to your job. The other is that we certainly don't expect folks to feel, so down and depressed that they have harmful thoughts or suicidal thoughts when they're burnt out. And if that is something that's happening, then for sure we're talking about severe depression. .

Oftentimes people with burnout don't have the same level of hopelessness that someone who's depressed may have. But definitely we see people who are burnout, especially if they've been burnout for a long time, or they're in severe stages of burnout, developing depression. So there can be both going on at the same time. And of course, if we find that someone is not just burnout, but also burnout and depressed. I certainly wanna make sure that they find the right help, and seek out employee assistance or psychiatric and psychological counseling and other kinds of support that will get them through depression, which can be more severe or a consequence of burnout.

Maggie McKay (Host): What can happen if you don't address burnout?

Dr Rachel Brown: I think a lot of folks think I'm burnout. It means I don't love my job. I guess I'll just have to live with that. But the reality is that burnout has very significant consequences. Not only are you not going to be as productive at work, regardless of how productive you may think you're being, but errors are increased. Our cost and our spend is higher when folks are burnout, we have a lot of turnover. And then of course that causes disruption within the system. On a personal note, burnout can cause, an increase in chronic disease, in obesity, in sleep apnea, in muscle and joint pain, in addictive behaviors, emotional diagnoses such as depression.

So it will absolutely impact your physical and emotional health. And sadly, burnout is what we call portable, meaning you do take it out of your career life and into your personal life. And we see that folks who experience burnout have higher rates of divorce, lower rates of education and financial gain. They don't do as well outside of their careers either. So burnout needs to be taken seriously because there are some serious consequences that come from it.

Maggie McKay (Host): What can you do to overcome burnout?

Dr Rachel Brown: So this is the million dollar question, right? Because the reality is that most people in the healthcare setting will experience burnout over their lifetime, if they do not do something to prevent that. And so one of the hallmarks of crisis burnout is an inability to, experience positive emotions. So a lot of the tools that we use to prevent burnout, which revolve around experiencing positive emotions aren't gonna work once you're burnout. So what I do when I'm working with an individual or a work unit is something called the wellness dimension exercise.

And this is based on research from years ago showing that there are eight wellness dimensions, that if we tend to them, we can overcome burnout and we can build resilience. Those eight dimensions are emotional. Financial, social, spiritual, occupational, intellectual, and environmental wellness. And in short, what I do is work with folks to make sure that they're tending to each one of those areas, and we find that they are slowly able to crawl out of that state of burnout.

Maggie McKay (Host): Wow, that sounds like a long list. If you're looking at it, you know, from a person with burnout. I mean, how long does that take to overcome?

Dr Rachel Brown: The goal is the journey of trying to get there. It is virtually impossible to juggle all eight of those balls at one given time, but what we do is identify where there may be gaps and where there may be wellness dimensions that aren't being tended to at all. And we design baby steps to get someone where they need to be. with a goal that we know they can accomplish, and very slowly we're able to say. That someone is tending to most of those wellness dimensions and doing it in a way that fits into their life, not adding another to do. And this takes anywhere from a few weeks to six months depending on where that person is in terms of tending to their whole wellbeing.

Maggie McKay (Host): So hopefully you catch it early. How can you avoid or prevent burnout?

Dr Rachel Brown: So Avoiding or preventing burnout is obviously exactly what we wanna try to accomplish. One of the ways to do that and the best way to do that is to build resilience. What we find with healthcare workers is they are already highly resilient people. but healthcare can whip that out of them. And so by maintaining our resilience, we're able to combat burnout and avoid all of those consequences I mentioned earlier, there's two really big bodies of research that show us how human beings build resilience.

And the first is that wellness dimension tool that I mentioned. So even folks who aren't completely burned out. Working on that wellness dimension tool exercise can make a huge difference in maintaining their resilience. The second body of research is around, the utilization of positive emotions and how being aware of our positive feelings. Really re hardwire our brain to handle stress in a completely different way. There are literally hundreds of evidence based tools that you can use to re hardwire your brain to focus on positive emotions.

Things like gratitude, letters, journaling, three good things each night. Mindfulness practices are hugely effective. Music, humor, taking walks, physical activity, you name it. There are so many, and a lot of these tools are the tools that I share with the work units, and individuals that I'm working on how to prevent, burnout.

Maggie McKay (Host): So, do you have any tips for someone who's trying to help another person who's burned out? Maybe a spouse or friend, or even an employee, a coworker?

Dr Rachel Brown: As I mentioned before, it's often the person who's burnt out, who is the last one to know that they are burnt out. They're really trying to push through and often have a hard time admitting that they may be struggling, whereas we may notice that a lot earlier. The first thing that's required is psychological safety. So I am always working with work units on how to create that sense of being able to share without any consequences, sensitive topics like this or being able to admit you're struggling.

Being able to approach someone and say, Hey, I've noticed you've been a bit more cynical lately. Or, Hey, I noticed you seem more tired or you've missed more work. So without that sense of psychological safety in a work unit, it's gonna be very hard to address this. However, if you do feel comfortable enough just letting the person talk to you and share their story with you, may enough. To get them to understand that it's time for them to look for some help. Now, that may be something like the wellness dimensions exercise.

It may be reaching out to EAP. It may be talking to the supervisor about how things may need to change at work to accommodate their burnout. And certainly reaching out to me at any point. I would love to hear from anyone, and help them work through their burnout. I do this all the time, but understanding where that person is coming to and simply listening is the first best step. If you feel comfortable recommending the wellness dimension exercise, you certainly can do that. Or as I mentioned, please feel free to reach out to me anytime.

Maggie McKay (Host): Well, this has been such a helpful and educational conversation about burnout. Such an important topic that affects so many people It seems. You for sharing your expertise and teaching us about recognizing and preventing burnout.

Dr Rachel Brown: Thank you so much for having me.

Maggie McKay (Host): That was Dr. Rachel Brown, Medical Director of Prevention and Wellness and family physician at Prisma Health. For more information, please visit prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Maggie McKay. Be well