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Burnout

Authors: Charlotte Davies / Editor: Liz Herrieven, Nikki Abela / Reviewer: James Johnson / Codes: SLO12, SLO2, SLO8, SLO9 / Published: 07/09/2021 / Reviewed: 09/06/2026

What is Burnout?

Burnout is a state of physical, emotional and mental exhaustion caused by prolonged, unmanaged chronic stress, most commonly in an occupational context. Much research has been done on burnout affecting emergency department teams:

The GMC National Training Survey 2025 highlights that Emergency Medicine (EM) continues to face the highest risk of burnout among specialties, with 30% of EM trainees at high risk, compared to 20% overall.

A 2024 University of Bath/RCEM Study found that a “severe burnout and retention crisis” in Emergency Medicine is threatening, the safe delivery of care. This was followed by the RCEM Acute Insight Series: Impact of staff burnout and retention (January 2024) which discussed the impact of burnout, its link to retention, and recommendations for improvement.

The World Health organisation defines burnout as:

  • Feelings of energy depletion or exhaustion
  • Reduced professional efficacy
  • Increased mental distance from job, or negativism or cynicism in the occupational setting.

 

It is caused by chronic workplace stress, not successfully managed. Because high-achievers are often so passionate about what they do, they tend to ignore the fact that they’re working exceptionally long hours, taking on exceedingly heavy work loads, and putting enormous pressure on themselves to excel—all of which make them ripe for burnout. Some say burnout only exists in overachievers.

RCEMLearning image generated with Google Gemini

 

There are many burnout risk factors, and I’m sure everyone has done a burnout risk score. They include:

  • Feeling like you have little or no control over your work
  • Lack of recognition or reward for good work
  • Unclear or overly demanding job expectations
  • Doing work that’s monotonous or unchallenging
  • Working in a chaotic or high-pressure environment
  • Taking on too many responsibilities, without enough help from others

 

Personal Risk Factors

  • Working too much, without enough time for socializing or relaxing
  • Lack of close, supportive relationships
  • Not getting enough sleep
  • Perfectionistic tendencies; nothing is ever good enough
  • Pessimistic view of yourself and the world
  • The need to be in control; reluctance to delegate to others

 

Listing these risk factors is useful, as if you can identify a risk factor you can mitigate the risk factor. The Maslach burnout score is fantastic as it highlights the protective scores too – many of us work in environments which by their very nature encourage burnout – the emergency department wouldn’t be the emergency department if it was controlled, low pressure, organised. But, the emergency department often negates that by having a close supportive team that provides supportive relationships. Some versions also list job satisfaction like “I reflect on the satisfaction I get from being a doctor”.

Rust Out

Rust – out is a profound sense of demotivation and chronic boredom borne out of unstimulating work. The alter ego to burnout. This means personal interest and enthusiasm is lost. Despite the causes being polar opposite to those of burnout, the symptoms are remarkably similar.

Am I burnt out?

There are lots of signs of burn out, and you don’t need them all to be considered “burntout”. Broadly:

  • Signs of physical and emotional exhaustion – chronic fatigue, insomnia, forgetfulness, lack of concentration, stress symptoms, increased minor illness, altered appetite, anxiety & depression and increased irritability.
  • Cynicism and detachment with loss of enjoyment, pessimism, feelings of isolation and detachment, and compassion fatigue.
  • Ineffectiveness and lack of accomplishment with apathy, increased irritability, lack of productivity

 

Are my colleagues burnt out?

Recognising the signs in ourselves is difficult, and it’s just as hard in each other. We see Dr X once a month, and think their irritability is just a one off. Dr Y is tired – but isn’t everyone? Dr Z isn’t very effective anymore – but that happens to everyone once in a while.

So how do you recognise burnout? We’d love to hear your suggestions – as if you can’t identify it in yourself or others, you can’t treat it. Keep an eye out for increased sickness rates, increased patient and colleague complaints, and reduced productivity.

Avoiding burnout in your colleagues is vital and is an important team function. Again, as a team you can’t change the chaos and the unpredictability but you can change:

  • What you talk about – Supportive vs. Negative Communication: Studies show a strong link between effective communication and lower stress. Emergency workers who perceive communication as effective feel more supported, which significantly reduces burnout and emotional exhaustion Leadership communication, stress, and burnout among frontline ED workers (2021)
  • How you talk about things – Civility Saves Lives (founded by Dr. Chris Turner) has done extensive work highlighting the link between workplace behaviour and burnout, particularly in healthcare. They focus on how incivility acts as a major driver of stress, while a civil culture acts as a protective factor against Burnout
  • Working Hours – There is strong evidence and consensus that high, unmanaged workloads in Emergency Departments (ED) drive burnout, and that protected, sustainable working hours are critical for staff retention. Ring fenced EDT, flexible self-rostering, implementing sustainable working practices (breaks, finishing on time, doing work admin in work hours) all combat burnout. As a team, encourage emails to be only answered in work hours, whatsapp to only be used for emergencies or social contact.
  • Reward Greatness – We’ve already talked about positive event reporting on our podcast, and learning from excellence is one way to reduce a burnout risk factor.
  • Encourage effective appraisals – Supportive appraisals can help decrease burnout in Emergency Department (ED) staff by focusing on wellbeing and providing tailored support. NHS Employers notes that for appraisals to be effective in reducing burnout, they must move away from being purely performance-driven to being supportive, reflective, and compassionate.

 

Preventing Burnout – Individual

Developing resilience is important, but not the only solution. When pressures are higher than resilience, burnout can result. Resilience is a dynamic process that can be learned through acquiring resources. It is the ability of an individual to bounce forward to wellness after significant emotional and / or physical adversity.

All this means that whilst individuals can do a lot to prevent burnout, they can’t prevent it 100% of the time. Here, we group preventative tips into six key groups.

1. Lifestyle Tips

This is where you need to relax, in whatever way relaxes you. Interests and hobbies that make you happy are essential, as are your friends. They can roughly be split into “doing”, “being”, “becoming” and “belonging” activities, and enable us to be introspective, discover the self, look to the future, and form relationships.

Is it a hobby or an extension of work? If you lost your GMC number, and it meant you couldn’t do your hobby – it’s work. Bellringing = a hobby. Piano playing = a hobby. Model railway building = a hobby. Cake making = a hobby. Crowd doctoring = different work.

Hobbies could be a physical exercise such as jogging, dance, self hypnosis or meditation, a creative outlet such as painting, writing or poetry reading.

In his book First Things First, Dr. Stephen Covey shares the following story. One day a professor stood in front of his class with a large mason jar and a stack of fist-sized rocks. He carefully placed all of the rocks into the jar until they reached the top and then the professor asked the class, “Is this jar full?” The class said, “Yes.” The professor then reached under the table and produced a bucket of gravel. He poured the gravel into the jar and shook the jar so that the gravel fell into all the spaces between the rocks. He asked the class, “Now is the jar full?” The class had caught on by now and one student piped up and said, “Probably not.” Next, the professor pulled out a bucket of sand from under the table and poured the sand into the jar, filling all the spaces between the gravel. He asked, “Now is the jar full?” The class responded in unison, “No!” Finally the professor pulled out a pitcher of water and poured the water into the mason jar. The professor then looked at the class and asked, “What was the point of this illustration?” One eager student raised his hand and said, “The point is, no matter how full your schedule is, if you try really hard you can always squeeze more stuff in.” “No,” the professor responded, “That’s not the point. The point is that if you don’t put the big rocks in first, you’ll never get them in at all.”

 

 2. Physical Health

Eat healthily, sleep properly, exercise well. If the sled dogs need rest, so do you. ProjectSelf from EM3 is a great summary of this.

 

3. Give yourself a Break

Give yourself a mental break – turn off the tech, don’t sweat the small stuff, outsource as much as possible (get a cleaner, use ready meals), be positive and look for the silver lining, use humour, give things lack of permanence “my boss didn’t like that piece of work” is better than “my boss never likes my work”.

If there are any stressors, remove them, change your perception of them, or control your stress response. By being kind to yourself, you can reduce the negative or distorted cognitive patterns in life balance. Overgeneralisation, catastrophic thinking, maximise negatives and minimise positives, all or nothing thinking, mindreading, fortune telling, personalisation and a selective negative focus are all unhelpful patterns, yet things many of us do. Maybe you secretly enjoy helping people who are suffering, and enjoy the drama – read this blog on co-dependency by St Emlyns to explore that further.

Resolve conflict with yourself and your friends and colleagues. You might have inner conflict that you’re not good enough to be a Doctor, or you might have a different conflict that you should be spending more (or less) time with family – and some of this results from not knowing or being true to yourself. Self identity is really important.  Be kind to yourself – and be your own Compassionate Friend. Matthew Syed in his Sideways podcasts talks about how it’s easier sometimes to have an alter-ego who can be the super-hero. Create your alter – ego, but what would they say to you, and what would you say to them? Would you say “you handled that really badly”? Or would you say “you handled that well, and you might like to consider being kinder next time”. We listen to you more than I.

Enjoy this brief “compassionate friend” exercise:

  • Close your eyes and remember a recent time when you had self criticism
  • Imagine something to symbolise the critical voice – listen to what it says – notice tonality – notice how it makes you feel
  • Imagine something to represent the strong, compassionate friend part of yourself – listen to what that part is saying – notice the tonality and how it makes you feel.
  • Which is working better to encourage you to do better?
  • Practice until your compassionate friend activates as easily as your self criticism!

 

RCEMLearning image generated with Google Gemini

 

Turning off the technology to give yourself a tech break is really really important – take your emails off your phone, don’t log on, whatsapp for social only – and don’t connect. If something bad is happening, don’t listen to the news – it’ll only make you more stressed.

 

4. Have a physical break

Give yourself a physical break – have a change of scenery. Always plan a holiday – use the Tarzan principle and swing from holiday to holiday.  Cycle to work one day instead of driving – or get an Uber instead of a drive.

The physical break also gives you a chance not to be at work. Are you an “alholic”? Maybe the careaholic who gets overly involved with worrying about others. The workaholic- thinking about work all the time. The busyaholic – constantly on the go, yet not meaningfully engaged in anything? The Rushaholic – always speeding up, but not noticing what is going on around you? Maybe you prefer to think of your excesses in less addictive terms. Are you a Busy Bee gaining satisfaction from the fast pace of life? Are you an endurer, compromising yourself to get the obligatory tasks done? Are you a deferrer seeing the light at the end of the tunnel? Are you an outsourcer or a resister?

This physical break should be done daily – not a holiday every day, but a break from technology or work. Lots of places have developed leaving checklists that focus on leaving work at work, and enabling home to be home – should turn email off be on the list?

 

5. Appraisal and support

We mentioned before that the appraisal can be a useful way of talking about wellbeing with your appraiser – tell your colleagues how useful you found it, and tell your appraiser how wonderful it was, to get the conversation started. Share your experiences of burnout or rust out. Talk about the resources available for everyone – and access as needed. As a reminder, there’s BMA Counselling, and the Practitioner Health Programme available to everyone, and your trust will also have lots of resources available.

 

6. Your Department

We mentioned above how your department can begin to prevent burnout. Your department is likely to be a “volatile, uncertain, complex and ambiguous environment”. In these VUCA environments, psychologically safe leadership is essential – have a read of the Civility Saves Lives Psychological Safety page for more information.

If someone is absent from burnout, PIES is a framework for discussion that could be useful. Return to work interviews are mandatory in many places, but sporadically and badly completed. PIES is one frame work that can be really useful for supporting a colleague.

Proximity – if possible, try to keep colleagues working within the team (rather than going off sick), but reduce stress (e.g. through a temporary change of role) – this helps people to continue feeling valuable. It can be hard to return to work after a period of absence, so staying at work may support someone better.

Immediacy – address concerns straight away – use a ‘nip it in the bud’ approach

Expectancy – acknowledge that things may be tough for a while, but also that they will get better

Simplicity – if you are in a crisis and having a difficult time, it is often the simple things that help e.g. having a day off, having a good night’s sleep, eating well, phoning a friend

 

7. Treating Burnout

If you are burntout, you will get through this, and it will get better. Make a start today – and every step is a step forward. Stop what you need to stop, start what you need to start, and connect with the connections you need – occupational health, staff counselling, practitioner health, GP etc.

 Whether you are or are not burnt out, now’s a good time to do a body scan. Close your eyes, and start at your head. Take a few nice deep breaths, then run through and review. Notice your body, and correct any problems. Move down towards your toes. Well done.

 

Other Organisations that can help

  • Occupational Health Service – If you think that your health problem/s (physical or psychological) are affecting your ability to work, your manager can refer you for advice and support. Most hospitals let you self-refer to the Occupational Health Service.
  • Employee Assistance Programme is available 24/7 at most hospitals.
  • Chaplaincy Service – The chaplaincy service is there to support staff as well as patients and are equipped to cater for a range of spiritual beliefs.
  • Primary Care Psychological Therapy – Increasing Access to Psychological Therapy (IAPT) services are NHS primary care psychology services available across the UK, providing evidence-based psychological therapy. You can generally self-refer via online referral forms, or you can visit your GP and ask for a referral.
  • Frontline19: Free psychological support service for staff working on the frontline. Fill in the form on their website to book an appointment https://www.frontline19.com/  
  • Body and Soul: Provide specialized mental health support and counselling to frontline NHS staff, particularly to address traumatic stress and burnout https://bodyandsoulcharity.org/refer#referral-process
  • GP: Your GP will be able to refer you on to more specialist services where necessary and may have information on other forms of support available to you in your local area.
  • National Suicide Prevention Helpline UK – Offers a supportive listening service to anyone with thoughts of suicide 24/7. 0800 689 5652 https://spuk.org.uk/
  • Samaritans: Confidential, impartial support.     Call: 116123              [email protected]

 

SUPPORT FOR NURSES

Royal College of Nursing Counselling Service: 0345 772 6100
Nursing and Midwifery Council FtP Careline: Support line for nurses and midwives going through a fitness to practice process.
0800 587 7396         https://www.nmc.org.uk/ftpcareline

 

SUPPORT FOR DOCTORS, DENTISTS & SURGEONS
NHS Practitioner Health Programme: Provides specialist support to doctors and dentists. 0300 0303 300         [email protected]          https://www.practitionerhealth.nhs.uk/

British Medical Association Wellbeing Support Service
0330 123 1245         [email protected]
https://www.bma.org.uk/advice/work-life-support/your-wellbeing/counselling-and-peer-support

Doctors in Distress: A charity committed to eradicating stigma, change behaviours & cultures and promote the value of good leadership to reduce suicide rates of medical doctors. https://doctors-in-distress.org.uk/

DocHealth: Provides specialist psychotherapy for doctors of all grades.  Sliding scale of fees based on grade and circumstances. 020 7383 6533         [email protected]         https://www.dochealth.org.uk/

Surgeon to Surgeon Helpline: Confidential peer support for surgeons run by the Royal College of Surgeons 020 7869 6221         https://www.rcseng.ac.uk/careers-in-surgery/wellbeing/

Doctors Support Network:  An independent, confidential and friendly self-help group run by doctors and for doctors who have experienced mental distress or mental health problems. [email protected]      https://www.dsn.org.uk/

British Doctors and Dentists Group: A Recovery Group for Doctors & Dentists Addicted to Alcohol and/or Drugs 07850125119           [email protected]      http://www.bddg.org/

Sick Doctors Trust:  Support and help for doctors, dentists and medical students who are concerned about their use of drugs or alcohol.
Doctors: 0370 444 5163     Dentists: 020 7224 4671
[email protected]                 http://sick-doctors-trust.co.uk/

 

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Personal stories

    Editor’s note: We decided to publish this as an anonymous blog because although there shouldn’t be any stigma associated with burnout, we wanted to respect the author’s confidentiality. So so many people are or have experienced burnout, and we hope this blog helps with taking the first steps to recovery. If this hits a note with you, please take the first step and seek out your support system.

     

    I didn’t realise I was burned out until I was properly scorched. I’d been close before, but thought I was doing ok this time. Even proud of myself for noticing things were getting challenging and taking the occasional day off to rest. Obviously, I told people I had a “migraine” – no need to admit you’re struggling, huh? And I never really rested. I mostly moped and worried about being behind on things. But I carried on. I knew I was snapping at people more than usual – totally their fault though, not mine, right? I was angry a lot of the time. And quite tearful sometimes, getting upset by little things. I put that down to being tired. I hadn’t been sleeping well for a while. Probably the caffeine. Way too much caffeine. And sugar. And, yes, probably more alcohol than usual. But that caffeine and that sugar kept me going and the alcohol helped me unwind at night. It’s difficult to stick to healthy meals when you’re working all the time. Like, literally all the time. Meetings from 8am, late shift finishing at midnight, but staying late because how will they cope if I don’t? On evenings off, working until late at night in front of the TV. Because if I didn’t do things, who would, right? And it all needed doing. Right now.

    There were lots of arguments at home, and the kids were playing up. I was way too busy to catch up with friends, get any exercise or do anything that might resemble relaxation. And there was COVID. I’m not completely blaming the virus, but it really didn’t help. Not only the increased workload, but the worry about keeping my family healthy, and the social isolation. Plus school closures not only stripped the children of their education (meh, they’ll catch up), but their contact with friends and their routine. Pent-up energy, lifestyle changes and young children is not a good mix. It also took away any chance of “me-time”. I was working way too much at my paid job, then straight home to work too hard at home, both doing work-related admin and being a parent. But I carried on.

    Someone I trust took me to one side at work and said people were worried about me. I had literally no idea why – yes, I was finding things tough, but I was coping, right? And doing a great job of putting on a game face….. Right??

    But then I got worse. More tearful. Anxious at silly times. And, although I didn’t make any mistakes, I was really struggling to make decisions as quickly as usual. I even started to think about what it would be like not to be around anymore. I wasn’t planning anything, but started to think that, maybe, if something happened to me, it wouldn’t be all that bad, really. Then came the clincher. I woke up one morning and couldn’t get out of bed. Not that usual thing of not being a morning person, or hitting snooze again, but literally not being able to get myself out of bed. I couldn’t function. I needed to take some time off.

    A week, I thought, maybe two? I didn’t want to be off for long. I felt awful about leaving my colleagues in the lurch, my to-do list was far too long to ignore, and it would be growing by the day. How would the department cope without me? And I did feel a bit better after a week. A bit of sleep, some crying, lots of comfort food. But I crashed again, without warning, over nothing.

    The realisation that this wasn’t going to be a quick fix took a long time to hit home. I mean, everything we see has to be sorted in four hours, doesn’t it? An illness lasting months just doesn’t seem feasible. I had days when I felt a bit more like me then, for no reason, the next day I’d be back in the deepest, darkest pit of hopelessness and sadness. Not only was I depressed, I was anxious. Popping to the shops left me shaking, lightheaded, feeling sick and completely unable to choose which flavour crisps to buy. What was wrong with me? I’d always thought of myself as pretty resilient. I was definitely not the type to have a panic attack in the confectionary and snacks aisle.

    Occupational health were lovely. This happens to lots of people, they explained. I needed to get some rest, get more fresh air, try some mindfulness exercises. That broke me. I didn’t have time for rest, fresh air or mindfulness. I needed to get on with work and play my part at home. I was too busy, with too many demands on me to do yoga or Sudoku. Some of my work colleagues were great, sending messages of support and offering to talk. I didn’t want to talk though. I didn’t want to see anyone. I didn’t tell people I was off work unless I had to. I felt a bit ashamed, I think. My line manager didn’t help with that. “Time off won’t help”, “You need to sort your life out”, “I don’t know what you think I can do” and, “I can’t rely on you anymore”. That was nice and supportive, wasn’t it? Forget all that “It’s ok not to be ok” stuff, huh?

    Eventually though, bit by bit, I’ve started to recover. Rest has helped. Friends have helped, when I’ve felt strong enough to see them. Knowing that people care has really meant a lot. I’ve started to realise that the department can survive without me. It’s ok to trust other people to get things done. Spending time with my family, actually being present and not distracted by my phone, has been lovely. And spending time alone, learning to be comfortable with doing nothing, or close to nothing, has been wonderful.

    Counselling has helped me to realise the areas I need help with. Occupational health, despite my initial thoughts, have been great – guiding and supporting. Practitioner Health, the NHS service which cares for healthcare professionals, has been an eye-opener. Helpful and practical, as well as a great reassurance that I’m not alone.

    My line manager? Well, actually, he’s made me determined to get better, so I guess I’m grateful to him too.

    I’m not over this yet. I might never be, and I’ll always be wondering if I’m near the edge again, but I’m definitely in a safer space, away from the precipice and feeling so much more hopeful about making it down the mountain.

    I know, I’ve mixed my metaphors, but who cares? What I want to say, I think, is that it’s really, really difficult to admit, even to yourself, that you’re not ok. But it’s the first and biggest step to getting better. Mental illness can happen to any of us, especially at the moment with the pandemic and the demands on emergency physicians, and it’s important to be kind to yourself, and each other.

    After 5 years of guilt free pleasure outside of NHS working on the cruise ships and providing ad hoc locum work in local EM departments for a pretty sum (to pay off an ugly mortgage), I am approached by one of my consultants who says, “you’ve had your fun, but now it’s time to grow up”. I admit the thought of working the same job for half the pay and less flexibility didn’t seem too attractive at first, but then again it would be nice to finally be called a consultant.

    Having successfully landed an ST4 training post, I start my first job in a small, yet busy, rural ED in Merseyside. I am excited and enthusiastic about this new training job and I enjoy exchanging stories with my colleagues who later fill me in on all things e-portfolio.

    A few months into my attachment things aren’t quite as light and fluffy as they once were. Impending “Winter Pressures” have arrived in fine form, with once empty corridors now replaced by reams of trolleys filled with sick patients, accompanied by hawk-eyed relatives and disgruntled paramedics eager to get back on the road.

    What was once considered an exciting challenge, is now viewed as a lost battle, where chronic understaffing and serious underfunding continue to ask all of us to give a little more each and every day.

    Outside of work my personal life is no better. The things in life that used to give me so much pleasure like playing squash and going out for drinks with the boys was slowing being replaced by social exclusion and a constant need for sleep.

    I pack my bag for the weekend nightshifts. As I pull up outside of the ED I see a queue of ambulances outside and walking through the waiting room, not a single empty seat. Tonight’s going to be a tough one. No sooner have I walked out of the changing room, has an ECG been cast in front of my to check.

    As I work alongside my colleagues to tackle an 8 hour wait, one of the nurses states that a 24 year old woman who has taken a mixed OD of antidepressants wants to discharge herself and that security are currently with her.

    I ask the mental health (MH) nurse to accompany me for a capacity assessment. When we get there, the young woman has her hoodie up and barely makes eye contact let alone participates in conversation. Fortunately the MH nurse is free to sit with our patient and finally brings her round to the idea of having bloods taken and staying for a cup of tea and a sandwich. This victory is short lived when I am later informed that she has run away leaving behind her an iphone and personal possessions.

    Half an hour later I take a stand by call. “Young woman found hanging from a tree, in cardiac arrest. ETA 5 minutes”. My worse nightmares come true as I find myself team leading a resuscitation effort for the young woman I had spoken to only moments before.

    Fast forward to my final night shift. I wake up in my dingy hospital accommodation and do the slow walk of a man who looks like he is on his way to the electric chair. The cold, dark corridor leading towards the ED is the final opportunity I will have alone with my thoughts before putting on this mask again in front of others. A feeling I have felt for quite some time now.

    The night passes and it’s finally over, I hand my patients over, throw my hoodie on and drag my feet to the audit department to discuss one of my personal projects. When I arrive I suddenly experience a strange feeling.

    My head is now a lead balloon and the room is swaying in motion. A sudden sense of nausea washes over me and I need to vomit. They point me in the direction of the toilet and I bounce off the walls like a drunken buffoon before redecorating the bowl.

    The audit team offers to take me back to A&E but that isn’t happening. I just need to sleep this off. I ‘drunk walk’ my way back to my hospital room, neck a pint of water and go straight to bed. I wake up and thank god I feel back to normal, except for a mild headache.

    Over the next 5 days I just cant shift this headache. I phone up a friend (another EM Registrar) and tell her, “I had a near collapsing episode 5 days ago at the end of a night shift and I’ve had this headache since”. The penny drops. Before I can answer my own question, she lectures me on how stupid I am and insists I get to A&E immediately for a CT scan. My friends are on shift and before I can even sit down I am being summoned to the CT scanner. My worst fears materialise as I ask to see my scan and notice a large black spot over my left cerebellum. I’ve had a stroke!

    Unfortunately I’m not cool enough to blame this on a sex, drugs and rock’n’roll lifestyle. Was I just unlucky? Or was it stress-related?

    The truth is that having being diagnosed with a ‘Cryptogenic Stroke’, I’ll never know. However, I feel very fortunate to be able to state that I have made a full recovery. Although my CT scan will always serve as a constant reminder of the dangerous effects of stress and depression. Following some regular NHS funded counseling sessions I now work 80% LTFT and feel much happier in myself, which additionally allows me to be a better doctor to my patients.

    So why tell this personal story to thousands of strangers via social media? Is it the catharsis of putting thoughts on paper and making sense of recent events? Perhaps. But more importantly, I feel ‘Burnout’, ‘Stress’, ‘Depression’, or whatever you want to call it is extremely difficult to define. Although we are probably more qualified than most to diagnose these conditions in others, there is a personal pride that clouds judgment in the diagnosis of self.

    Unfortunately my story is not unique and I would bet serious money that we can all account variations of this story during at least one part of our careers (junior or consultant). Chronic exhaustion, mental slowing, impaired concentration, compassion fatigue were all telltale signs I was experiencing burnout.

    So what is burnout? This is a difficult question as no one has been able to agree on a formal definition. Furthermore, if this is impossible define, how can we diagnose this in ourselves? Interestingly, burnout has also been labeled as ‘Overachiever Syndrome‘. From this, I would conclude that doctors of all specialties are at risk just through recognition of their prior achievements. However, burnout is not unique to healthcare, with many other industries including banking, teaching and sales being equally at risk.

    Extremely hostile work environments with long waiting times, increased patient expectations, poor staffing ratios and the sickening sense of guilt felt examining patients on public corridors, clearly all play their role in burnout. So what can we do? Our environment is unlikely to change given the yearly trends, so we need to look elsewhere if we are to help reconcile this problem.

    If you type ‘how to deal with anxiety / depression / burnout’ into google you’ll likely read a variety of self-help advice, including the importance of healthy eating and drinking, the need for adequate sleep and the physiological benefits of daily exercise, as well as the increasingly popular practices of meditation and mindfulness.

    Although I believe all of these are important, it does strike me as the metaphorical equivalent of telling prisoners in Guantanamo Bay that they can maintain a healthy outlook on life with lots of self-practice and daily scheduling. In other words, perhaps changing the work environment is a better method of tackling this problem.

    The NHS is the biggest employer in the UK, yet employee morale and team building is very low down the agenda (probably for financial reasons). When I worked on the Cruise Ships we had a dedicated Crew Welfare Officer whose primary responsibility was to organise regular social events and I would argue their job was among the most important.

    So, instead of self-help here are some other practical ways that may provide everyone with ‘Burnout Prophylaxis’:

    • Arrange Team Building Sessions

    Try to create a social committee (Consultants, Trainees and Nurses) in your ED for everyone. Organising a meal, activity or just drinks once a month will allow everyone to get to know each other on a more personal level.

    • Motivate your Team Regularly

    Try to engage everyone that you meet. Learning what is going on in other peoples’ lives is at the very core of a community spirit and is likely to lead to better conversations than those regarding busy wait times or work politics.

    • Set Clear Goals

    All humans need personal goals to maintain high self-esteem and grow as individuals. Want to learn EM Ultrasound? Practice. Want to be a better Trauma Team Leader, insist on being watched. It’s all your responsibility!

    • Show Appreciation

    Tell your juniors that they’ve done a good job. Make notes of excellent practice and feedback to their supervisors. In some hospitals they have A&A (Amazing & Awesome) or Greatix reporting systems to highlight excellent practise.

    • Create Positive Competition

    A&E versus AMU 5-a-side Football? Inter-hospital Tough Mudder? I’ve even heard of Major Incident Training where other hospitals send enclosed envelopes to other hospitals with secretive Major Incident Scenarios… Nasty, but fun!

    • Be Inspirational!

    All of these ideas above require action. It’s easy to wait for others to organize events, but leading by example is the sure way to promote change in a longstanding culture.

    Links are attached below for more advice on burnout, anxiety and depression. If you feel that these issues apply to you please remember as an NHS employee you have access rights to free counseling through your lead employer. It’s free, and extremely helpful!

    Most importantly, look out for each other!

     

    Further reading/resources

     

    Naturally online resources can only help so much and if you feel your mental health is having a major impact on your daily life or your ability to provide quality care to your patients, I would strongly recommend contacting your local occupational health department for a personalised assessment.

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