Dr. Sanziana Roman, Professor of Surgery at the University of California San Francisco, posted those words in her Twitter feed earlier this spring, on National Doctors Day. In a thread that garnered thousands of “likes” and hundreds of “retweets,” Roman shared her experience with burnout — its roots, ramifications, and how she’s managed to overcome it.
We’ve reached out to Dr. Roman, who graciously allowed us to republish her posts in the spirit of helping fellow healthcare professionals. You’ll find the full thread transcribed below (minus the many comments she received).
(You can read the original post, interact with Dr. Roman and other commenters here.)
I am going to make a confession. I too, along with thousands of doctors, once suffered from burnout. During residency, I thought about quitting pretty much all the time. I burned out again through my professional life. Now that I have overcome it, I’ll tell you what I learned.
For me, the greatest contributor to burnout was fatigue. In residency it was physical combined with mental fatigue with the sense of loss of power over my own person. (That was in the 90s, so put it into perspective.) This is pretty common among trainees. Winters were worse.
Seasonal affective disorder is real and can come upon anyone, especially if one is mentally and physically tired. Additive are toxic environments leading to feelings of devaluation, disrespect, inadequacy, giving rise to insecurities and “impostor syndrome.”
Yes. I believe it IS is exogenous and systemic. Recognizing this allows one to overcome it. Whether you are a med student, resident, attending or leader, observe your environment, find what is oppressive, aggressive, toxic, and change it.
This takes me to my next point: The next clear contributor to burnout is loss of a personal sense of purpose. In my later years, whenever I felt the symptoms of burnout and depression, I could trace it to (1) toxic environments and (2) loss of purpose. The latter can happen in multiple ways.
One’s sense of purpose erodes when one’s work is devalued, biases start mounting (attribution, gender, halo, affinity, veiled or not racism, homophobia, etc.) topped with systemic “thousands of paper cuts” stressors (RVU targets, EMR, inefficiencies, blame games, competition).
To gain this back, we must reset our professional/personal sense of self: Who am I? Why did I do this in the first place? What are my talents? How can I put those to use? Who values my work? Can I be better? What areas can be improved? We must be kind but honest with ourselves.
If the environment is toxic, change it (whatever that may mean). Get back your sense of purpose. Bring back your sense of empathy, altruism, and kindness. Speak out against injustice toward you and others. Be courageous. Don’t hold grudges. Forgive, don’t forget. Find allies.
In summary: I overcame my burnout by regaining a sense of control over my time; changed toxic environments; rediscovered my sense of purpose; became outspoken and unafraid; became kinder and more patient toward others; made allies, and honestly… I slept more.
Does Dr. Roman’s experience resonate with your own? How have you managed stress as a healthcare leader, and how have you empowered teams under your care to prevent and overcome burnout?