American College of Physicians: Internal Medicine — Doctors for Adults ®

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Write this down: ways to overcome burnout

From the July/August 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Edward Martin

NEW ORLEANS—For some internists, the pressure was noticeable as far back as medical school. "The people who are rewarded are the ones who don't need sleep and have a 13-megabyte hard drive in their head," explained one physician.

Others found the demands became intolerable after they finished training and entered practice. "Expectations have gone berserk," said Philip R. Alper, FACP, an endocrinologist in Burlingame, Calif.

For the mostly male group of 100 internists gathered at an Annual Session presentation on preventing burnout, one thing was clear: There is no easy way to stay invigorated in a profession that strains altruism, taxes emotional and physical stamina and tests the family and social bonds that are so vital for support. Nonetheless, they shared techniques for dealing with change and disillusionment in medicine and ways to renew their energy.

Several physicians, including William M. McClatchey, FACP, an Atlanta internist and rheumatologist, said that keeping a journal focuses attention on personal issues and provides time for contemplation. "Writing is a real catharsis," Dr. McClatchey said. "I've got a very full hard drive to prove it."

Another physician who began a journal eight years ago told the group that he discovered early morning writing sessions before his wife and children were up helped him work out a troubled period in his marriage. "I realized I had not really been listening to the things my wife was telling me," he said.

One physician has begun reading aloud with his family and having them role-play each other at dinner. "My kids say, 'This is dad,'" he said. "It's amazing how they can see the things you're trying to hide."

Another doctor described how he returned to playing the violin after a 20-year hiatus, while several others adopted exercise programs or became active in churches or synagogues.

One key, explained Linda Hawes Clever, MACP, medical director of the Health Professional Renewal Program at Sutter Health System in California, is to guard against forces that sap energy. "'No' isn't a sign of weakness, it is a sign of strength," she said. "No, I have to go to my child's soccer game. No, I have to go for a walk. No, I have to take care of myself."

Finally, Eric B. Larson, FACP, medical director of the University of Washington Medical Center in Seattle and a College Regent, suggested that physicians—particularly those who are workaholics—examine why they work so hard.

In his current post, Dr. Larson has had to counsel a number of physicians who had lost their jobs. "The ones most successful coming out the other end had answered for themselves, 'Why am I doing this?'" he said. "Is it love of the task, or is it just to be the chief Pooh-Bah? If it is merely ambition and all you want is to be at the top of the pile, you've got a problem."

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