Peter Brindley and Matt Morgan: Burnout in healthcare workers—are we surprised?

There is a picture of a vending machine that went viral. This is because a note was placed on the glass that describes how many of us feel: “the light inside has broken, but I still work.” Sure, there are “lies, damn lies, and statistics,” but approximately half of healthcare workers appear to be struggling against psychological burnout. Melodrama aside, when we come to work we are battling for more than just our patient’s health. The diagnostic criteria for burnout are woefully imprecise, but usually encompass exhaustion, depersonalization, and loss of meaning. Given that much of modern society recognizes those same symptoms in themselves we ought not to be surprised. Along with everyone else, we healthcare workers are tired of being asked to do more with less. Please just allow us to put on our own oxygen mask before assisting others.

Healthcare workers are not asking for special consideration, or even fawning praise, but a bit more give and take would help. Let’s be clear, many days are great and many patients are lovely, but certainly not all. Call us old-fashioned but we are growing weary of being pelted with expletives and threats. Of course, terrible stuff doesn’t happen everyday, but the cumulative effect takes a toll. As outlined, doctors and nurses are not special. Therefore it is informative to paraphrase the UK policeman John Sutherland who wrote a moving memoir entitled “Blue: Keeping the peace and falling to pieces.” He points out that the bobby’s maxim “every contact leaves a trace” applies to coppers not just crime scenes. Back in our medical world, resuscitation can be difficult, and end of life issues can be draining, but it’s being treated like crap that is the most exhausting. With that in mind, just a friendly word to the medical brass: keeping up with clinical advances is a walk in the park compared with accommodating computers and administrative edicts.

Modern life is tough for all of us. It is stressful and stress-filled, and algorithms are replacing humans at a terrifying rate. Accordingly, perhaps we’re not even surprised at the tsunami of drug abuse, or that suicide is one of the Western world’s commonest causes of death. Many of us are exhibiting varying levels of despair. Doctors and nurses are not immune, but we are famously bad at seeking help. The rate of death by suicide among healthcare workers is 2-3x the rate of the general population. Clearly, we have a problem, but so does the public that relies upon us. These abstract statistics mean the very real loss of 500 doctors per annum in the United States alone. Expressed another way that is an entire medical school each year, or more than one doctor per day.

When a doctor or nurse suffers from that euphemistic state called “compassion fatigue,” and the job has been squeezed of all its juice, then the public probably doesn’t want us as their state appointed professional. Fortunately, there is a simple cost-free way of improving morale. It is no panacea, but a genuine “thank you” is often all we need; well, that and occasional baked goods. In contrast, studies are showing what common sense would otherwise intuit: if rudeness were a drug it would come with warnings on the label.

During resuscitation, rudeness has been shown to worsen performance both at the individual and team level. This might seem intuitive; what is fascinating and terrifying is the extent of its harm. Rudeness may affect outcome more than fatigue and it cannot be conquered with technology. Early rudeness studies involved nothing more than a doctor phoning into a resuscitation simulation. The physician actor merely told the healthcare professionals that “they did not know what they were doing”, and that “he would not want his loved-one in their hospital.” Follow up studies looked at the impact of families being rude to healthcare professionals, and showed a similar detrimental effect. In short, rudeness is not only unnecessary, it can be dangerous.

Of course, we professionals sometimes simply need to “suck it up”. We also need to bring our best self to work, and to remember that patients and families are often having the worst experience of their lives. Equally patients and families should speak up when care is insufficiently delivered and inadequately communicated. But there is never an excuse for rotten behaviour. Remember that “hurt people hurt people”, and that behaviour might be as contagious as the common cold. The expression can also apply to the likelihood of medical errors. Hurt people don’t mean to hurt people although unknowingly they probably do.

As doctors and nurses we fear burnout like patients fear that conversation when the test results come back. The term “burnout” is currently carrying the load for emotions ranging from everyday frustration to clinical depression. As such, let’s not unfairly apportion blame, or offer platitudes and bromides. Adversity presents each of us with a choice to be the best or worst version of ourselves. These authors have both been the victims and perpetrators of rudeness, and we offer a belated though sincere apology. Much like that vending machine we all need to keep on working. Going forward, we politely suggest that we all pull together so that the light remains on.

Peter Brindley, Professor in the Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada @docpgb

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan