Join Sharee Johnson, registered psychologist and executive coach as she describes the landscape of practitioner burnout, including the contributing factors to increasing burnout numbers.
Defining burnout, Sharee discusses Christina Maslach’s definition of burnout with our ambassador, Dr. Michelle Woolhouse, identifying areas of vulnerability for practitioners within the healthcare profession.
Sharee refers to the PERMA model when explaining to Michelle how practitioners can support themselves to both evade and recover from burnout, focussing on personal safety and agency.
COVERED IN THIS EPISODE
[01:07] Welcoming Sharee Johnson
[01:27] Defining burnout and how it differs from anxiety
[04:44] The wellbeing continuum
[10:57] The PERMA model
[14:39] The power of agency
[21:36] Strategies to flourish
[25:16] Psychological safety
[29:55] Navigating post-lockdown anxiety
[34:19] Sharee’s tips for preventing burnout
[38:28] Thanking Sharee and closing remarks
- Historically, the culture within the medical and healthcare system has involved competition, stoicism, putting others first and refusal to ask for support.
- The definition of burnout is based on Christina Maslach’s definition involving:
- Extreme exhaustion
- Loss of self-efficacy and self-agency
- The wellbeing continuum presents wellbeing as being highly dynamic with many factors influencing our wellbeing.
- Patients can identify practitioners who are ‘surviving’ or ‘languishing’ or on the verge of burnout which may influence their confidence in the practitioner’s capacity to support them.
- Listening to, connecting with, and being present with a patient is an important clinical skill.
- Martin Seligman was one of the first psychologists to redirect his research from what does wrong in psychology, to how those who are happy and well adjusted manage to maintain this state. This was done through the PERMA model which includes people who:
- Demonstrate positive emotion
- Are really engaged
- Positive relationships
- Agency is about your personal power to influence outcomes and accomplish our desires.
- Small amounts of consistently regular contemplative practice may support neurological change and and increase in resilience.
- Psychological safety involves the ability to speak up and own a mistake in the workplace to allow for growth, learning and development without fear of retribution.
Resources discussed by Sharee in this episode
Further reading and additional resources
Burnout in healthcare
|Research: ‘Analyses of burn-out among medical professionals and suggested solutions – a narrative review’. Journal of Hospital Management and Health Policy, 2022
|Research: ‘The future of Australia’s nursing workforce: COVID-19 and burnout among nurses’, The University of Melbourne, 2021
|Article: ‘Burnout in healthcare staff is common – and can make empathising with patients difficult’, The Conversation, 2020
|Article: ‘How to tackle burnout among healthcare workers’, Grattan Institute, 2022
|Article: ‘A burnt out workforce impacts patient care’, NewsGP, 2022
|Research: ‘Burnout among healthcare workers in the COVID 19 era: A review of the existing literature’, Frontiers in Public Health, 2021
|Research: ‘Burnout in healthcare workers: Prevalence, impact and preventative strategies’, Local Reg Anesth., 2020
Practical Advice for Burnout
Dr. Christina Maslach
Michelle: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr Michelle Woolhouse, and joining us today on the show is psychologist, mindfulness meditation teacher, and wellness coach for doctors, Sharee Johnson. Welcome to FX Medicine, Sharee.
Sharee: Thanks so much, Michelle. It's terrific to be here.
Michelle: Today we're going to discuss caring for those who care. Caring for the healthcare provider, the practitioners, the doctors, the allied health staff, and even the patients who might be caring for a family member who's sick. So, often, medicine's prevailing culture or even the whole of healthcare is that of competition, stoicism, showing no weakness, never asking for help, putting patients first irrespective of what's happening for you or in you, and ignoring everything internally.
Sounds like a recipe for burnout. So, what is burnout, Sharee, and how does it differ from anxiety?
Sharee: Wow, a really good question to start with, Michelle. We mostly use Christina Maslach's definition of burnout. So we're still using that framework of extreme exhaustion, the kind of exhaustion that having a couple of days off doesn't seem to really ameliorate. Depersonalisation, where we're really becoming quite removed and hostile and cynical about the work or the purpose of the work or our mission. And Christina Maslach's more recent research is really pointing to this attitude of cynicism that is a problem in burnout. And that third part of...that loss of self-efficacy, where we really feel like, what's the point? Nothing I can do makes much of a difference anyway. Really losing our sense of agency and feeling empowered, that we can contribute or support the people we're trying to help.
So, those three things together. A lot of the research around burnout says most of it is in doctors. There's some research for the nurses. It's really quite hard to measure these things in real-time and when people do measure it in their organisations, they're hesitant or even reluctant to share the data. So it's quite hard to get a hold of, but most of the research says about 50% of people will have a burnout experience in a 12-month period in healthcare. What that really means is one of those symptoms. So I think we need to get a little bit more nuanced in our understanding of the research. That we're not really saying that people are having all three of those things and they're actually burnt out and left work. We're really saying when people self-report saying they've had at least 1 of those symptoms in the last 12 months.
So when we try and distinguish it from anxiety... Anxiety is, well, of course, we can have specific phobias and so on, but often anxiety is a generalised experience. When we're talking about burnout, we're still very much talking about work. So the landscape is changing all of the time and there is research and a lot of leadership, literature, and so on now that's talking about burnout in relation to parenting or caregiving, or other kinds of burnout. But the burnout that I'm interested in and that I'm talking about, and that the research is still mostly grounded in, is in relation to the helping professions, so work. And it's very specific to that.
In the pandemic, of course, we've had lots of experiences of anxiety that's much more generalised across whole workforces, this experience last year of bringing the pandemic home to our families because we were doing work where we might be exposed to COVID-19. But that anxiety is really, I want to say new, it's not really new, it's really amplified in the context of COVID. So I think we're still really learning a lot about that.
Michelle: Absolutely. It was such a new experience, wasn't it? So you mentioned in your book, and I love this statement as well by the World Health Organization who define health as more than the absence of disease, and that it is a state of physical, mental, and social well-being. So, a definition that I think really underpins the whole of the naturopathic world's principles, but not so much do we see that in the mainstream.
But if we dive a little bit deeper, the word “well-being” has been bandied around so much over the last decade. We've got a whole wellness industry now that we never had 10, 20 years ago. You write about a thing called the “wellness continuum,’ which I thought was great to further break down all those varied aspects of our well-being. Tell us about the well-being continuum and how we can assess this in ourselves, perhaps, as practitioners but also in those that we support.
Sharee: It's interesting how our thinking keeps developing, doesn't it? I probably am starting to think of it as a well-being spectrum more than anything now. But certainly, we are all on a continuum all of the time in the sense that our well-being and our wellness is highly dynamic. So we don't know what will happen in the next moment, in the next hour, in the next day. And all of those contextual possibilities can change our experience of well-being or wellness. And the classic example is going to the doctor to receive results and being on that anxious edge of what the results will tell us about our health. So that can change in any moment.
But the well-being continuum really is us moving up and down between surviving, coping, really flourishing and thriving, back up the other end of languishing. Languishing is not depression, but it's that very flat effect where we don't feel like we've got much energy, and we can't really be bothered, and we really have to work a bit harder to rally ourselves to do our usual things.
And then through to burnout, and you might extend it further along to be chronic depression or something. The wellbeing continuum in "The Thriving Doctor" in the book is a double-headed arrow, because to give that feeling of movement and to say, "Well, I don't really know where the end result is, perhaps the end is when we're dead.” I don't know. But certainly...
Michelle: Oh, yeah, that's such a dynamic state, isn't it? And we rely upon our coping strategies, and some of them are fantastic and helpful, and some of our coping strategies are not so good, really, aren't they?
Sharee: Absolutely. Yeah. Absolutely.
Michelle: And so we can kind of be coping but we're actually using an unhealthy coping strategy, which will then end up kind of taking us backwards on the wellness continuum.
Sharee: Totally. And I think in health we often talk about surviving. People say, "How you going?" We'll say to our colleagues, "I'm surviving," as if that's okay and that's enough. And that's really not enough on a day-to-day, week-to-week, year-to-year basis. It's good to be surviving, we want to be certainly managing and surviving. Our whole homeostasis, our whole body is set up to help us survive.
So, certainly, that's good and that's an achievement in a context where we're working under a lot of pressure in the pandemic, and so on, surviving in itself is something to be celebrated. But it's really not thriving or flourishing. It's really the classic, “I'm just keeping my head above water” sort of scenario. And I think we can do much better than that in health.
Michelle: Yeah, I think so too.
Sharee: We need to be walking the talk. I know, for me, if I go and see a health professional who appears to be well and healthy and resourced and able to be present and listening to me, and truly in the room, that's a much more positive, encouraging experience. I'm more willing to trust their...
Michelle: That's right. Yeah.
Sharee: ...what they might be sharing, than somebody who looks like they're hanging on by their fingernails.
Michelle: That's right. I know. And we all liked it. Flourishing is almost like an addictive experience. Like when we're around people that are flourishing, it kind of helps lift us. We get lifted to sort of that higher energetic point, really. And when we're with people that are languishing, I love that word languishing, I think we need to spread that around a bit more, languishing and burnt out we can feel it. We're energetic beings that we share each other's energies. And so, when you are sitting with a healthcare practitioner that might be languishing or burnt out, I think the patient can feel that and then that would, equate to, I guess, less confidence, and then that's a negative experience, really, for the patients who are looking for support themselves.
Sharee: Yes, it is. And you're really pointing, I think, to one of my current little things that I'm working on is this idea of clinical skills. Perhaps it's more in medicine, perhaps more than in some of the other integrated and allied health professions, but this idea that really attending to a person, being present, sharing positive energy, which we know is contagious as you're pointing to, is a clinical skill, in fact. Listening and being present is a therapeutic treatment in and of itself. And so this idea that we would call that a non-clinical skill seems to be wrong to me. I think that it is a primary clinical skill to be able to meet and connect with another person. And if you're with a patient or a client who is vulnerable or scared or just sick, then being able to be fully present with them and to hold an energetic space that's warm, and trusting, and encouraging is a therapy. And so, I think we really need to start reviewing some of our language. I think the clinical skill is really referring to our technical skill, or I was chewing around that that might be a science skill.
Michelle: Kind of a knowledge base. Yeah. Around knowledge base you know?
Sharee: Yeah, but there's a lot of science behind compassion and empathy and a lot of the psychology that I'm working with, and there's a lot of empirical evidence-based science there. So it's not really even the science or the non-science or the science and the art. So language can be a bit tricky sometimes but I think that we want to revisit the idea that what we might traditionally think of as soft skills or people skills, as non-clinical skills, I think that's a bit of a trap that we might have walked into that we should revisit.
Michelle: Yeah, I think you're right. In your book, "The Thriving Doctor," which is a great read, by the way...
Sharee: Thank you.
Michelle: ...you talk about the father of positive psychology, Martin Seligman. So Martin was one of the first psychologists or one of the first-known psychologists to shift the research frame of psychology from looking at what goes wrong in human mental health and behaviour, and then going on to ask questions about what goes well.
So he wanted to know what people with no pathology did that was keeping them well. And he came up with that framework to discuss this, which was the PERMA model. Tell us about the PERMA model. Because I think, actually, if we can really understand this, we can use this as practitioners, not just for ourselves, but for our patients as well. So tell us about the PERMA model. How does that work?
Sharee: So I think when Martin Seligman started asking that question exactly as you describe, instead of saying, "Why isn't anybody saying, Well, what are the well people doing?" So, when he started asking that question, he really concluded that there wasn't a recipe. There wasn't one prescription that we could give people. And so what he concluded was that actually the people who were doing really well, who were flourishing and really thriving, have these ingredients, but they have them in varying amounts and they have them in this very dynamic process.
So that those five ingredients, more positive emotion, so they feel pleasure and happiness and they know how to savour it and build it and grow it to have more positive emotion in their lives. That they're really engaged in the things that they do in their life, that if they notice, if they love riding their bike, that they do more of that. That if there's somebody who they feel happy when they meet, they make sure they meet that person more often.
So they look for the things that they feel really naturally that they're drawn to, that they're engaged in, and they've become skilled in those areas. So they really have those experiences of flow where they're totally immersed in something and enjoying it, and it's giving them energy instead of just drawing energy from them.
Really positive relationships. And that might be with pets and animals, as well as people that they are invested in relationships. They don't see that as a nice byproduct. They're actively engaged and involved in building and valuing those relationships. Lots of meaning. So the work around understanding the purpose, why they're doing a thing, which I think we lose in health often. We have very clear meaning and intention and purpose at the beginning, but we get so immersed in the bureaucracy and the systems and the pressure, that we sometimes forget what we're doing there in the first place.
So really tuning in to this sense of belonging and connection and service, what's the purpose of me being here? And then accomplishment, and we sometimes call this autonomy or achievement when we talk about self-determination theory. So this idea that as a self-propelled adult, particularly, and we see this also in our teens, of course, and even with small children, but just not consistently, we want to have a sense of being able to set our mind to doing a thing and achieving it. To being able to look back and we know, I mowed the grass on the weekend, it's a great sense to look around and go, "Oh, doesn't that look neat and tidy." That feeling of being able to decide to do a thing and then be able to deliver that thing, which, again, I think is challenge for many of us in health, inside these big complex systems. We forget that there are many things that actually we did achieve in the day. And so, coming back to noticing.
And so a lot of the practices that some of the other people in wellbeing talk about are savouring and appreciation and gratitude. And you can see those tools all through the PERMA model. We're not letting the positive aspects of our life just slide off like Teflon. We're really noticing them and locking them into our memory and appreciating them in very active ways.
Michelle: Yeah. And even just managing our goals, not setting our goals too high that's unachievable. So setting really achievable goals can make a big difference to how we experience accomplishment, because if we set our goals way into the future, then it's a long time in between accomplishment. So, yeah, so it's a wonderful way to kind of reframe, I think, what thriving is because really, if we're languishing or we're burnt out, then we want to go beyond surviving into that flourishing mode.
And I want to read this definition you have in your book because it's really great. And I think, as people listening to it, it's like we need to ask ourselves, does this sound like me? So, you write, "A flourishing practitioner is upbeat, enjoys their work, feels like they've got the work-life balance sorted most of the time, is committed to partnering and collaborating with others, values their relationships, is emotionally in tune and has a can-do mindset most of the time. They're able to manage their own internal responses to their work as well as the external environment, including the complexities of healthcare electively. These practitioners are empowered and fulfilled, and they can feel their own agency in their life."
Wow. And I particularly love the last line of this “feel their own agency.” And you go on and talk about this professor of organisational behaviour, Jeffrey Pfeffer, and you quote him. And you say, "Power is one of the most important things that we need to build in ourselves." And he says, "We have to basically seek our own personal power like our life depends on it." Tell us about agency. How do we get more agency? What do we mean by agency? Because I often think that sometimes the word power feels too strong for some people and they kind of avoid it and see it as a negative. But you write about how important it is, in terms of preventing burnout and working towards a more flourishing mindset.
Sharee: Yeah, they're big concepts, and our language isn't helpful always, I agree with that. And we did actually...I toyed with calling the book, "Agent of Change in Healthcare" or something like that. And I had some feedback that it sounded like something to do with the police, so we changed that.
Michelle: So true.
Sharee: But I think agency is just so powerful. I've had a counselling practice for many years of coaching people in corporate spaces, a lot of the meditation work I do is about people tapping back into their own source and their own energy. So I think agency is just alive in all of the work I do. Whichever hat I'm wearing, it's really about helping people find their own personal power. If we can't lead ourselves really effectively and ask ourselves, "What do I need? What help do I need so that I can be true to my own desires, or my own values or, help myself find more wellness?" Then, really, I think it's almost disrespectful to think that I can help somebody else if I can't even help myself. And so I take this very personally.
People constantly tell me it's the system, and I know the health system is incredibly difficult. There are many things that we need to change, and very often one single individual can't make those changes. But each individual that is empowered is better at finding the other people who can help them and better at harnessing the energy for change.
And so I really just believe wholeheartedly that if we can’t harness our own energy and find our own capacity and our own belief to make change even in our own small daily habits, then how do we think we're ever going to change any big system or even a small system? So systems are built by people, they're enabled by people, they're delivered by people. It's only people who can change them.
So, people who are clear about their own capacity, or at least their capacity in connection with other people, those are the people who are going to create better systems for us all. And every single person has the capacity for personal agency, but we sometimes can't find that by ourselves. We need supporters and encouragers and people who are like-minded in terms of what we're trying to achieve. And we need to say things out loud if we’re going to find those people.
Michelle: It's that combination of language where you're talking about semantics of like, as doctors or as all health practitioners, we tend to be self-serving, serving others ahead of ourselves. And so when we talk about agency or even self-care, self-compassion, it almost feels oxymoronic in a system that is driven by striving and hard work and self-sacrifice, etc.
So, I think, from my perspective, as well, finding your own agency for your own personal change makes the biggest difference to your ability, I guess, to be humble as a healthcare practitioner as well as working towards manifesting health in yourself, which then has just this kind of flow-on effect, which we referred to before.
Sharee: Yeah, and if you feel that in yourself, you genuinely believe that other people can feel it. If you don't believe you've got any agency yourself, it's really hard to convince somebody else. It's kind of a hollow promise. And anybody who has done a degree in health has agency, right? We have to have some agency to get ourselves through school, to get ourselves into university, to sit exams and write assessments and do research and find new friends when we're in foreign environments. We all have that kind of agency. It's just how and where we apply it.
And of course, if we're burnt out or highly anxious or unsupported then it's very hard to remain self-driven. And I think it's one thing that health professionals really need to build their skill in asking for help and partnership and collaboration. It's in partnership and collaboration that we generate new things, that we give each other energy to push through when things are very difficult, when we don't feel like we've got the support of the administration or the funds or whatever we need. It's in collaboration when we can look across the room and see somebody else who believes in whatever the project is too, and that ebb and flow of our energy, we pick each other up, we were talking about uplift before. We help each other see and envision something better.
Michelle: But I think also it is hard when you are burnt out to see the fog beneath the trees kind of thing. We can't see ourselves out of the mud. And whether it's someone listening to these podcasts that kind of is saying, "Maybe I am burnt out or even languishing," or some of the patients that they're supporting, because there's such an element of fatigue and despondency and despair in that burnout phase.
There was some research done by Richard Davidson, the U.S.-based neuropsychiatrist. And he did a lot of research on Buddhist monks and how they actively pursue more positive states of thinking to counteract negative states that increase their suffering in many ways. And you wrote in your book the four aspects that we can work on, or that we can support a patient to work on, that actually develop our neurobiology to help us prevent burnout or go from burnout into more positive states of being, like coping or flourishing. Take us through them.
Sharee: So Richie Davidson's research, or his team, is really interesting because they've been doing for a long time. As you said, they've studied monks who have meditated for 40 and 50 years. But they've also studying a lot of novice meditators and the machinery now to look at what's happening with our neurons and our neuronal pathways is so advanced from what it used to be.
So we can see a lot of things we couldn't see before. And certainly, they're saying that they can measure resilience, outlook, which is really around positive or negative frames about what's going to happen in the world, our attention, our ability to focus, and our capacity to be generous and altruistic in our behaviours. That they can map these neurological pathways that relate to these behaviours over time when a person is having practice at compassion or mindful meditation or loving-kindness meditation that you're really building compassion and connection. And that in these practices, doing generous acts for people, they can map and watch people's brains change, literally. It's pretty amazing stuff.
One of the challenging things is, to see resilience change neurologically requires really thousands of hours of meditation. And when I first was reading and listening to Richie's research, I was feeling quite despondent and discouraged that all this effort to meditate, how could I possibly ever meditate enough hours without becoming a monk? But certainly, over time, they are starting to show that a small amount of meditation or contemplation practice... Richie Davidson says that mindfulness has hijacked the conversation a bit, that we shouldn't just be talking about mindfulness meditation, we should be talking about contemplation practices more broadly, which I think is really interesting and shows...
Michelle: Yeah, that's a good point.
Sharee: ...that kind of level of nuance that his research is getting to now. And certainly what they're saying is small amounts often is going to be the key for our neurological change.
And if you think about, for instance, learning tennis, you can go and hit a tennis ball against the wall or with your coach for an hour or once a week and you'll probably improve. But if you play and if you hit against a wall in between, and even if it's only for 5 or 10 minutes a day, you'll probably improve more rapidly because you're inviting those neurons to talk to each other more often. And so, you're just really strengthening their connections because of the regularity of the talk, the electrical chemical talk that they're doing together.
Michelle: That consistency is so important. Yeah.
Sharee: Yeah. So we really want to be looking at small amounts, often.
Michelle: Yeah, I was just thinking about back to when I was watching my kids learn to talk or learn to walk, they never had a day off. Once they started babbling, they're off learning language day after day after day. So going back to that how you build your neurons, sometimes looking at children can be such great inspiration.
Sharee: I love that analogy of they never have a day off. It's great.
Michelle: I think what I loved, which is a new term for me, which was, you mentioned, psychological safety. And psychological safety being a state where we feel safe, we feel trustworthy, and we can have that, not only just inside ourselves but within our teams and within our relationships, and within, I guess, our systems.
And one of the things that strikes me in, I think we're talking about the hospital systems, is that they can tend to have an element of mistrust from an individual. But you talk about developing psychological safety. Tell us a little bit about what you mean and how we can go about improving that.
Sharee: So Amy Edmondson had written a terrific book called "The Fearless Organization," and that's more about organisations and teams. I really recommend that to anybody who wants to look at her work.
But essentially, psychological safety is this ability to be safe enough at work to question something, to call something out, to say out loud, "I made a mistake." And really, we won't do that if there's any concern about being safe. And so, teams that foster that, really allow people to develop and learn and grow because that's how we develop and grow, right? We make a mistake and we say, "I really didn't expect that to happen. Has anyone else had this happen before? What should we do next time?" It's in those conversations that we develop and grow. And because we've shared it together, we build a bit of trust with each other, and these teams are really high in respect.
And so, Google did some big research called the Aristotle project in I think 2016 around this space too. And they found for all their hundreds of teams inside Google, the distinguishing factor that made a team effective was the level of psychological safety. Nothing to do with diversity, or gender equity, or age or experience, but how safe do people feel in their team at work?
And certainly, in health, if we have a medical error and a person doesn't speak up because they're ashamed or they're too scared, which we know happens often, medical error is the third cause of death in America after heart disease and cancer. So medical error comes about because of secrecy and shame, because people are in these deep hierarchies and don't feel like they can say something to the people up from them when they think a decision is wrong or something's been missed because they are very aware of their position in the hierarchy.
So psychological safety is where teams are going to intentional conscious links to make it okay to be able to say, "I got this wrong," or, "I don't think we're making the right decision. Can we revisit this? Can we pause?" without any ramification without any career detriment happening as a result.
Michelle: That's right. I mean, it's such an important thing. And we're talking in medical practice or in all practice to kind of encourage to ask our patients whether they feel safe in their job or in their life or at home. But also, it's really important to ask ourselves, do we feel safe? Do we actually feel safe within the conditions of work that we work in? And if we don't or if there's an inkling that we don't feel safe, how do we go about really ameliorating that, because it's such a powerful aspect, I think, that holds you back from thriving and flourishing.
Sharee: Yeah. I think there are some systems things happening. Just to give you one example, the 2020 Medical Training Survey last year had 57% response rate of doctors in training, which the year before it was 27%. So I think that's a fantastic inquiry from the Australian Medical Board to find out what's happening for training doctors. They've obviously put in some pretty good systemic intentional work to raise the respondents from 27% to 57% in 1 year. So that's a terrific example of systemic inquiry.
In terms of how do we actually build those skills, we really need to do a lot of work over a long period of time with the leadership. We know the junior doctors are bringing a case to court because of the numbers of hours they work. That's a systemic problem that no one doctor can respond to and leadership endorsement can help. The leaders who say, "Yes. Speak. Take that issue. I'll support you." It's like in the gender issues, women need men to support them in their claims, black people need white people to support them in their claims. So I think we definitely need leadership very actively engaged in some of these things.
Michelle: Yeah, and bravery, really, as well.
So, I wanted to move now to the particular issue of reentry anxiety. So for some of us in Australia, we experienced a really long lockdown. You and I were one of them. And obviously we're out of lockdown now in Victoria and New South Wales, but all over the world, we've seen people experience lockdowns of various lengths and time. And for some, COVID-19 and the ability to work from home and to come away from that team environment, it's actually been really positive.
But now we're finding more anxiety or even fear of burnout on the other side of that re-entry back into the busy life to making sure our neurology adapts to all of these different team and collaborations. What's going on, in your experience? What are you seeing happening post lockdowns? What's the research telling us there?
Sharee: I think the research isn't telling us very much yet because it's too early. Certainly, there's a lot of conversation in the various journals and medical and health newsletters and so on. But I don't think we know the answers yet because people are in all stages, as you said. Some people are desperate to get out of their house and get back to work, other people are very reluctant.
I went to a community hall gig on the weekend and noticed in myself that I felt really, not so much anxious, but just really unfamiliar about being in this crowd of a couple of hundred people, sometimes inside, sometimes outside. Nobody with masks on. It's a very strange experience. We've been two years practising, asking ourselves, do I need a mask? Can I go? Where can I go? How many people can I be present with? So to have all the shackles come off does feel really very unfamiliar and strange. We've been building these new habits of checking, and all of a sudden, apparently, we don't need to check. It's very strange.
So, again, I think so much of human health and well-being is about safety. Our brains are assessing, first and foremost, before we can ever do anything else, both before COVID and after COVID, am I safe? And so, I think those questions and making room, making space for people to ask those questions, giving ourselves permission to ask those questions, it's our evolved, hardwired, natural thing to do. So let's accept that and acknowledge that and be really present too that that's a basic human need and a common human need.
And then I think after that, we ask a second safety question, which is, “Do I belong? Am I safe in this group of people? Can I trust this group of people? Am I in relationship with these people?” And so, again, more permission, more space, more allowance. Some people are going to come into those gatherings more gingerly, more carefully than others. I had a retreat with some doctors a week ago and we were checking if, can we hug or can't we hug? Everybody had to make their own decision about whether they wanted to do that. I have had some experiences where people have said that they have hesitancy about particular places that they're telling their friends, "I really do want to see you but I can't come into that situation just yet." And so, I think with our patients and our clients, we need to be very aware of that too. Telehealth is here to stay, and some people will prefer to do that, rightly or wrongly.
And I think we do also want to stretch our envelope a little bit. Humans can't survive on their own. We do do better in company. And so we do need to be reaching out to people that we think are reluctant to come out and encouraging them, can they come? If we want to visit somebody, they don't want us to come inside or they don't want to come to our house, can we meet in your front garden? Can we meet at the park? Can we, outside somewhere and have a conversation? The other complication we have is checking with people, are you vaccinated or not? And some people are very concerned about that. And that's a really divisive question that we're still only learning how to manage.
Michelle: And I think we don't feel safe when it's divisive, either. So it's another impact on how safe we feel. But I really love that kind of, I guess, perspective of understanding safety and trust. It's almost a primacy of where we meet people at. And so, if we can talk about the psychological safety, then we can move so much further, as long as we've established some sort of ground.
But I know, Sharee, you are a big fan of prevention, like most of us healthcare practitioners. So burnout is a stage of despair and despondency, and empathy fatigue, etc., which needs a lot of work to turn it around. But we were talking before the show about what your top tips are for prevention of burnout. Take us through them.
Sharee: Well, I think it is what we've touched on already around a little bit often. So, I think that would probably be my primary rule, a little bit, often. I love what you said about little kids, they don't have a day off. So we don't have a day off for our well-being. We can have a day off from, if I have to go and exercise, I have to do yoga, or I have to meditate. We can certainly have a day off from that. But every day we want to be doing something that's encouraging and nourishing of ourselves. And some days that might be that we sleep in. Some days it might be that we go to bed early. Somedays we stay on the couch and binge Netflix.
Michelle: Yeah. We go out for dinner, or...
Sharee: Yeah. We're really looking for some consciousness about it though. That we're consciously choosing, that we're sort of running this low-grade inventory, what have I done today that's really filling up my tanks? And there are lots of practices for that. You can do the evening gratitude practise, what we've grateful for today. The early morning intention, what’s my intention for today? It might be to totally relax, to switch off from all my obligations. It might be my intention today is to really give a lot of energy to helping other people. But really having a consciousness about what's our intention and what's our reflection, if you like? At the end of the day, what's gone well? What's been useful?
And giving ourselves a bar, if you like, that we want to meet, but it's a fairly flexible, adaptable kind of bar. So I'm not saying every day is the same. I'm not saying I have to do an hour's exercise every single day, otherwise I've failed. You've already set yourself up to be stressed if you're making those kinds of commitments.
Michelle: That's a good point.
Sharee: So we want to have a little bit of...recognise the value of adaptability. We are adaptive species, and that's part of the key of resilience. Resilience is not just fall down, stand up, fall down, stand up on an endless cycle. Resilience is being able, when we've fallen down or when we've crashed or when we've had a hit, to be able to say, "Wow, that's really taken the wind out of me. What do I want to learn out of this before I front up to that again? What am I going to adapt, or change? Whose help do I need? Who do I need to tell that this has happened to me?” So, really, taking a moment to breathe, essentially, and take in what's happened, and make those small adaptations and adjustments so that we are better equipped in the environment when we stand back up. To be knocked over and just keep standing up endlessly like many health professionals do is Einstein's version of idiocy, really. If you want more of what you're getting, keep standing up and get more of what you're getting.
Michelle: Yeah. It's karma as well.
Sharee: Yeah, we're really enabling poor practice. We're not enabling safety, we're not enabling the best error-free care, we're actually putting ourselves and our clients at risk if we just keep mindlessly standing back up. So, I think recognising that we are adaptive and that we can adjust and change and tiny little tweaks on any given day can help us do well and do better.
So the three key things really, Michelle, am I learning how to regulate my mind so I've got a clear process of thinking? And this is about consciousness, intentionality, and so on. Now, can I regulate my emotions, my physical body? Do I understand the signposts? Can I name them? Am I articulate in my emotional capacity, my emotional intelligence? And can I be with whatever emotion is here? I don't have to be frightened of them, I just need to know how to respond to them.
And the third thing is, can I ask for help and am I building a community of supporters and helpers and people I can trust around me? And we're all responsible for that, individually and collectively, that this idea of powering on on our own is really flawed in terms of our evolutions.
Michelle: Yeah, that's brilliant, Sharee. Thank you so much for taking us through some of these tips. I love it. And it's a really important reminder for all of us practitioners that we need to prioritise our own mental, and emotional, spiritual, and physical well-being, otherwise we risk burnout. And that's a mistake for us as a healthcare team.
And I think so often, as we said before, it's our nature to put others first when we work in a caring profession, but if we don't put ourselves into the soup, if we don't constantly keep this in mind, our own care, especially through difficult times, then we risk this languishing and burnout, which is no win for anyone, really, let alone ourselves.
Sharee: No, it's not. And I want to say that the contract's not a swap contract. I didn't become a psychologist so that I could lose my mental health in an effort to help somebody else gain theirs. Most of us who've come into health hope to enhance the collective well-being, and to share good health and well-being. And so this idea that many health professionals have got caught up in, that is this patient-first kind of idea exists for...it came about for ethical reasons.
It's a fantastic principle for us when we're in difficult circumstance to try and work out what we should do. And I'm not for a minute suggesting that we should put our own benefit or gain above the patient, but nor do I think we should somehow give up our own well-being for the patient's well-being. And I don't think the patient expects us to do that. It's kind of what got us…
Michelle: No, well, the patient loses as well.
Well, we'll finish on that note. So, thank you so much, Sharee, and thank you, everyone, for listening today. And don't forget that you can find all of the show notes, transcripts, and, of course, other resources, including Sharee's book from today's episode on the FX Medicine website.
I'm Dr Michelle Woolhouse, and thanks for joining us. We'll see you next time.
ABOUT SHAREE JOHNSON
Sharee is a registered Psychologist, Executive Coach and Meditation Teacher. She is the founder of Coaching for Doctors, Australia's first coaching practice dedicated solely to doctor development. She has been working as a psychologist for 25 years and has spent the past seven years deep in conversation with doctors, individually and in groups, seeking to understand their experience of work and their goals for their own futures and the future of the health system. She has worked across all levels of government, in the private and not for profit sectors and until 2020 ran her busy private counselling practice in Regional Victoria.
She has taken to heart the finding that healthy providers of healthcare achieve better health outcomes for patients and have happier, longer term careers. All of Sharee’s work is about giving individual people the skills they need to have a long term sustainable career in health that is fulfilling and joyful. She would like to think doctors can feel hope and love in their work. Sharee has become an advocate for doctors. Her new book The Thriving Doctor came out last week.
In 2011 Sharee’s husband Tim died of cholangiocarcinoma. Her lived experiences with Tim during that four year journey together with cancer informs her practice every day. She is the proud mother of their three amazing young people.
The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.