BEATING BURNOUT

Medicine should be a fulfilling and enjoyable profession; but the pressure of work, impossible targets and deadlines and the loss of privilege and prestige are resulting in more NHS doctors becoming disillusioned, dissatisfied and disappointed -leading to burnout. An effective avoidance strategy involves recognising first that busyness is partly a matter of personal choice. We need to know our gifts and abilities, prioritise and delegate carefully and maintain a strategic reserve. Learning to say 'no', honouring a weekly day of rest and fencing off time for personal devotions are essential coping mechanisms.

Recently, a consultant surgeon in mid-career wrote to me, 'Many of us are very tired and many just want to get out of work as soon as possible. There is certainly a perception that things have never been worse in the memories of anyone working today. I think perhaps the worst thing is that a lot of us can see no hope that things will get significantly better. In fact, we think that things will probably get worse.' My GP speaks in similar vein.

The tiredness, disappointment, disillusionment, hopelessness and job dissatisfaction that I sense in many senior NHS staff strongly suggests that they are at the end of their tether and heading for burnout. Why should this be so? In many cases, over-work is a factor: Britain is said to have the longest working hours in Europe. However, the problem is not simply the volume of work: it is more the pressure of work with impossible targets and deadlines. This is often compounded by disappointment, frustration and non-forthcoming promotion as well as reorganisation leading to loss of privilege and prestige. For those serving overseas, things are often much worse. The volume of work can be phenomenal, ill health is common and there are frequently legal hassles, to say nothing of severe satanic opposition.

Is there an answer? I believe there is, even before more reasonable terms and conditions of service are introduced. Firstly, it must be accepted that many doctors choose (often subconsciously) to be over-busy. We find our work enjoyable and fulfilling: the constant stimulus of diagnosis with remarkable recoveries and gratitude from patients and relatives. We also like to be busy and to appear to be busy: such an aura is a useful defense against the call to give time to people whose needs are not strictly our concern.

A desire for greater professional prestige or power is another element involving choice. So, in some cases, is a commitment to research. It is also tempting to take on additional well-paid work such as writing. However such activities are very time-consuming and need to be balanced against any value in terms of status or income.

Christians also face additional demands on their time. Many of us are urged or drawn to commit ourselves to specifically Christian service, sometimes to the detriment of the work we are paid to do. This can lead to a false distinction between sacred and secular. We are called to serve God primarily by doing our work conscientiously and well and by discharging our responsibility to our spouse, family and society. To put overtly 'spiritual' work on a pedestal is a fundamental misunderstanding of vocation. Duty is sacred and it is essential to get one's priorities right. Trumbull's rule(1) is a good guide: 'Do first the things you are paid to do, then the things you have promised to do, then the things you would like to do.'

If we don't have such a safety margin, crucial matters can blow up suddenly and overwhelm us. As in the planning of a military operation, it is important to maintain a strategic reserve. Time can then be set aside for people. Important things rarely have to be dealt with the same day or even week. Urgent tasks call for instant action and so devour our energy and crowd out the important matters. So, learning to distinguish between urgent and important issues is very important.

Before committing ourselves to non-essential but prestigious work, we should think carefully of the time and strain involved. It is important to be prepared to say 'No' to things outside the main thrust of our lifework. Our Lord did this - he had a clear goal and made everything subservient to it.(2) Periodically, it is important to review our workload and priorities, particularly when ill or before embarking on any major additional commitment. Whilst ensuring that junior staff do not become overloaded, we should readily discard duties that others could do just as well.

Dr Robin Taylor of Dunedin, New Zealand gives a valuable talk for medical students on stress management. He makes three points: know yourself and your capabilities, be prepared to take advice (especially with regard to delegation)(3) and honour God on his day. It is important to make a realistic evaluation of our talents. There is great inequality of gifting between one individual and another. Some have a brilliant intellect or a phenomenal memory. Still others have a strong constitution and need very little sleep. In one of Jesus' parables, he spoke of one man being given five talents, another two and another one. Most of us have only one or two talents and we are wise to recognise our limitations. One talent used wisely can be of lasting value.

I find that Christians are often confused about Sunday. Of course, we often have to work on a Sunday and we should do our duty without hesitation. Nevertheless, it cannot be denied that the fourth commandment is embedded in the Decalogue and that none of the other nine commands has been abrogated. We should accept that this command is still relevant today but that it has to be kept in the spirit rather than the letter. Legalism was Christ's criticism of the religious leaders of his day. In my view, there is no need for rigid dos and don'ts. We 'keep the Sabbath day holy' when we are kind and merciful and do activities that enhance our service to God. Sunday should be different and special. In past generations, Sunday was prized as a day of physical and mental relaxation. Today, we still need a day when we can turn our thoughts to eternal things. As Wordsworth wrote: 'The world is too much with us; late and soon, getting and spending, we lay waste our powers'.(4) We need to pause and contemplate God and eternity. Meeting with other Christians and hearing God's Word is immensely valuable.

Part of each day (ideally the beginning) should be fenced off for a brief, attentive, reading of the Word of God with meditation and prayer. We need a right attitude to success, viewing it as the fulfilling of God's will for our life. We need to recognise that success is in God's hands. What he said so long ago is still true: 'Those who honour me, I will honour'.(5)

How to beat burnout

1. Adopt a right attitude to success
2. Get your priorities right
3. Regard duty as sacred
4. Distinguish between the urgent and the important
5. Maintain a strategic reserve
6. Know yourself and your limitations
7. Be prepared to delegate
8. Build in regular recreation
9. Honour God on his day
10. Undertake periodic review
11. Embrace the 9th beatitude - 'Blessed are those who expect nothing, for they shall not be disappointed'.
12. Follow Trumbull's rule: 'Do first the things you are paid to do, then the things you have promised to do, then the things you would like to do.'
13. Find and be faithful to a complementary life partner who shares your Christian commitment

References

• Trumbull was an American poet of the period 1750-1830
• Matthew 15:24; Mark 1:38
• Exodus 18
• Wordsworth W. The World is Too Much with Us. In Miscellaneous Sonnets, 1807
• 1 Samuel 2:30