3 Myths of Burnout You MUST Understand

Let’s really talk about burnout, shall we?

Today I’m diving deep into the emotional exhaustion component of burnout, and centering our conversation around the excellent book, Burnout: The Secret to Unlocking the Stress Cycle by Emily and Amelia Nagoski, a must-read. If emotions are tunnels with a start and a stop and we are supposed to move through them, emotional exhaustion is us getting stuck in the tunnel and feeling an emotion so chronically that we lose capacity to feel anything else.

Join me, and let’s explore this idea and 3 common misconceptions that are preventing you from getting help, and how to change them for yourself.

Transcript

00:01
Well, hello, hello, and welcome to another episode. I'm thrilled as always to have you here. And today we're going to be talking about one of my favorite topics, burnout. Yay. But specifically, we're going to be talking about some common myths or misperceptions around burnout that are really, really important to understand. And

00:25
not a new topic. We have certainly talked about this before, but it's always a great topic to come back to and to really share how this problem shows up in our lives. The reason why I am coming on today specifically to talk about this is I was chatting yesterday with a good friend of mine. She is a very successful and accomplished surgeon.

00:51
and recently in her own practice. So she left an employed position, an academic position, to become an independent surgeon, which is its own special magic, I think. And she noticed that she could just sort of feel the burnout coming on. And so many of us think that if we're working for ourselves, that we won't experience burnout.

01:20
And my friends, I'm here to tell you that that's just not true. And to understand that more, we really need to do this deep dive into the parts of burnout that stick to us when we change positions. Now, you may be asking, well, how do we define burnout? What are we talking about when we talk about burnout? And really, the definition comes from

01:49
work by Christine Maslock. I never know if I'm saying her name right. But the three elements that are key are emotional exhaustion, depersonalization, which is also sometimes called cynicism, and this sense of futility. The sense that you are doing all of this work and none of it really seems to matter. Just saying those words, ugh, I just, I just feel it in my body.

02:18
those three elements together. And if you dive deep into the literature and really geek out, you'll see that there are some gender lines that some of these elements fall through, where women are more often gonna have sort of their strongest characteristic of burnout, be that emotional exhaustion part, and men are more likely to have the depersonalization or cynicism be sort of the primary element.

02:47
But all three elements are there in order to, you know, technically define burnout, which do we need to technically define it? I don't think so. Do we need to acknowledge what we're feeling, what we're experiencing when we think we're in burnout? Yeah, absolutely. But we're really gonna kind of focus the most today on that part that is around emotional exhaustion and...

03:14
I was just looking back through one of my favorite books, which is Burnout, The Secret to Unlocking the Stress Cycle by Emily and Amelia Nagoski, which is a great book and really sort of dives into the feminist perspective on burnout with some practical strategies for completing the stress cycle. And they talk a lot about how this shows up in women and this concept that they call human giver syndrome.

03:43
but their definition of emotional exhaustion is caring too much for too long. And I just want you to think about that for a minute, how in our work, we are asked to care for in all the ways that that looks, right? Physically, emotionally care for all of these humans for very long hours, for years and years and years.

04:14
Now, of course, burnout is not unique to the medical profession. It's not unique to physicians, right? It does cross all across health care, as well as other caring professionals. Right. We can think about therapists. We can think about teachers. We can think about social workers. And this element of parenting. They talk also in this book about how burnout

04:43
occur in any kind of a situation where there isn't a unique start and stop, right, to the work, right? It sort of expands to fill the space. If you think about parenting, I guess there is a technical start to your parenting, but there is no technical end to it, right? Our children don't reach 18 and then we stop parenting them. Now the relationship may change, right? But we

05:12
don't consider it a stop and there's this drawn out nature of them of needing to continue to attend to the work without there being a discrete stop right and how that can create some emotional exhaustion so I think it's really important that we kind of understand these underpinnings as we talk about the myths or the misconceptions right that often pop up when I'm talking with people.

05:42
So let's dive into some of those misconceptions. And as you are listening, I want you to think for yourself, oh, where does this show up for me? Is this kind of a pattern of thinking that I, you know, am familiar with, that I kind of get stuck in? Another way that they conceptualize the emotional exhaustion is if emotions are a tunnel, right? We have sensations that happen in our body, in our minds.

06:12
and we are meant to move through them. So with a tunnel, we come to an entrance, we go through the tunnel, and then we exit the tunnel. The emotional exhaustion part is getting stuck in an emotion, the same way that we might be stuck in this tunnel and not really able to get out of it. I think that's a great metaphor for thinking about that experience of

06:40
emotional exhaustion component of burnout. So misconception number one or myth number one. Burnout is weakness or failure or caused by too little yoga and you can insert anything you like for yoga, meditation, rest, play.

07:10
Burnout is not personal failing. It is not you being weak. Now for so many years, it has been treated that way, especially in the boys club of medicine, right? There was an and still is in many, many places, this idea that if you're tough enough, you're just gonna you're just gonna show up and you're just gonna do the work and you're gonna continue to be amazing. And just put all

07:39
Put all that emotional stuff aside, right? Only the weak burnout, only the sad failures, experience burnout and chicken out by quitting, leaving, taking a break.

07:59
In my experience, the conversations about burnout have changed really dramatically over the course of my career. And yet, I can still point to many pockets where this idea that burnout is weakness or failure, I can see how that is still something that we are steeped in. And I think you can as well. There's a lot of literature that's come out in the last.

08:28
10 to 15 years about physician burnout, healthcare burnout, caregiver burnout. And although we've been talking about it, there is often still this cultural part within medicine that if somebody is taking a break, if somebody is, you know, flipping out, if somebody is quitting and they don't have another job lined up, but they're just, you know, if they're throwing their hands up and they're stepping out, they're like, I can't do this anymore.

08:59
there is still this projection of failure that exists on them. When if we dial this back and we really turn back to that idea that emotional exhaustion is caring for too long, too much, right? Then we can see is that weakness or failure? Is that really how we want to conceive it? I don't think so.

09:29
Now do I need to make some changes to the way that I'm operating so that my care is not being depleted chronically? Yeah. Is yoga at lunchtime going to fix that? No. No. Are there some things you know systematically that need to happen? Yes and we're going to kind of get into that. But if you

09:56
are experiencing burnout, whether or not you've named that for yourself, there is probably a part of you that believes there is weakness or failure there, that you haven't been doing the right things, and that there's something wrong with you, that you're experiencing that. That has been baked into you by the culture of medicine, by this tough enough, you know, sort of mentality. And really...

10:24
I know I talk about gender constructs all the time, but really that comes from the patriarchal nature of medicine. And you think about, you know, kind of the olden days of, you know, the old white male physician, right? As the leader, as the pinnacle, and the supports that he had that were quite different from what we experience today. And I wouldn't say that he was emotionally healthy or,

10:53
balanced. I have no idea. I can't presume to know you know 40, 50 years ago what that experience was like of being that sort of cultural icon of again sort of white older male physician. I don't know what that was like, but I can imagine that that person was probably not super emotionally healthy, but they probably had a lot more support.

11:21
than what most of us have in terms of things at home, right? Probably a non-working spouse who took care of all of the things at home, probably a robust nursing staff, a whole host of things, and the ability as a man, I'm really honing in on this gender stuff right now, but the ability as a man to be more disconnected than women physicians are expected to be.

11:51
Now, do all men fall in that bucket? No. Do all women fall in the bucket of over caring for their patients? No. But just to say that we're socialized along those lines, and so that has also sort of baked into us. But if you are out there again, sort of thinking that I can't admit burnout, I can't do anything about it because we have this perception of it means weakness or failure.

12:21
that holds us back, that keeps us from engaging in the things that we know will be helpful for us and getting the help that we deserve. So let's let go of that myth.

12:34
The next myth is burnout is caused by this job. And what I mean is that sometimes we are walking around feeling like your current employer or your current specialty is just intrinsically causing burnout. And when we believe that, we will naturally conclude

13:01
things like the following, one that I have to leave this job or this specialty in order to fix my burnout in order to feel better. Believing that the simple act of leaving will fix it. Believing that it's better elsewhere, just by nature of not being here anymore. There are a lot of things that we attach to this idea

13:28
that burnout is caused by this particular job. Now, I do hear stories all the time of severe understaffing, severe toxic workplaces, where they just expect to sort of turn through physicians and other healthcare providers, right? While they're retaining huge profits. There are lots of instances

13:56
where a particular job is very problematic. But when we believe that burnout is exclusively tied to this position, we are setting ourselves up for a real problem because if we simply leave and go somewhere else, but we are remaining emotionally exhausted, emotionally stuck in this tunnel, we will not feel better.

14:26
And that is so critical to understand. And it's not to say that we shouldn't leave a toxic job, that we shouldn't find a role where we have more balance. That's not what I'm saying. But what I'm saying is that it is not exclusively related to the external circumstances of the position that you're in. How do I know this? Well, I know this from personal experience. That's one part.

14:52
I know this because we can burn out working for ourselves. Do we think that we are a toxic workplace? No. But do we think that we are accustomed to caring for people in such a way and always putting other people first in such a way that we take ourselves off the table, that we put ourselves last, and in so doing, we do not...

15:21
care for our emotional and physical selves, absolutely. So my friend who I referenced, right, who is a successful surgeon who's working for herself, she isn't feeling the onset of burnout because she's working for a terrible employer. She is experiencing a recurrence of burnout coming on because she is used to working so hard in such a way and she has not yet learned how to...

15:50
set some limits for herself, how to set some personal boundaries where she is putting her self-care first, where she is, you know, sort of setting reasonable hours and expectations for herself. We are such high achievers and we're so used to, you know, being successful and driven and accomplished that we will take our burnout into any circumstance. If you left medicine right now.

16:18
and you went to go work at McDonald's or Starbucks, you would overwork your butt off because you believe that the work has to be done a certain way and you are so used to that work ethic, you are gonna make all the things better and guess what, you will be burned out there too. It is so important that we not believe.

16:41
that burnout is simply related to the job circumstances that we are in and that we see it as a set of beliefs and thoughts that we have had over and over again. And yes, absolutely influenced by the jobs that we've had, by the training that we've had, by years and years and years of putting our own needs last. All of those things are absolutely true, but we have to see it that...

17:08
just leaving the external circumstances of this job or this specialty or this type of practice isn't enough. We have to work on the emotional exhaustion part. We have to work on figuring out how can I do well in any job or any role, like a parenting role, where I am getting my needs met, where I'm moving through emotions like tunnels the way I'm supposed to, where...

17:36
I can be fulfilled and balanced as I am doing whatever it is that I want to do. Right? We really have to take away the power of thinking that it is just about this job. It is not my friends. Okay, a third myth or a misconception is that something has to happen before I can fix this. Now this is linked to

18:05
the second myth, but it's also a little bit different. So we might believe that in order to fix our burnout, we have to leave this job. So that's the part that's tied into this last one. We might think, I have to change this job in order to heal my burnout. We might also think that some kind of crisis needs to happen, right? So maybe.

18:30
I don't know, we're hospitalized with a kidney stone or debilitating panic attacks or something like that. If you've ever read Christine Carter's book, oh gosh, which I can't remember the name of right now, she talks about an experience of having been hospitalized with a kidney stone and how grateful she was for the break that she got in being hospitalized in horrible pain with a kidney stone because that allowed her to pause her work

19:00
allows her to pause her parenting. She's not a physician, she's a PhD and studies happiness science. But it just resonated with me when I read that part of her story, right? Because how many of us are hoping for a mild illness or injury so that we get some kind of rest and relief from our work and or our parenting responsibilities?

19:26
You are not alone if you've had that thought. It is not unique to physicians. And that kind of crisis is not necessary for you to decide that we're going to do something different. What are some other circumstances that come up? Some other things that we might be leaving have to happen before we can work on our burnout. Another common one is that I have to prove that my situation is worse than everyone else's.

19:56
before I make change or get help. So often when I'm talking to my physician clients, they are telling me things, they're sort of laying out all the challenges that they have. And then, but I also have, you know, a husband at home, but I also, you know, I don't have it as bad as so and so, but also, and they go on and on about the different circumstances that make

20:25
their existence better than someone else. And my friends, we can always find someone in a worse circumstance than we are. And if we constantly believe that we have to be in the worst position in order to get help, guess what? We're always gonna find somebody who's in a worst position. And that is not helpful, nor is it necessary. So let's let go of that part.

20:51
The other big hang up here that sometimes is preventing people from getting help is the belief that someone has to give me permission in some way in order for me to believe that I can fix this.

21:11
This is such a deep belief and I absolutely was in this for just a ridiculous amount of time myself and it's tied in with this last one you know having to feel like I had to prove that my position was worse than everybody else's but also that if I kept trying to prove

21:38
that my position was worse than everybody else's, that somebody was gonna swoop in and give me permission to make some changes. You will wait for forever if you think that someone is gonna come and give you permission, if you think your employer's gonna come tap you on the shoulder and be like, we notice how hard you're working and we really think you're needing a vacation, so we're just gonna cancel all your patients. Now,

22:07
Does it happen sometimes that something bad has happened and you get put on administrative leave or some similar circumstance? Yeah, no, that definitely happens. Let's not let it go there. But if you are waiting for cosmic permission before you make changes or get help, you're going to be waiting a damn long time.

22:37
fall into that belief that you need someone else's permission or you need for them to declare that you're so burnt out that you need some help, do not wait for that. If you are hearing my words and you're just like, oh no, that's me, take this as a sign. Take this as me giving you permission right now to go and get the help.

23:07
to make the changes that you need to make in order to feel better.

23:14
Let's go back to that idea again of emotional exhaustion. So I've named three common misconceptions of burnout that are holding us back. So the belief that burnout is weakness or failure or that we're not doing enough yoga, that's number one. Number two, burnout is caused by this job or specialty. Number three,

23:41
something has to happen before I can fix this. We're dropping those ideas right here, right now. Now, they are very entrenched beliefs often, and so don't be shocked if they are bubbling up, you know, as you are trying to navigate this for yourself. That's just what well-worn thought pathways do. Nothing has gone wrong if that's you, but...

24:07
If we're focusing on the emotional exhaustion part, on that idea that we are getting stuck in this emotional tunnel, whatever you want to label it, for me, I keep going back to the word overwhelmed because I just felt chronically overwhelmed. You might feel I get stuck in the emotion of resentment. I get stuck in the feeling of depletion, right? It doesn't matter what you call it, you know.

24:37
what that sensation feels like and if that's you, what needs to change in order for you not to get stuck there anymore?

24:48
we will never be able to immunize ourselves against a particular emotion. I can't do some kind of work or go to some kind of retreat and never feel anger again. That's not the point. The point is, how do I start to take care of myself differently so that I don't get stuck in these feelings anymore? What would that be for you?

25:18
Do you believe that it might be possible that you could practice medicine and not get stuck in this emotional exhaustion before? Now, maybe you haven't had that experience before. You might be able to point to some people though, who don't seem to be dealing with that, because there are physicians who, they may or may not have experienced burnout in the past, but...

25:47
When you look at them, you see that they are practicing boundaries. You see that they are not seeming to get stuck. And those of us who are very used to getting stuck in our feelings and that emotional exhaustion might look at those people and be like, well, yeah, but I don't wanna be like that person. That person seems like a jerk. There is some gray here. It is not either I'm a jerk or...

26:14
I'm over here and I'm caring and I'm burned out. We need to think that there is a middle area of this continuum and you know, you're gonna vacillate as you're figuring this out. There might be some times when you are practicing boundaries where you are saying no to people and disappointing or upsetting people, having people leave your practice, having people just frustrated with you.

26:43
And if we never do that, we probably aren't practicing good boundaries. Now, it's not my, it's not my role to act like a jerk, but sometimes people are going to interpret my actions and my boundaries as such. And you know, for myself, I've had to decide, you know what, I don't control their thoughts, I don't control how they feel about the circumstance. I can empathize that.

27:11
Yeah, from their perspective, I can see how they don't like, you know, the situation that we're in, I get that. And I'm still gonna choose to make my choice over here. I'm still gonna choose to take care of myself in this instance over here, because that's important for me.

27:31
We don't control what other people think about us, but I wanna invite you to come with me and believe that there is a place for you. And leave medicine if you want to, that's fine. That's not even what we're talking about here. But I want you to believe that there is a place where you're not stuck chronically in emotional exhaustion, where you can see

27:59
that there is a space in the middle between I give everything to everyone and leave nothing for myself and I'm so exhausted I can't see straight on one end of the continuum and over here where I'm a disconnected jerk who doesn't care about anyone and you know who leaves the office skipping every day and counting my money. There is room in the middle my friends.

28:29
And if we think that it's either this or this, so unhelpful. What would it take for you to stop being emotionally exhausted? And let's make it not dependent on other people. Therefore, it's not dependent on your employer tapping you on the shoulder and saying, here's a two week paid vacation.

28:57
We're going to fix all the problems when you come back. You're going to have 17 assistants working with you and three RNs. And you're going to see three patients a day. It'll be marvelous. That's not going to happen.

29:15
that's also not automatically gonna fix your burnout, right? Because you're gonna be feeling like you're not doing enough. I know you, I know you. Okay, so what would it take to fix your emotional exhaustion? I'm gonna share some examples and I just, you know, I want you to think about them. So things that have made a tremendous difference in my life

29:45
my morning walk. My morning walk is exercise, but it's also quiet, personal time. I'm usually listening to a podcast. I'm usually looking for the wild bunnies that are out there in my neighborhood. It is a time that is just for me, and yeah I have to wake up stupidly early to do it before my family gets up.

30:09
but it is so important to my wellbeing. And I don't wanna say that that means that you have to do the same thing. I just wanna say that I derive a lot of meaning and enjoyment out of it. I realize that it makes me calmer, it makes my day feel more organized and smooth because I've had some time for myself before everybody gets up and on their way. I've had some time to settle my thoughts and be curious.

30:38
That makes a tremendous difference for me.

30:43
not engaging in chronic numbing behaviors. So my chronic numbing behaviors are like staying up way too late watching stupid YouTube videos, not really usually that dumb, just like comedy stuff. No judgment. I'm not into reality TV. And just kind of mindlessly eating. Those are my numbing behaviors and I know that when I'm doing that more,

31:13
I'm not taking care of me. That is like a warning light for me. So when I'm choosing to do other things, that might be taking a bath, it might be spending some time with my husband, it might be doing some journaling, it might be going to bed. Those are things that tend to help me when I'm feeling whatever the feelings are that lead me to want to numb. And that's usually after a long day.

31:41
I might be stressed out about something, right? I might've just read a nasty comment from somebody or received a portal message from a patient that's bothering me in some way, right? When I choose to engage in numbing, like I know that I'm not doing my self care and that's not gonna help me resolve the issue or feel any better. The goal is not zero though. The goal is just noticing like, yep, okay, am I gonna choose to do this?

32:10
tonight or I'm going to choose to do something else, choose to take care of myself in a different way. Deciding for myself how do I make this easier? This is something I work on all the time and the more curious I get about what will make things easier for myself, the better and better my brain gets at figuring it out. But that has come from a place of believing

32:38
that I deserve not to be burned out. I deserve to take care of myself. I deserve to have things be easier. And often when we are experiencing burnout, when we're deep in it, and certainly that's true of where I was for many years, like I didn't really believe that I was worthy of getting help because I felt like I had been told so many times that I wasn't gonna get any special treatment that, you know, I...

33:08
you know, work just like everybody else and everybody else was okay. So, you know, I don't get any special favors. We incorporate that belief into ourselves and that keeps us from doing things that will be easier for us. Let's stop doing that. When you start to believe that you can have things easier, right, then your brain opens up to show you all the ways that that could happen.

33:36
but it has to come from a place of changing your thoughts. What else can be helpful? Working on changing your thoughts. And that can look a lot of different ways. I talked recently in an episode about the thought model and how our thoughts create our emotional states. That would be a great episode to go back to. I believe that's 134. And practicing noticing what those thoughts are.

34:05
when we are feeling an emotion and choosing to get a little curious, is that really helpful here? Yeah, that's a really old thought that I've often had. It's not really helping me right here. It's actually making me feel worse. What do I wanna practice thinking instead? This can be an out loud practice. This can be a journaling practice, but getting used to identifying what are these thoughts that are leading me down this pathway.

34:33
What would it take for you to be feeling less emotionally exhausted? Don't walk out of this conversation thinking that what I'm saying is that burnout is your fault, but I think it's really important that we understand that so much of burnout is things that we have absorbed from outside and are now running the burnout programs inside ourselves.

35:01
right? We have learned to ignore our own physical needs of hunger, needing to go to the bathroom, needing to stay hydrated. We have learned to tune that out, but no one can take care of that for us. We have to learn to connect back to our hunger. We have to learn to hydrate ourselves. We have to be willing to use the bathroom when we need to go. Maybe not in the middle of an emergency surgery, right?

35:28
but I can go to the bathroom in between patients. I can and I should, right? And you should too. We have to understand that we have been trained so well to run the default programs of ignoring ourselves and serving other humans, that we are the only ones who can interrupt that pattern. And that's again,

35:54
where my friend who is now in her own practice is needing to tune in, right, and see, ah, what are the programs that I'm running inside myself that are leading me to feel burned out? How am I going to stop those programs? How am I going to change the algorithm, right, so that I'm putting in my self-care practices, that I'm putting in some boundaries and some limits that work for myself.

36:23
that I'm changing the way that I think about how I work so that I can lean into things that give me more support that help me to make my workflow easier because I am worth it, I deserve it. Because everything is better when I'm taking great care of myself.

36:46
My friend, if you're listening, I love you, and this episode is just for you. But everybody else can listen to it too, because these are messages that we all need to hear. So I'm gonna wrap it up here for today. Thank you as always for tuning in. Thank you to all my friends and my clients and people who connect with me on social media and share their experiences.

37:14
love hearing how things resonate with you. I love hearing how your experiences are going and what is changing in your life because of these conversations that we have. And I feel like we are in conversation when I hear from you. And so please continue to reach out and share your experiences with me. Until next week, take care.

00:01
Well, hello, hello, and welcome to another episode. I'm thrilled as always to have you here. And today we're going to be talking about one of my favorite topics, burnout. Yay. But specifically, we're going to be talking about some common myths or misperceptions around burnout that are really, really important to understand. And

00:25
not a new topic. We have certainly talked about this before, but it's always a great topic to come back to and to really share how this problem shows up in our lives. The reason why I am coming on today specifically to talk about this is I was chatting yesterday with a good friend of mine. She is a very successful and accomplished surgeon.

00:51
and recently in her own practice. So she left an employed position, an academic position, to become an independent surgeon, which is its own special magic, I think. And she noticed that she could just sort of feel the burnout coming on. And so many of us think that if we're working for ourselves, that we won't experience burnout.

01:20
And my friends, I'm here to tell you that that's just not true. And to understand that more, we really need to do this deep dive into the parts of burnout that stick to us when we change positions. Now, you may be asking, well, how do we define burnout? What are we talking about when we talk about burnout? And really, the definition comes from

01:49
work by Christine Maslock. I never know if I'm saying her name right. But the three elements that are key are emotional exhaustion, depersonalization, which is also sometimes called cynicism, and this sense of futility. The sense that you are doing all of this work and none of it really seems to matter. Just saying those words, ugh, I just, I just feel it in my body.

02:18
those three elements together. And if you dive deep into the literature and really geek out, you'll see that there are some gender lines that some of these elements fall through, where women are more often gonna have sort of their strongest characteristic of burnout, be that emotional exhaustion part, and men are more likely to have the depersonalization or cynicism be sort of the primary element.

02:47
But all three elements are there in order to, you know, technically define burnout, which do we need to technically define it? I don't think so. Do we need to acknowledge what we're feeling, what we're experiencing when we think we're in burnout? Yeah, absolutely. But we're really gonna kind of focus the most today on that part that is around emotional exhaustion and...

03:14
I was just looking back through one of my favorite books, which is Burnout, The Secret to Unlocking the Stress Cycle by Emily and Amelia Nagoski, which is a great book and really sort of dives into the feminist perspective on burnout with some practical strategies for completing the stress cycle. And they talk a lot about how this shows up in women and this concept that they call human giver syndrome.

03:43
but their definition of emotional exhaustion is caring too much for too long. And I just want you to think about that for a minute, how in our work, we are asked to care for in all the ways that that looks, right? Physically, emotionally care for all of these humans for very long hours, for years and years and years.

04:14
Now, of course, burnout is not unique to the medical profession. It's not unique to physicians, right? It does cross all across health care, as well as other caring professionals. Right. We can think about therapists. We can think about teachers. We can think about social workers. And this element of parenting. They talk also in this book about how burnout

04:43
occur in any kind of a situation where there isn't a unique start and stop, right, to the work, right? It sort of expands to fill the space. If you think about parenting, I guess there is a technical start to your parenting, but there is no technical end to it, right? Our children don't reach 18 and then we stop parenting them. Now the relationship may change, right? But we

05:12
don't consider it a stop and there's this drawn out nature of them of needing to continue to attend to the work without there being a discrete stop right and how that can create some emotional exhaustion so I think it's really important that we kind of understand these underpinnings as we talk about the myths or the misconceptions right that often pop up when I'm talking with people.

05:42
So let's dive into some of those misconceptions. And as you are listening, I want you to think for yourself, oh, where does this show up for me? Is this kind of a pattern of thinking that I, you know, am familiar with, that I kind of get stuck in? Another way that they conceptualize the emotional exhaustion is if emotions are a tunnel, right? We have sensations that happen in our body, in our minds.

06:12
and we are meant to move through them. So with a tunnel, we come to an entrance, we go through the tunnel, and then we exit the tunnel. The emotional exhaustion part is getting stuck in an emotion, the same way that we might be stuck in this tunnel and not really able to get out of it. I think that's a great metaphor for thinking about that experience of

06:40
emotional exhaustion component of burnout. So misconception number one or myth number one. Burnout is weakness or failure or caused by too little yoga and you can insert anything you like for yoga, meditation, rest, play.

07:10
Burnout is not personal failing. It is not you being weak. Now for so many years, it has been treated that way, especially in the boys club of medicine, right? There was an and still is in many, many places, this idea that if you're tough enough, you're just gonna you're just gonna show up and you're just gonna do the work and you're gonna continue to be amazing. And just put all

07:39
Put all that emotional stuff aside, right? Only the weak burnout, only the sad failures, experience burnout and chicken out by quitting, leaving, taking a break.

07:59
In my experience, the conversations about burnout have changed really dramatically over the course of my career. And yet, I can still point to many pockets where this idea that burnout is weakness or failure, I can see how that is still something that we are steeped in. And I think you can as well. There's a lot of literature that's come out in the last.

08:28
10 to 15 years about physician burnout, healthcare burnout, caregiver burnout. And although we've been talking about it, there is often still this cultural part within medicine that if somebody is taking a break, if somebody is, you know, flipping out, if somebody is quitting and they don't have another job lined up, but they're just, you know, if they're throwing their hands up and they're stepping out, they're like, I can't do this anymore.

08:59
there is still this projection of failure that exists on them. When if we dial this back and we really turn back to that idea that emotional exhaustion is caring for too long, too much, right? Then we can see is that weakness or failure? Is that really how we want to conceive it? I don't think so.

09:29
Now do I need to make some changes to the way that I'm operating so that my care is not being depleted chronically? Yeah. Is yoga at lunchtime going to fix that? No. No. Are there some things you know systematically that need to happen? Yes and we're going to kind of get into that. But if you

09:56
are experiencing burnout, whether or not you've named that for yourself, there is probably a part of you that believes there is weakness or failure there, that you haven't been doing the right things, and that there's something wrong with you, that you're experiencing that. That has been baked into you by the culture of medicine, by this tough enough, you know, sort of mentality. And really...

10:24
I know I talk about gender constructs all the time, but really that comes from the patriarchal nature of medicine. And you think about, you know, kind of the olden days of, you know, the old white male physician, right? As the leader, as the pinnacle, and the supports that he had that were quite different from what we experience today. And I wouldn't say that he was emotionally healthy or,

10:53
balanced. I have no idea. I can't presume to know you know 40, 50 years ago what that experience was like of being that sort of cultural icon of again sort of white older male physician. I don't know what that was like, but I can imagine that that person was probably not super emotionally healthy, but they probably had a lot more support.

11:21
than what most of us have in terms of things at home, right? Probably a non-working spouse who took care of all of the things at home, probably a robust nursing staff, a whole host of things, and the ability as a man, I'm really honing in on this gender stuff right now, but the ability as a man to be more disconnected than women physicians are expected to be.

11:51
Now, do all men fall in that bucket? No. Do all women fall in the bucket of over caring for their patients? No. But just to say that we're socialized along those lines, and so that has also sort of baked into us. But if you are out there again, sort of thinking that I can't admit burnout, I can't do anything about it because we have this perception of it means weakness or failure.

12:21
that holds us back, that keeps us from engaging in the things that we know will be helpful for us and getting the help that we deserve. So let's let go of that myth.

12:34
The next myth is burnout is caused by this job. And what I mean is that sometimes we are walking around feeling like your current employer or your current specialty is just intrinsically causing burnout. And when we believe that, we will naturally conclude

13:01
things like the following, one that I have to leave this job or this specialty in order to fix my burnout in order to feel better. Believing that the simple act of leaving will fix it. Believing that it's better elsewhere, just by nature of not being here anymore. There are a lot of things that we attach to this idea.

13:28
that burnout is caused by this particular job. Now, I do hear stories all the time of severe understaffing, severe toxic workplaces, where they just expect to sort of turn through physicians and other healthcare providers, right? While they're retaining huge profits. There are lots of instances

13:56
where a particular job is very problematic. But when we believe that burnout is exclusively tied to this position, we are setting ourselves up for a real problem because if we simply leave and go somewhere else, but we are remaining emotionally exhausted, emotionally stuck in this tunnel, we will not feel better.

14:26
And that is so critical to understand. And it's not to say that we shouldn't leave a toxic job, that we shouldn't find a role where we have more balance. That's not what I'm saying. But what I'm saying is that it is not exclusively related to the external circumstances of the position that you're in. How do I know this? Well, I know this from personal experience. That's one part.

14:52
I know this because we can burn out working for ourselves. Do we think that we are a toxic workplace? No. But do we think that we are accustomed to caring for people in such a way and always putting other people first in such a way that we take ourselves off the table, that we put ourselves last, and in so doing, we do not...

15:21
care for our emotional and physical selves, absolutely. So my friend who I referenced, right, who is a successful surgeon who's working for herself, she isn't feeling the onset of burnout because she's working for a terrible employer. She is experiencing a recurrence of burnout coming on because she is used to working so hard in such a way and she has not yet learned how to...

15:50
set some limits for herself, how to set some personal boundaries where she is putting her self-care first, where she is, you know, sort of setting reasonable hours and expectations for herself. We are such high achievers and we're so used to, you know, being successful and driven and accomplished that we will take our burnout into any circumstance. If you left medicine right now.

16:18
and you went to go work at McDonald's or Starbucks, you would overwork your butt off because you believe that the work has to be done a certain way and you are so used to that work ethic, you are gonna make all the things better and guess what, you will be burned out there too. It is so important that we not believe.

16:41
that burnout is simply related to the job circumstances that we are in and that we see it as a set of beliefs and thoughts that we have had over and over again. And yes, absolutely influenced by the jobs that we've had, by the training that we've had, by years and years and years of putting our own needs last. All of those things are absolutely true, but we have to see it that...

17:08
just leaving the external circumstances of this job or this specialty or this type of practice isn't enough. We have to work on the emotional exhaustion part. We have to work on figuring out how can I do well in any job or any role, like a parenting role, where I am getting my needs met, where I'm moving through emotions like tunnels the way I'm supposed to, where...

17:36
I can be fulfilled and balanced as I am doing whatever it is that I want to do. Right? We really have to take away the power of thinking that it is just about this job. It is not my friends. Okay, a third myth or a misconception is that something has to happen before I can fix this. Now this is linked to

18:05
the second myth, but it's also a little bit different. So we might believe that in order to fix our burnout, we have to leave this job. So that's the part that's tied into this last one. We might think, I have to change this job in order to heal my burnout. We might also think that some kind of crisis needs to happen, right? So maybe.

18:30
I don't know, we're hospitalized with a kidney stone or debilitating panic attacks or something like that. If you've ever read Christine Carter's book, oh gosh, which I can't remember the name of right now, she talks about an experience of having been hospitalized with a kidney stone and how grateful she was for the break that she got in being hospitalized in horrible pain with a kidney stone because that allowed her to pause her work

19:00
allows her to pause her parenting. She's not a physician, she's a PhD and studies happiness science. But it just resonated with me when I read that part of her story, right? Because how many of us are hoping for a mild illness or injury so that we get some kind of rest and relief from our work and or our parenting responsibilities?

19:26
You are not alone if you've had that thought. It is not unique to physicians. And that kind of crisis is not necessary for you to decide that we're going to do something different. What are some other circumstances that come up? Some other things that we might be leaving have to happen before we can work on our burnout. Another common one is that I have to prove that my situation is worse than everyone else's.

19:56
before I make change or get help. So often when I'm talking to my physician clients, they are telling me things, they're sort of laying out all the challenges that they have and then, but I also have a husband at home, but I also, I don't have it as bad as so and so, but also, and they go on and on about the different circumstances that make

20:25
their existence better than someone else. And my friends, we can always find someone in a worse circumstance than we are. And if we constantly believe that we have to be in the worst position in order to get help, guess what? We're always gonna find somebody who's in a worst position. And that is not helpful, nor is it necessary. So let's let go of that part.

20:51
The other big hang up here that sometimes is preventing people from getting help is the belief that someone has to give me permission in some way in order for me to believe that I can fix this.

21:11
This is such a deep belief and I absolutely was in this for just a ridiculous amount of time myself and it's tied in with this last one you know having to feel like I had to prove that my position was worse than everybody else's but also that if I kept trying to prove

21:38
that my position was worse than everybody else's, that somebody was gonna swoop in and give me permission to make some changes. You will wait for forever if you think that someone is gonna come and give you permission, if you think your employer's gonna come tap you on the shoulder and be like, we notice how hard you're working and we really think you're needing a vacation, so we're just gonna cancel all your patients. Now,

22:07
Does it happen sometimes that something bad has happened and you get put on administrative leave or some similar circumstance? Yeah, no, that definitely happens. Let's not let it go there. But if you are waiting for cosmic permission before you make changes or get help, you're going to be waiting a damn long time.

22:37
fall into that belief that you need someone else's permission or you need for them to declare that you're so burnt out that you need some help, do not wait for that. If you are hearing my words and you're just like, oh no, that's me, take this as a sign. Take this as me giving you permission right now to go and get the help.

23:07
to make the changes that you need to make in order to feel better.

23:14
Let's go back to that idea again of emotional exhaustion. So I've named three common misconceptions of burnout that are holding us back. So the belief that burnout is weakness or failure or that we're not doing enough yoga, that's number one. Number two, burnout is caused by this job or specialty. Number three,

23:41
something has to happen before I can fix this. We're dropping those ideas right here, right now. Now, they are very entrenched beliefs often, and so don't be shocked if they are bubbling up, you know, as you are trying to navigate this for yourself. That's just what well-worn thought pathways do. Nothing has gone wrong if that's you, but...

24:07
If we're focusing on the emotional exhaustion part, on that idea that we are getting stuck in this emotional tunnel, whatever you want to label it, for me, I keep going back to the word overwhelmed because I just felt chronically overwhelmed. You might feel I get stuck in the emotion of resentment. I get stuck in the feeling of depletion, right? It doesn't matter what you call it, you know.

24:37
what that sensation feels like and if that's you, what needs to change in order for you not to get stuck there anymore?

24:48
we will never be able to immunize ourselves against a particular emotion. I can't do some kind of work or go to some kind of retreat and never feel anger again. That's not the point. The point is, how do I start to take care of myself differently so that I don't get stuck in these feelings anymore? What would that be for you?

25:18
Do you believe that it might be possible that you could practice medicine and not get stuck in this emotional exhaustion before? Now, maybe you haven't had that experience before. You might be able to point to some people though, who don't seem to be dealing with that, because there are physicians who, they may or may not have experienced burnout in the past, but...

25:47
When you look at them, you see that they are practicing boundaries. You see that they are not seeming to get stuck. And those of us who are very used to getting stuck in our feelings and that emotional exhaustion might look at those people and be like, well, yeah, but I don't wanna be like that person. That person seems like a jerk. There is some gray here. It is not either I'm a jerk or...

26:14
I'm over here and I'm caring and I'm burned out. We need to think that there is a middle area of this continuum and you know, you're gonna vacillate as you're figuring this out. There might be some times when you are practicing boundaries where you are saying no to people and disappointing or upsetting people, having people leave your practice, having people just frustrated with you.

26:43
And if we never do that, we probably aren't practicing good boundaries. Now, it's not my, it's not my role to act like a jerk, but sometimes people are going to interpret my actions and my boundaries as such. And you know, for myself, I've had to decide, you know what, I don't control their thoughts, I don't control how they feel about the circumstance. I can empathize that.

27:11
Yeah, from their perspective, I can see how they don't like, you know, the situation that we're in, I get that. And I'm still gonna choose to make my choice over here. I'm still gonna choose to take care of myself in this instance over here, because that's important for me.

27:31
We don't control what other people think about us, but I wanna invite you to come with me and believe that there is a place for you. And leave medicine if you want to, that's fine. That's not even what we're talking about here. But I want you to believe that there is a place where you're not stuck chronically in emotional exhaustion, where you can see

27:59
that there is a space in the middle between I give everything to everyone and leave nothing for myself and I'm so exhausted I can't see straight on one end of the continuum and over here where I'm a disconnected jerk who doesn't care about anyone and you know who leaves the office skipping every day and counting my money. There is room in the middle my friends.

28:29
And if we think that it's either this or this, so unhelpful. What would it take for you to stop being emotionally exhausted? And let's make it not dependent on other people. Therefore, it's not dependent on your employer tapping you on the shoulder and saying, here's a two week paid vacation.

28:57
We're going to fix all the problems when you come back. You're going to have 17 assistants working with you and three RNs. And you're going to see three patients a day. It'll be marvelous. That's not going to happen.

29:15
that's also not automatically gonna fix your burnout, right? Because you're gonna be feeling like you're not doing enough. I know you, I know you. Okay, so what would it take to fix your emotional exhaustion? I'm gonna share some examples and I just, you know, I want you to think about them. So things that have made a tremendous difference in my life

29:45
my morning walk. My morning walk is exercise, but it's also quiet, personal time. I'm usually listening to a podcast. I'm usually looking for the wild bunnies that are out there in my neighborhood. It is a time that is just for me, and yeah I have to wake up stupidly early to do it before my family gets up.

30:09
but it is so important to my wellbeing. And I don't wanna say that that means that you have to do the same thing. I just wanna say that I derive a lot of meaning and enjoyment out of it. I realize that it makes me calmer, it makes my day feel more organized and smooth because I've had some time for myself before everybody gets up and on their way. I've had some time to settle my thoughts and be curious.

30:38
That makes a tremendous difference for me.

30:43
not engaging in chronic numbing behaviors. So my chronic numbing behaviors are like staying up way too late watching stupid YouTube videos, not really usually that dumb, just like comedy stuff. No judgment. I'm not into reality TV. And just kind of mindlessly eating. Those are my numbing behaviors and I know that when I'm doing that more,

31:13
I'm not taking care of me. That is like a warning light for me. So when I'm choosing to do other things, that might be taking a bath, it might be spending some time with my husband, it might be doing some journaling, it might be going to bed. Those are things that tend to help me when I'm feeling whatever the feelings are that lead me to want to numb. And that's usually after a long day.

31:41
I might be stressed out about something, right? I might've just read a nasty comment from somebody or received a portal message from a patient that's bothering me in some way, right? When I choose to engage in numbing, like I know that I'm not doing my self care and that's not gonna help me resolve the issue or feel any better. The goal is not zero though. The goal is just noticing like, yep, okay, am I gonna choose to do this?

32:10
tonight or I'm going to choose to do something else, choose to take care of myself in a different way. Deciding for myself how do I make this easier? This is something I work on all the time and the more curious I get about what will make things easier for myself, the better and better my brain gets at figuring it out. But that has come from a place of believing

32:38
that I deserve not to be burned out. I deserve to take care of myself. I deserve to have things be easier. And often when we are experiencing burnout, when we're deep in it, and certainly that's true of where I was for many years, like I didn't really believe that I was worthy of getting help because I felt like I had been told so many times that I wasn't gonna get any special treatment that, you know, I...

33:08
you know, work just like everybody else and everybody else was okay. So, you know, I don't get any special favors. We incorporate that belief into ourselves and that keeps us from doing things that will be easier for us. Let's stop doing that. When you start to believe that you can have things easier, right? Then your brain opens up to show you all the ways that that could happen.

33:36
but it has to come from a place of changing your thoughts. What else can be helpful? Working on changing your thoughts. And that can look a lot of different ways. I talked recently in an episode about the thought model and how our thoughts create our emotional states. That would be a great episode to go back to. I believe that's 134. And practicing noticing what those thoughts are.

34:05
when we are feeling an emotion and choosing to get a little curious, is that really helpful here? Yeah, that's a really old thought that I've often had. It's not really helping me right here. It's actually making me feel worse. What do I wanna practice thinking instead? This can be an out loud practice. This can be a journaling practice, but getting used to identifying what are these thoughts that are leading me down this pathway.

34:33
What would it take for you to be feeling less emotionally exhausted? Don't walk out of this conversation thinking that what I'm saying is that burnout is your fault, but I think it's really important that we understand that so much of burnout is things that we have absorbed from outside and are now running the burnout programs inside ourselves.

35:01
right? We have learned to ignore our own physical needs of hunger, needing to go to the bathroom, needing to stay hydrated. We have learned to tune that out, but no one can take care of that for us. We have to learn to connect back to our hunger. We have to learn to hydrate ourselves. We have to be willing to use the bathroom when we need to go. Maybe not in the middle of an emergency surgery, right?

35:28
but I can go to the bathroom in between patients. I can and I should, right? And you should too. We have to understand that we have been trained so well to run the default programs of ignoring ourselves and serving other humans, that we are the only ones who can interrupt that pattern. And that's again,

35:54
where my friend who is now in her own practice is needing to tune in, right, and see, ah, what are the programs that I'm running inside myself that are leading me to feel burned out? How am I going to stop those programs? How am I going to change the algorithm, right, so that I'm putting in my self-care practices, that I'm putting in some boundaries and some limits that work for myself.

36:23
that I'm changing the way that I think about how I work so that I can lean into things that give me more support that help me to make my workflow easier because I am worth it, I deserve it. Because everything is better when I'm taking great care of myself.

36:46
My friend, if you're listening, I love you, and this episode is just for you. But everybody else can listen to it too, because these are messages that we all need to hear. So I'm gonna wrap it up here for today. Thank you as always for tuning in. Thank you to all my friends and my clients and people who connect with me on social media and share their experiences.

37:14
love hearing how things resonate with you. I love hearing how your experiences are going and what is changing in your life because of these conversations that we have. And I feel like we are in conversation when I hear from you. And so please continue to reach out and share your experiences with me. Until next week, take care.