Burnout, Wellbeing and Performance

Dr Alfari* didn’t hear the words being spoken to him, he was lost in his own thoughts, so it took a minute before he realised he had been asked a question about the patient in front of him. He was annoyed at himself for losing attention, but it came out as irritation at the person asking the question. He only realised this when he saw the startled look upon their face as he snapped back a response. The mood in the clinic tensed up. The last 10 minutes of the consultation felt like an eternity for everyone. Normally, he would have remained focused or at least able to regulate his emotions so that others were not impacted or distracted by his mood. Not today.

As an eye care professional, Dr Alfari was a high achiever, hardworking and dedicated to his patients, colleagues and the practice. Having grown up in a medical family, he knew that his career choice would be mentally and physically challenging, especially when trying to juggle the demands of the job and the hopes and expectations of his own young family. However, the past few years had been something else, not just for him but for many of his colleagues. Pandemic protocols, under staffing, long hours, career decisions to make, and high expectations, had created the perfect conditions for physical and emotional exhaustion – something he had seen happen to colleagues but thought he was immune from.

But that day Dr Alfari had woken up feeling unwell and overwhelmed.

The signs had been there for a while and he had made some attempts to let others know, to request support, and to try to reset worklife boundaries. He had extended his summer break by an extra week, thinking that would give him time to recover from a tough year. While it helped, the effect was short-lived.

Burnout is sneaky. It creeps up on you inch by inch. A bit like boiling a frog. The frog notices if it is placed in boiling water and jumps out. However, if you place it in cold water and slowly heat it up, it doesn’t notice, so it stays until the water is boiling and… well, you know how the story goes.

While, in reality, frogs may not be as stupid as we think, the metaphor is a good one to describe the insidious nature of long-term stress.

WHAT IS BURNOUT?

Burnout is the result of being exposed to chronic work stress – or a slow boil – that places the body and mind under duress and leads to the kind of physical and emotional exhaustion you might experience at the end of running a marathon. Activities or challenges that used to bring energy and motivation instead become overwhelming and you are no longer able to function as effectively; professionally or personally.

Often, we think of stress being caused by difficulty or crisis, however, it can also be created by too much of a good thing. Trying to grab hold of too many amazing opportunities without adequate resources – time, energy, people, finances – to meet the ongoing demand. Regardless of the stress being caused by opportunity or threat, the impact can be the same.

Burnout is not reserved for a particular profession, gender or job role – whether you are an ophthalmologist, optometrist, practice manager, clinical nurse, orthoptist, optical dispenser or administrative support, you are still human and vulnerable to the impact of chronic work stress. This is especially true if you do not have the psychological tools, organisational and social support to manage it.

The ICD-11 diagnostic manual describes burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:

• feelings of energy depletion or exhaustion,
• increased mental distance from one’s job,or feelings of negativism or cynicism related to one’s job, and
• reduced professional efficacy – feeling ineffective or a lack of progress/achievement.

According to the World Health Organization, burnout is not considered a medical condition in and of itself, however, it is often a precursor to significant mental and physical illness if left unchecked. It can also negatively impact individual and team performance at work and in other important life domains, such as relationships and parenting.

The journey to burnout is marked with warning signs and, if you know what to look for, you can recognise them and take action before it is too late. Each symptom exists along a continuum from mild to severe and the earlier (milder) the symptoms, the easier to turn things around. Examples of changes in thinking, feeling and behaviour that you may see in yourself or in colleagues are:

Fatigue: In the early stages, you may feel a lack of energy and a tiredness that takes longer than usual to recover from. In the latter stages, you feel physically and emotionally exhausted, drained, depleted most days, and no amount of coffee, sugar or sleep revives you.

Sleep: In the early stages, you may have trouble falling asleep or staying asleep one or two nights a week. In the latter stages, insomnia may turn into a persistent, nightly ordeal; as exhausted as you are, you can’t sleep, or you do sleep but never wake feeling refreshed.

Appetite: Weight fluctuations can happen, either because you crave more sugar and fatty foods, or you lose your appetite, skip meals, and eat less.

Memory and attention: Lack of attention, mild forgetfulness and minor errors are early signs. Later, the problems may get to the point where you struggle to maintain task focus, the workload takes longer to get through, or just builds up.

Mood changes: You might find yourself feeling more anxious, or on edge. This can lead to irritability and anger, maybe finding yourself short and snappy with others, or yourself. It can also manifest as feelings of sadness, lack of interest or enjoyment in your usual activities, hopelessness, guilt or worthlessness. At the more severe end, this mood change can develop into an anxiety disorder or episode of depression.

Physical symptoms: These can include chest pain, heart palpitations, shortness of breath, gut pain, light-headedness and/or headaches that increase in frequency and duration.

Detachment and isolation: Detachment is a general sense of feeling disconnected from others or from your environment. It can take the form of avoiding social interaction or work tasks and responsibilities. You might cancel a lunch date, call in sick, avoid making phone calls or returning emails.

Illness: Chronic stress weakens your body’s immune system, making you more vulnerable to coughs, colds, and physical injury e.g., strained or pulled muscles.

Performance: The changes in thinking, feeling and behaviour can all lead to being less effective or productive at work. People will often respond in the early days by working longer hours to ‘catch up’ or ‘stay ahead’, which just results in increased stress and likelihood of burnout. Even minor mistakes or drops in performance can be challenging for self-identity, particularly for high achievers or perfectionists. This can lead to deflecting blame or responsibility to outside circumstances or other people, or to excessive self-criticism.

FROM BURNOUT BACK TO FLOURISHING

If you think you may be experiencing burnout – pause. Take stock. What are you noticing? If you are unsure, then speak to your GP or psychologist. Getting a second opinion can help you see things more clearly and really understand what is going on.

If in doubt, reach out and ask, as early intervention is key to recovery. If you know that you are experiencing burnout – stop. Burnout is unlikely to resolve on its own without you making some significant work or lifestyle changes. Knowing what changes will have the greatest impact can be unclear when you are in the thick of it, so before you do anything hasty like quit work, or move to the country, take a break.

Step 1 – Rest 

The first step to recovery is rest. Your mind and body need space to refuel and rejuvenate. It is hard to make good decisions when you are not feeling yourself or thinking clearly. So, talk to your employer, GP and/ or family about taking a break from work or reducing your workload. Give yourself the best chance to recover. How long will depend on your personal circumstances, this is not a one-size-fits-all approach.

Resting is hard to do. People who end up with burnout are often driven, high achievers, loyal and care about their work. They worry about the impact on others if they stop or reduce work. It is also common to worry about being judged – that they have failed, look weak or imperfect. Feelings of shame, guilt and embarrassment are common. It is an act of courage to stop and prioritise your own wellbeing, to take time out to rest and recover.

Ask yourself the following questions:

• What do I find most challenging about resting or taking care of myself?
• What would I say to a friend/colleague with burnout?
• How can I create space in my own life to rest mentally and physically? and
• Who is in my network that can guide or support me through this process?

Step 2 – Identify the Cause 

Burnout is most often a complex interplay of personal psychological and workplace factors. It is rarely an individual problem that can be solved independently of the workplace. Identifying the underlying cause is key to creating your personal plan for recovery and return to a thriving relationship with work. The personal psychological factors are where we have greatest control – our own energy, attention, emotions, choices, and behaviour. Workplace factors – such as safety, workload, role clarity, resources, remuneration, social support, and environment – are often where we have less control or influence, depending on our role in the organisation.

When establishing the causes of burnout, ask yourself:

• What workplace factors do I find most draining or dissatisfying?
• What personal factors contribute to my burnout?
• What workplace or personal factors can I control or influence? and
• What do I have no control over and need to accept or let go of?

Step 3 – Know Yourself 

Most people go through life on autopilot. Not really taking the time to understand their mind and body and, consequently, what they need in life to not just survive, but thrive. Experiencing the symptoms of burnout is the mind yelling at us, letting us know that our tank is empty, the way we are living is not working right now, and we need to take stock and adapt.

Too often we compare ourselves to some idealised other – that doctor who only needs five hours sleep, the practice manager who is always full of energy and optimism, or the nurse who maximises their time and productivity with military-like precision. This comparison is unhealthy and unrealistic. Instead, learn how to focus on yourself and understand what you need to feel and function at your best.

Whether you are experiencing burnout or simply want to have a better relationship with work, there are three internal resources that we can take charge of – how you manage your time, energy and values. When we get the right balance of these three factors we not only feel better but we perform better.

Time is a limited resource – 24 hours in a day, 168 hours in a week. We often focus on how to be more productive with the time we have but fail to factor in down time, unproductive time, time for the body and mind to heal and re-energise. We are also subject to cognitive biases such as the planning fallacy, where we vastly overestimate what we can achieve with the time we have. Often, we over commit ourselves, with good intention but a disconnection with the actual limits of time.

Consider your relationship to time with these questions:

• How well do I understand and manage my time commitments?
• Do I reserve enough time for mental and physical rest?
• If I had to reclaim time for rest or rejuvenation, what would I be willing to let go of ?

Energy, like time, is another limited but renewable resource. A lack of energy is a key indicator of burnout, as much as the presence of the right amount of energy is the hallmark of great performance.

The key levers you have for managing energy are how you rest, refuel, connect, and play.

Reflect on how you manage your energy with these questions:

• How well do I understand and manage my energy levels?
• How much sleep do I need to function optimally?
• How do I best fuel and hydrate my body for optimal energy? And
• What type of connection and play helps me re-energise? e.g., exercise, socialising, meditation, cooking, gardening, time in nature, reading, naps.

Once you have your energy back, then understanding your personal values is key to making better life choices at work and home. Think of your values as your life guide, like an internal compass that tells us which direction to head. Understanding what you stand for in life is a powerfully motivating force and behaviour change agent. The decisions we make every day are driven by our personal values, for example, curiosity, mastery, loyalty, adventure, or compassion. They guide the small life choices (saying no to extra work requests) and the bigger life choices (changing jobs or relationships).

Living a life that is in congruence with your values – where your behaviour or actions match your core values – leads to greater authenticity, clarity, and wellbeing. When you act in ways that do not match your core values you often feel uncomfortable, dissatisfied and, over time, begin to languish or burnout.

Reflect on how well you understand and live your values with the following questions:

• What are my priority values for this stage of my life? Have they changed?
• Am I living a values congruent life – do my choices and behaviour reflect my values? and
• Do my values feel challenged or supported by my work life? If so, how?

Step 4 – Know Your Work 

Our relationship with work and our workplace is a key component of burnout. Understanding the strengths and limitations of the organisation you work within can set you up for a healthier work life. Also, knowing who, within your workplace, you can talk to if something is not working for you, or others, is important.

Consider the following:

• What workplace factors challenge or support me best?
• What is it that I want or expect from the workplace?
• Do they have the adequate resources to meaningfully support me?
• Am I willing to accept their limitations as much as their strengths?
• If I am struggling at work, who would I talk to?

TAKE ACTION

Burnout is not an individual or ‘I’ problem to solve, it is a ‘we’ issue. For employers, there is a responsibility to recognise the workplace stressors that contribute to burnout or poor mental health and have a clearly communicated strategy to address them. As individuals, talk to trusted people in your life who can help you recognise the work and personal causes of burnout, address the stressors you have control or influence over, release the stress, and sustainably rebuild your energy. As hard as it may seem to stop, rest and rejuvenate, it is the only way forward when it comes to shifting from burnout back to flourishing.

The information in this article is not a substitute for medical advice, nor is it to be used for diagnosis and treatment. You, or anyone you are concerned about, are encouraged to seek professional advice and treatment from General Practitioners and/or qualified practitioners and providers in specific cases of need. If you or the person you are concerned about appear at risk of self harm or harm to others, please seek immediate professional assistance. * Patient name changed for anonymity.

Jo Mitchell, PhD, is a clinical and coaching psychologist and co-founder of The Mind Room. She has over 30 years’ experience in health, sport and business. Dr Mitchell works with organisational leaders and high performers to help them realise their vision, values and performance potential. The Mind Room team creates and delivers professional development experiences to build fit minds and flourishing lives. Visit: www.themindroom.com.au.