Canadian Physicians on Slippery Slope of Burnout

In a recent CMA survey of 2251 physicians, over 45% were found to be in an advanced state of burnout. If this reflects the seriousness of the problem in the general population of physicians in Canada, then it can safely be said that the healthcare system is at serious risk of collapse. In this article we outline our understanding of the reasons for this situation and propose a new approach to helping empower physicians. Additionally, we believe our model will empower their patients thereby reducing the burden on the healthcare system.

Our approach to physician empowerment and wellbeing considers the following issues:

a) Increasing expectations on physicians from their environment (both external and internal)

b) Physicians' conditioned responses to expectations posed by their environment

c) How these conditioned responses severely limit choices that physicians feel they have and the consequences of these limitations

d) A new definition of empowerment

e) A means by which empowerment can be achieved

f) The benefits of this approach for physicians, their families, their patients, and the health of the healthcare system as a whole.

We start by addressing the Medical Environment. This includes both the external as well as internal expectations impacting on physicians' stress levels.

The external expectations are self evident:

a) dealing with an aging population with unremitting chronic conditions taxing resources, energy and time

b) enduring an increasingly litigious environment

c) treating an increasing patient load due to higher physician turnover, lower medical school enrollment and physician exodus,

d) making due with aging equipment

e) enduring serious public illnesses which impede normal operating practices

f) addressing needs for stricter recording practices and evidence based procedures

g) adapting to rapidly changing technological advances

h) keeping up with the research and internet driven information overflow

i) enduring the threat of record audits that often entail the return of large sums of money

j) an increasing strain on personal and family relationships, either to be more available or to keep working in order to remain an adequate provider

k) to take less personal time out for oneself to revitalize themselves

and many others that are not mentioned here.

The physician's internal environment is an area that has received much less attention, yet we believe to be the main source of most of the problems contributing to physician burnout. This internal environment largely consists of unconscious conditioned responses that many physicians become imprinted with throughout their lives and which contribute to maladaptive responses later in life.

By maladaptive, we mean any behavioural choices made which are not fully aligned with and support the core values of that individual. Core values here refers to deeply held values that each of us holds dear. Some of these include a desire for: integrity, inner peace, health, love, joy, fulfillment, self esteem, self worth, self confidence, contentment, energy, freedom, abundance etc.

The conditioned responses of physicians often include such internal beliefs and/or emotions as:

1. I can't say no when I want to.
2. Trying to be in control of my life takes too much work.
3. I fear the college.
4. I fear I may be sued.
5. My feelings are just a nuisance that get in my way.
6. I have to accept unbearable working conditions.
7. I'm a failure if I make a mistake.
8. My patient's needs are more important than mine.
9. My family's needs are more important than mine.
10. I'm letting my colleagues down if I put my needs first.
11. Being a good physician means being self-sacrificing.
12. My needs are not important.
13. I'm not important.

Such a set of unconscious conditioned responses can make physicians feel trapped, helpless and totally disempowered. This disempowerment is evident at several levels. At the individual level we observe burnout, high suicide rates, substance abuse and dependence, sexual acting out, unethical behaviour, etc. More hidden are feelings of inadequacy, low self worth, low self esteem, low self image, guilt, shame, an inability to trust others with their feelings, fear of appearing weak, fear of letting others down, and worst of all, a fear of being found out.

Systemically, from medical school to practicing specialist, this disempowerment breeds a culture promoting a sense of paranoia, alienation, isolation, fear of failure, tendency for high self sacrifice, low self respect, cynicism, fear of reprimand, denial of personal feelings and ultimately denial of self.

In summary this yields a fragile and ailing healthcare system. Hoping to rectify this problem we focus on empowering physicians; that is, helping them replace maladaptive unconscious conditioned responses to external challenges with choices that are motivated by the internal wisdom of their core values.

To effect this it becomes necessary to recall first the purpose of Core Values in our lives. Core Values are those internal feeling experiences that we value most, which we know instinctively and which act as "set points" telling us whether or not we are on course towards our success. In other words we don't have to be told what is good for us, we already know.

Of course some of us seem to forget, why? Well, because we have chosen to live our lives directed by the maladaptive conditioned responses mentioned earlier, which became imprinted largely out of fear. For instance, can you remember having sacrificed one or more of your core values as a result of some fearful, or traumatic, experience? How has that experience affected your ability to reassert those core values following that event? As you may recognize, once a core value has been de-valued by fear based imprinting it seems to go underground, only to re-emerge as an experience of feeling emotionally or physically stressed. That is, your body reminding you that you are compromising a core value, which ultimately means you're compromising yourself and everything you've been trying to accomplish in your life. So how do we move back into alignment with our entire core values and become empowered?

Our approach, which we call the Mind Resonance Process(TM), entails looking at the paradox which arises when we look at two questions pertaining to a given maladaptive conditioned response:

1) What is this conditioned response doing to my life? and

2) What is the purpose of this conditioned response for my life?

The paradox often elicits an unconsciously held "faulty logic" or "lie" about the purpose of the conditioned response. Often the individual accepts this "lie" without question and thereby succumbs to the conditioned response in a reflex manner. This sends them out of alignment with their core values and into a state of stressful self-compromise. Once an individual acknowledges the "lie", they have begun the process of releasing it, as well as the maladaptive conditioned response, from their lives.

What follows is a spontaneous realignment of the mind and body of that individual with important core values. This shift is immediate, palpable and is experienced as a return of vital energy to the body and mind, a feeling of inner peace, joy, buoyancy, energy, clarity, focus fulfillment, and a sense of wholeness.

We describe an application of the Mind Resonance Process(TM) to the negative belief "I can't say no when I want to". We start by looking at the "purpose" of accepting this belief, and it goes something like this:

Accepting I can't say no when I want to is so that,
I can be available to my patients whenever they need me, so that,
I can do my duty as a good and caring physician, so that,
I can feel happy and good within myself, so that,
I can feel at peace and like a worthy person, so that,
I can feel fulfilled and my quality of life will improve.

We then look at what the belief actually does to the individual, and it goes something like this:

Accepting I can't say no when I want to,
Makes me feel enslaved to my patients, thereby,
It makes me feel trapped, helpless, frustrated and resentful, thereby,
It makes me dislike my patients and my work, thereby,
It makes me less attentive and conscientious, thereby,
It makes me less of a caring person and physician, thereby,
It makes me feel ingenuine, guilty, ashamed, thereby,
It makes me feel low self-esteem and low self-worth, thereby,
It makes me feel like a lousy physician and a lousy human being, thereby,
It makes me afraid of being found out, thereby,
It causes me to bury these feelings in alcohol, drugs and/or leads me to suicide.

Summarizing these two scenarios we note that we have reached two different and contradictory conclusions about the belief " I can't say no when I want to ", i.e.

1. It's purpose appears to be to enhance one's quality of life, but what it actually seems to do is,

2. Destroy one and one's life.

Clearly these contradictory results cannot be simultaneously true. As one looks at one's actual experience of holding on to the negative belief one realizes that (1) above is clearly not true even though unconsciously they have lived as if it were true. In fact one chooses to lie to them selves about the belief if they choose to go on accepting that (1) rather than (2) is the truth about the belief.

When one can come to this realization then it becomes a simple matter of going deep within the core of ones' self and requesting that the lie (i.e. conclusion (1) above) and the belief itself be "purged" from their lives forever. This is followed by a simple assertion, from that person's core self their desire to live from a place of being in full control of ones' life from then on.

What has been described is a brief example of the Mind Resonance Process? and it is meant to give the reader an outline of the basics of the process. As each individual's situation is slightly different this often entails slight personal modifications in its elaboration.

Dr. Nick Arrizza is Founder & President of Arrizza Performance Coaching Inc., Organizational Psychiatrist, Professional, Executive & Life Coach, Stress Expert, Researcher and Speaker. He hosts an ongoing series of International Teleconferences on helping to Empower Physicians Dealing With Stress. His Web Site can be found at: http://www.telecoaching4u.com

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