RESILIENCE AND BURNOUT: LESSONS FROM DR. WAYNE SOTILE PHD AT THE ANNUAL FEAGIN LEADERSHIP CONFERENCE DUKE UNIVERSITY.
I am indebted to Dean Taylor, MD for inviting me to the Feagin Leadership Program Annual meeting at Duke University. The topic on RESILENCY was one that I often pondered but was seldom able to locate real experts to learn from. After our surprise visit from Coach Mike Krzyzewski, Wayne Sotile, PhD, discussed the role of building resistance to BURNOUT as a key process when developing a resilient leader.
The first shocker came when Dr. Sotile explained that the development of a ‘balanced’ life is a MYTH. All we ever hear is how we need to balance our lives. He stated that inevitably what occurs when one tries to balance out work, family, themselves and an intimate relationship, is that you and those around you end up feeling angry, guilty or anxious, which is certainly not the model of a “balanced” life. Unfortunately, surgical professionals are at the top of the “most likely to be burnt out” list, so it behooves us to understand and take charge of this process. So why are medical professionals and especially surgeons so prone to burnout? As expected we are all high producers used to high demands. When we have high control we do great, but when we begin to lose control, then the stress levels go up. What happens when we are stressed? We get temperamental, angry, distressed and develop reduced mental processing powers: we “get mean and stupid”. What happens when we become mean, stupid and narcissistic? Those around us hate us and then we fight each other.
So who suffers when physicians hit the burnout threshold? Well asides from us and our families, it turns out that our patients and teammates suffer. There have been multiple studies that correlate signs and symptoms of burnout to reduced quality of care due to an increase in medical errors, increase in litigations, and decrease in patient compliance and satisfaction.
How do we know if we are burnt out? Dr. Sotile said that is easy, just look into the eyes of the ones we love, our teammates and our patients. If you see a look of distrust, then rest assured you are burnt out. If you are feeling guilty over or stressed over or arguing over priorities in your daily life…. You are burnt out.
Is there anything we can do about this? The obvious choice is to blame and correct the system: increase efficiency and support, reduce documentation burden, develop leaders who foster engagement, work on our community,…. And on and on…. Dr. Sotile said that ultimately, you need to look into yourself and find what you personally can do for any real change to occur. Sure, you cannot control 90% of the stuff going on around you but if you really want to make a stance, figure out what 10% you can change. To make any changes you need to: “use realistic roadmaps. Honestly assess yourself. Counter hassles with uplifts, and deepen your relationships.”
At the end of it all Dr. Sotile left us with these messages to take home:
“Face what is beneath your feet not what you are grasping for.”
“ You don't just decide to be resilient…You need health, You need collaboration, you need career satisfaction, you need family satisfaction and to have that you must be satisfied at work.”
“It's not the number of hours you work but your attitude when you come home that affects your family- in the end you will see that, how you treat someone at work affects how they react when they get home.” So be nice to one another.
“Little changes (in your thinking, behavior, self-care, and ways of dealing with others) go a long way.”
“Find meaning- see the familiar in unfamiliar way”
“Rethink balance- only inanimate objects have balance. Don't mix your obligations - switch rocks regularly.”
“Look for joy in others- don't ruin it.”
“Don't share irritability, anger...”
“Enjoy moments of serenity.”
“Believe, have hope and have Interest.”
“Find Amusement, wonderment, pride, awe, and love as often as you can”.
After discussing this summary with Dr. Sotile, I had a few questions
- In dealing w very busy, very focused, and very skeptical physicians- what's the one thing you do that captures their attention to instill the desire to make a change (assuming they were not deemed a disruptive physician and this was recommended to them)?
- As one takes on additional roles from being a clinician and family partner and parent to include major leadership roles (Department Chair or Chief Surgery) you essentially have gone from two to three "competing" interests all of which are equally important. What's your advice to the leaders about making sure everyone senses that you have not deprioritized them- that is you are not even more distant?
- It's easy to say "I don't sweat the small stuff" but in family, clinical care and organizational leadership, what you class as the "small" stuff likely is not small to your patients, family, or organization. So how does one prioritize three seemingly non-intertwined worlds?
KENNETH A. LIPSHY, MD, FACS