Dear BCMS Member,

We have heard it said many times. We need to take care of ourselves, or we will suffer from burnout.

I recently had a conversation with one of my colleagues about stress, burnout, and self-care. This colleague had just documented the time of death of his patient. This was not in the height of the Covid-19 pandemic; it was just a routine day. He looked very worn and tired as I asked him if he was alright. He told me that the patient had been in the ICU for several weeks and the death was not unexpected. But he, like most physicians, told me it still hits pretty hard when death occurs.

I asked him about burnout, and he told me that he has never experienced burnout because he always makes time every day for himself. Noting that his body language was telling me something different, I asked him to explain to me how he does that, and what he does for his self-care. In a very serious voice, he told me that he makes it a priority to take five minutes out of each day for what he calls, “my time.” continued on next page >

After talking with him more I wondered if he would get as much stress relief if he called it “Mai Tai” instead of “my time.” In this time of what he described as pure solitude, he does five minutes of slow breathing. Sarcastically, I asked him if he ever goes longer than five minutes. Again, in a very serious voice, he admitted that occasionally he has been known to take up to 10 minutes. Physicians and other healthcare providers notoriously do not take time to grieve. Yes, we have family and friends in whom we confide, but no one truly understands. And just like that, he was off to see another ill patient. The sad part about this interaction is that he was serious and truly believed that five to ten minutes of slow breathing each day would negate 12 to 18 hours of daily stress.

I asked another colleague how he manages the stress in his life. He told me that he makes sure that he gets 5,000 steps of walking in each day. I thought this was a great step forward (pun intended) so I pressed further. I wanted to know when, how, where, and with whom he got his walking in. I was picturing a power walk with a little elevated heart rate or a casual stroll with his wife holding hands. But when I questioned him further, I realized that his walking occurs as he moves through the hospital seeing one critically ill patient after another. Other colleagues have told me that they do yoga or take a warm quiet bath at the end of a day. But none of this is what well-being is about.

To ultimately get to the solution, we first need to understand where the problem comes from. Burnout is caused by stress – not a stressful hour, not a stressful day, not even a stressful week. The stress of administrative responsibilities, insurance hassles, and productivity demands all lead to a stressful, if not stress-filled, environment and lifestyle.

As medical providers, we are expected to be resilient. But often resilience means shutting ourselves off from our emotions. The Penn State and Tower Health Systems, to their credit, have been trying to boost morale and keep providers from quitting or retiring early. They have been offering programs of entertainment and collegiality. I encourage the health systems to continue with these endeavors. The staff and providers of a health system are the most valuable assets the systems have. But the efforts are small, even if they are sincere, and honestly the health systems are not well versed in this arena. In the end, it is up to each of us to be responsible for our own self-care.