01/03/2024

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This article is co-published withZcalo Square.

In early 2020, weeks before COVID changed our lives, I sat uneasily with a close friend from medical school listening to a panel of experts discuss burnout, morale impairment, and well-being. self-care strategies including a healthy diet, exercise, yoga and mindfulness. Many colleagues have found these sessions helpful. I left feeling even more bad.

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These discussions began popping up in hospitals, including mine, well before the pandemic helped push stress and burnout levels among healthcare workers to an all-time high. Healthcare worker burnout has been linked to physician and nurse suicides, depression, and medical errors. It impacts cognitive function, patient safety, and quality of care.

My fractious relationship with presentations on burnout and wellbeing begins with their dominant focus on data. I don’t need research to explain what I feel. Over the course of three decades, I overcame increasing hurdles caring for patients as an emergency physician in a failing healthcare system. Over the past three years, crushing constraints have eroded my integrity as a healer. I knew the patients deserved better and I could feel their confidence slipping away.

I often feel numb from all of this. I want to feel more, care more and recognize myself again. I want to work with uncertainty and understand that burnout can never be fully defined or mastered, only honored and engaged.

Psychology researchers define burnout as an experience of depersonalization, emotional exhaustion, and loss of fulfillment or effectiveness. Wellness presentations should address such symptoms. But I have found that when interventions oversimplify and universalize complicated feelings under the banner of burnout, they exacerbate my feeling of losing control, depersonalizing an experience already marked by depersonalization.

The problem is not the message, but the framing. Why do hospitals and doctors treat burnout as a problem and not a mystery?

French philosopher Gabriel Marcel distinguishes a problem from a mystery in a way that I find helpful. A problem, he writes, is external to us. Its goal is universal, and its solution is available to everyone. Take a faulty electrical circuit that won’t turn on a light bulb. Let’s troubleshoot the power source, wiring, and even the bulb to figure out how to fix it. The repair process is rooted in a shared understanding of principles, functions, technique and scientific knowledge.

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A mystery, explains Marcel, is a problem that invades his own data. We cannot objectively study a mystery because the problem itself is rooted in the person. We cannot rely on a generalizable technique because the individual is involved in the research. With mysteries we cannot substitute one person for another, one experience for another, without altering the question itself. The person asking the question is important.

Through a prism of mystery, we counter the urge to universalize, define, break down a problem into its parts, and analyze with detachment, which are standard techniques we bring to our study of problems in medicine. Despite the wealth of health burnout research, I fear it has become shorthand for a set of complicated individual experiences that are difficult to put into words, let alone define, measure, or master.

The discourse changes when the focus moves from the occupational burnout syndrome to the individual, from ready-made answers to questions about the experience itself. What if wellness experts spared overworked doctors from their next PowerPoint presentation and instead asked them to invent their own language to capture their experiences and feelings? Doing so would force us to dig inwards, which can be difficult. But the struggle to articulate our stories is the struggle to fight for control over our experiences.

If they had asked me, in early 2020, what was bothering me, I would have pointed to the useless medical bureaucracy and its apprentice torturer, the electronic health record. I would have complained about the way the system leans on emergency rooms to address mental health and substance use issues that community leaders and other institutions can’t or cannot handle.

If you asked me the same question now, I’d say I was stumbling through post-pandemic normalcy, unhinged by everything I absorbed and not fully processed: needless death and suffering; patient anger, name calling, and violence against emergency room personnel; degradation of standards in response to resource constraints and limitations; staff redundancies.

Talking about burnout is easier than talking about burnout. Doctors and nurses fear the judgment and stigma of being perceived as not tough enough, smart or resilient enough. Admitting my feelings out loud instead of hiding vulnerability and hearing in return how colleagues have struggled, I would also acknowledge our range of experiences in all their clutter and design possible bridges from isolation to community.

Talking about burnout is easier than talking about being burned out out.

Building a culture that supports well-being is critical, as US surgeon general Vivek Murthy noted in his recent call to get to the roots of the healthcare burnout crisis. System change begins at the level of human interaction. The pressures and waves of disturbance that make life for different personalities, relationships, backgrounds, and institutions are complicated and individual. Fostering an authentic conversation is a good place to start.

To see ourselves differently, we have to slow down and change our angles of understanding or make our former ways of knowing strange. This idea of ​​defamiliarization, made famous in a 1917 essay by Russian literary critic Viktor Shklovsky, is based on our tendency not to notice things we frequently encounter. Our perception gets used to it. Defamiliarization disturbs all of this and forces us to see experiences and objects again.

Writing and the arts function as a means of defamiliarization. Critics often perceive the humanities and arts-based medical education, from collaborations between museums and medical schools to reflective writing courses, as soft, pleasant but extra, or a pill for humanism. But the arts provide rigorous critical thinking skills, foster perspective change, remind us to consider cultural, historical and social forces, and prepare clinicians for situations that push them out of their comfort zones. In 2020, the Association of American Medical Colleges released a landmark report recognizing the need to integrate the humanities and arts into medical education through writing, visual arts, dance, improv, museum-based experiences and more.

Wellness or burnout initiatives should prioritize exploration and value curiosity and uncertainty. Interventions should be about easy answers with healthy skepticism. An authentic process, even without a cure, is an end in itself. In the third space between the art and science of medicine, we can foster vulnerability and the emergence of different discussions and insights. I find that museums, with their quiet rooms and curated objets d’art, provide psychologically safe spaces for nurturing destabilization. In my experience, dialogue with artists and art experts raises different kinds of questions than typical medical wellness programs. It forced me to engage with alternative ways of looking at and appreciating everyday experiences.

The jury is out on the role of the humanities and the arts for burnout. The effects of such programs are difficult to measure. Arts-based reflection neither promises answers nor does it lend itself to data sets. But it could leave each of us room for contemplation, an opportunity to reclaim what is mysterious in our lives, a moment to recognize who we have become, what we have lost, and what is still within our reach.

Let’s not forget we were talking about human hearts in peril, looking for that ferry from burnout to best. I can’t say what travel looks like, only that it requires new things maps.

State of Mind is a partnership between Slate and Arizona State University that offers a hands-on look at our mental health system and how to improve it.


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