Apr 26, 2017
By Claire Hiles, MD
San Antonio Military Medical Center
Why do some health care providers burn out while others do not, despite undergoing similar stressors? Let me start with the caveat that I am by no means a trained psychologist. Yet over the years, I have personally witnessed how my emotions and the emotions of my colleagues directly impact our ability to react and respond to the stressors of life. Knowing your Emotional Quotient (EQ), also called Emotional Intelligence (EI), may help you recognize, manage, and even prevent professional burnout.
In 1990, researchers Peter Salovey and John Mayer coined the term emotional intelligence, defined as “the subset of social intelligence that involves the ability to monitor one’s own and other’s feelings and emotions, to discriminate among them and to use this information to guide one’s thinking and actions.”1 Another way to define EQ is the individual’s ability to perceive, understand, and manage emotions. We all know at least one person in our life who seems very empathetic and easy to talk to, just as we know those who seem emotionally clueless and self-centered. Like an Intelligence Quotient (IQ), an EQ can be measured (i.e., EQ-i 2.0 and EQ360 assessments), qualified as low or high, and improved with conscientious practice.
EQ researchers have broken the understanding of EQ into five categories:
- social skills
Self-awareness is your ability to recognize your own emotions and their effects as well as sureness about your self-worth and capabilities. Recognizing and naming an emotion is key to managing our emotions, or, as Publilius Syrus wrote in the first century BC, “Rule your feelings, lest your feelings rule you.” Being self-aware allows us to understand the sources of our frustration or anxiety and to improve our ability to consider different responses.
Self-regulation involves managing disruptive impulses, maintaining standards of honesty and integrity, taking responsibility for your own performance, handling change with flexibility, and being open to new ideas. Being human, we don’t tend to have control over when we experience emotions; however, we can shorten the duration we experience a negative emotion through these mechanisms of self-regulation.
Motivation towards any achievement requires clear goals and a positive attitude. Regardless of our natural inclination toward either a positive or negative attitude, we can attempt to reframe negative thoughts in more positive terms. Our individual achievement drive, commitment, initiative, and optimism are part of our motivation when pursuing goals.
Empathy is more outward-focused than the first three principles. It is the ability to recognize how other people feel. Key components of empathy include anticipating, recognizing, and meeting the needs of others; sensing what others need to progress and bolstering their abilities; cultivating opportunities through diverse perspectives; reading a group’s emotional currents and power relationships; and discerning the feelings behind the needs and wants of others. Compassion can counter the physiologic effects of stress which lead to burnout. Furthermore, attuning to another’s perspectives, attitudes, and beliefs improves our ability to gain trust and influence others.
Social skills, or people skills, are a multitude of learned interpersonal skills that include effective persuasion tactics, communication, leadership, initiating or managing change, conflict management, nurturing instrumental relationships, collaboration and cooperation, and creating group synergy in pursuing collective goals.
Relating EQ to burnout prevention
Application of these EQ principles may take a lifetime of personal practice for some, while other people may catch on by observing others. I would like to share a couple of personal examples of how knowing your EQ can prevent burnout.
My husband, a pulmonary/critical care fellow (a field with one of the highest burnout rates), has effectively avoided burnout. While on a busy MICU rotation, he tends to compartmentalize certain aspects of his day. At work, he remains focused on his patients and the team he leads. He has a high degree of self-regulation and motivation to keep sharp and stimulated throughout his long workday. By the end of the day, he is of course tired, but knows the workday always has an end and the rotation will eventually be over. On the more stressful rotations, he favors countdowns to remind himself of this temporary condition so that he might bear more now to feel relief soon. Time away from work is protected time to destress and relax. For him, running reduces stress as well as keeps his body healthy. Over the years, he has trained himself to be committed to lifelong learning, so that nightly studying is reframed positively in his mind: not as work, but as part of his achievement drive.
Midway through my first hematology/oncology fellowship year, I experienced burnout after back-to-back inpatient rotations. I was relearning how to communicate in the new language of oncology and translating that to patients and families as I broke bad news. I became emotionally exhausted. While I find it natural to read others’ emotions and empathize, I was draining and emptying myself. Despite good patient and peer reviews, I felt little personal accomplishment. I had effectively lowered my self-worth by not addressing my emotional burnout. I sought care through family, peers, and a physician wellness initiative at my institution called the Harbor Program. I still think the true key to my recovery and prevention of future burnout was my personal recognition that I could not make this job my primary source of self-accomplishment. That position had to be held by something more stable and external to my abilities. For me that was my faith.
I share these stories to highlight a few key points. First, it’s okay to ask for help. This is a key tenant shared by those with high EQs. Next, we can learn a lot about ourselves during our trials and tribulations. While we can’t avoid our emotions or all of the external pressures that set them off, we can retrain the way we process and respond to our emotions. In turn, I expect, this will make us better doctors for our patients and better people overall.
Finally, it’s a good idea to simply admit that we’re all works in progress. This removes the idea that burnout is failure. It’s not. It also negates the idea that perfection is achievable. It’s not. Don’t be the source of your own stress. This happens too often in the arena of high achievers and perfectionists.
Instead, reframe the experience in a positive way. Leaders who are attuned to the pressures they put on themselves are better able to control their stress level.2 As I work on knowing my EQ and preventing my own burnout, I’m more apt to recognize and help colleagues going through a similar situation. Fittingly, as I write this article, I have been helping a colleague go through his own burnout. My prior experience and the help I received from others gave me the tools to recognize my peer’s emotional distress and guide him, hopefully, toward a quick recovery. We’re not all going to experience burnout, although a staggering 45% of U.S. oncologists have reported at least one symptoms of burnout.3 Still, we can all work on preventing burnout in ourselves and others through honest conversations, empathetic listening, and a little more best supportive care for all.
- Salovey P, Mayer JD. Imagination, Cognition and Personality. 1990;9:185-211.
- Wiens KJ. Leading through burnout: the influence of emotional intelligence on the ability of executive level physician leaders to cope with occupational stress and burnout (Doctoral dissertation). 2016;220: Retrieved from PQDT Open (Accession No. 10158565).
- Shanafelt TD, Gradishar WJ, Kosty M, et al. J Clin Oncol. 2014;32:678-86.