By Atlal Abusanad, MD, MSc, FRCPC, CIP
January 2020—As the winter winds whistle and the streets get wet with raindrops, I felt the cold reaching to my soul. I was stressed for no apparent reason, my mood suffered swings and my desire to excel was diminishing. I thought I was going through winter blues until one morning when a surprising thought occurred to me. I was thinking of quitting oncology. My mind spoke loudly and alarmingly, "Are you serious? Why? You have always enjoyed your career. You saw the beauty in the grim and appreciated the value of being able to help patients with cancer. It humbled you, satisfied your human instincts, enriched your craving for progressive knowledge, and wowed your curious mind.”
I used to pride myself on going at whatever I was doing longer and tougher than anyone else. However, I felt heavy and unwell. My proficiency and interest in communicating with patients became less enjoyable, less appealing, and more exhausting. I felt ashamed that I was feeling burdened with my patients' care. I managed to deliver the same quality and consistency of care, but what I once used to do effortlessly became effortful and draining. I was emotionally consumed and on the brink of being detached. I thought I was going through a phase and that it would go away in a few weeks or so. However, it did not. I shared what I have been going through with a trusted colleague. To my surprise, she expressed a mutual experience! But silently.
I self-diagnosed myself with burnout. I ran a search on burnout among oncologists, which disappointedly showed to be frequent with significant variation among different countries and medical subspecialties. Unfortunately, the literature on burnout in oncology from the Middle East and the North Africa region (MENA) is nonexistent. Similarly, there are no burnout education and/or support activities for the oncology workforce. There is a knowledge gap that is yet to be closed. The need for an evidence-based measurement of burnout became obvious in my mind. If I wanted to argue about and support my claim of how common this issue is, and how it might affect patient safety and work productivity, I should follow a scientific approach and create a reliable proof to use. Inspired by the lack of knowledge on burnout, I initiated a multinational large-scale survey study to estimate and examine burnout in our region.1 I did not expect that the work on this research would help me deal with my burnout—but it has. It has put me on the healing pathway and guided me through recovery. Studying burnout, and related concepts such as work engagement, clarified how professionals are affected and what factors might contribute to its development. I breathed a big sigh of relief when I learned that I was not alone and not even a minority in this experience. The development of burnout is a complex, yet gradual process that may go unnoticed for a while, just as I initially thought I was going through a different condition. Once I had the courage to admit to myself that I was not well, I gained insight and started to look for triggers. In my case, the culprit was my pursuit of perfection. I stressed myself over the unsolvable; instead, I should have created alternatives.
The ability to self-reflect on and assess the situation(s) that probably led to burnout is crucial. I knew I had stressors, deficiencies, aspirations, and qualities that I had to sum up in a solvable equation to achieve the fine balance. It took hours of mindfulness and self-reflection to find resilience, to adjust, and, more importantly, to know my own limits. I found solace in solitude. Naturally, we are willing to see ourselves just the way we were before the incident, which is not amenable after burnout. A new state of mind replaces the previous, but it also differs from the original. A change that is new requires adjustment as well. Still, through my journey from burnout to the new balance, I gained insight into the following:
- There is no immunity against burnout, whether you are a seasoned profession or in the early stages of your career. Everyone is at risk. Some are more likely to be burned out than others.
- Burnout is nothing to be ashamed of. The first step to recovery is to recognize that you are not well.
- There is no place to hide and wait for the “phase” to go away. It will never go away until it is confronted.
- There is no one-size-fits-all answer for how to handle burnout. Find recovery with self-focus.
- There is no quick fix. Achieving a new balance is the goal. Do not dwell on the old self.
- There is no guarantee that it will not happen again. Be prepared and avoid the trigger(s).
- No one is going to advocate for your well-being. It is your responsibility. You have to reach out.
- No reward is greater than self-satisfaction and self-contentment. Set your priorities accordingly.
- No one is limitless. Admit your limits and work around them.
- No life is fully busy. We create busy-ness. Remember to connect with your inner wisdom and intuition.
- Abusanad A, Bensalem A, Shash E, et al. Burnout in Oncology: Magnitude, Risk Factors, and Screening among Professionals from Middle East and North Africa (BOMENA study). Psychooncology. Epub 2021 Jan 11.
Dr. Abusanad is an associate professor of internal medicine and medical oncology at King Abdulaziz University and Hospital, in Jeddah, Saudi Arabia. Follow her on Twitter @atlal_abusanad. Disclosure.
Ahmed Mohamed Badheeb, MD
Jan, 28 2021 1:54 PM
Well done! Dr. Atlal,
I think oncology clinicians have an important role in identifying symptoms, acquiring resilience skills, and building positive relationships with colleagues, while at the organizational level, leadership must optimize the clinical practice environment and institutional culture in order to promote clinician well-being.