Burnout, COVID-19 and humanitarian work, what do they have in common?

Blog 19 May 2021

You are a doctor working in the UK, and you love your profession. 

You are getting daily satisfaction from helping patients, giving your 100% at every consultation and smiling every time someone drops a “thank you” card at your desk. You are also signing up for as many extra activities you can fit into your schedule, to stay up-to-date and get more CPD points towards your next appraisal. Life could not be better.  

The next minute you know, you are staying late to finish your notes. You also start working through lunch breaks and start avoiding contact with fellow colleagues in your commute in case the chatting leads to a waste of precious time. You just cannot afford that now. Does any of it sound familiar?

You have also probably worked through the COVID-19 pandemic and, if you are a student at LSTM, you are probably thinking of doing some work in the field in the future, which most times takes place in deprived regions.

There is extensive awareness of the knowledge and skills required to work in a crisis or in a country with a high prevalence of tropical diseases. LSTM students are particularly familiar with that. However, it is not that frequent to consider the psychological and emotional challenges that working in the field can demand. After all, it is not coincidental that adaptability, flexibility and preparedness to overcome stressful situations are seen as assets when applying to work in the field.

Humanitarian work,away from family, friends and facing emergency situations, can be stressful. There might also be different living conditions, diet and frequent changes in the projects.

How do we manage stress? Do we tell ourselves to be resilient and that we just need to get through the next few weeks?

As healthcare professionals, it is inevitable to have to deal with stress at some point in our careers. Denying it would be like telling ourselves we won’t get wet when jumping into water. What can ultimately make a difference is the way we deal with and, particularly, how soon we deal with it.

If you have thought about applying to work in the field or in a catastrophe, you might want to be ready beforehand, planning strategies to overcome any issues that might arise.

And if you are not thinking of working in emergency situations, but you are healthcare professional, you might want to your MBI score anyway. We face stress daily and we have faced an enormous change in our working conditions all over the world, particularly due to the COVID-19 pandemic. 

What is the MBI score? 

The Maslach Burnout Inventory (MBI) is a validated questionnaire, considered the standard tool for measuring burnout. First published in 1981 for professionals in human services, it has undergone several modifications since then. 

You’ve probably heard about burnout…

Burnout and resilience are words that healthcare professionals have heard repeatedly since even before starting their first shift. We are aware that it can happen, but what we might not know is that, previous to the onset of the severe syndrome that we all imagine, there are different stages and it usually happens very gradually. According to the WHO (2019), burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed.   

The prevalence of burnout has been alarmingly increasing in recent years, with latest data suggesting that at least 44% of physicians experience symptoms, characterized by emotional exhaustion and/or depersonalization, more than once a week (Colin P, July 2020). 

The COVID-19 pandemic has also changed the way burnout is distributed among the medical professionals: Critical care physicians are now at the top of the list, with 51%, followed by rheumatologists (50%, up from 46%) and infectious disease specialists (49%, up from 45%) (Frellick 2021). 

Women doctors have traditionally experienced higher levels of burnout than men, and the pandemic seems to have increased the gap, with cases now at 51% among women and 36% among men. Although there is no data to correlate this with the pressures of home schooling, women doctors who are also mothers can most likely testify for it. 

In the UK, doctors usually work 12-hour shifts. However, in other European countries shifts usually last 24 hours; and in medium-low income countries, 36 or even 48-hour shifts are not uncommon. Working conditions can also vary greatly, especially given the contrasting resource availability and protocols in non-European settings. The COVID-19 pandemic has certainly widened the gap between rich and poor and has underlined the deficits in healthcare systems globally.

It has been identified that factors such as lack of social support, family status, higher workload, rapidly changing public health guidelines and lack of recognition at work are highly defining (Sriharan 2020; Soares 2007). On the women’s side we need to add workplace sexism and the fact that women tend to be more “people pleasers” (Barker 2021). 

Has the concept of resilience been mishandled?

Psychologists define resilience as the process of adapting well in the face of adversity, such as family and relationship problems, serious health issues, or workplace and financial stressors. 

Many organisations have used an approach based on supplying their employees with resilience questionnaires and online courses. However well-intentioned, they often actually add to the high pile of mandatory courses that professional must do to get yearly approval, instead of providing respite.  

Higher levels of resilience might protect us, however even the most resilient doctors are at a high risk of burnout. In fact, working in healthcare just happens to be one of the risk factors by itself. The first stage of burnout is called the “honeymoon phase”, which is characterised by high job satisfaction and commitment. This is the phase where we should start planning strategies to cope ahead, so we can go on without progressing into the “stress onset” stage. 

We are often made to feel like we just need to get on with it; that the problem resides within the individual, who may lack the capacity to deal with the situation (Dean 2019). But rather than a problem with the usage of the word resilience, it resides in the misconception that because doctors are highly trained and educated people, they will know how to take care of themselves.  

After all, we know better than anyone else what to do, right? Eating healthy, sleeping well, exercising, and keeping socially active. Yet we are also repeatedly haunted with the guilty feeling that if we are trying to take care of ourselves, we may not be dedicating enough time to our patients. 

Individual factors certainly do play a role, however external factors have shown to have much more impact: burnout prevalence has not only increased during the COVID-19 pandemic, but it has been noted to be related to high workload, job stress, time pressure, and limited organizational support (Morgantini, Naha. June 2020, Lancet).

Fortunately, there is something we can do.  

In fact, there is plenty we should do to take care of our mental health, particularly if we are considering a position in emergency situations or humanitarian work.

The first step is abandoning the long-sustained belief that those who get burned out are people who just don’t like their job enough; they are just not “made” for the profession. Contrary to this victim blaming idea, the reality is that people who love their profession are at most risk of burnout, because they identify with their jobs so much that it's difficult for them to put the limit between work and personal life. 

Challenges in healthcare are insurmountable at present: we are often pulled between our own needs, the patient’s needs, the system’s needs, and that enormous pile of admin to do at the end of the week. The first step is recognising that we are not impervious and we are not machines. It is important to get rid of guilt and reflect on experiences. A good opportunity to do it might be when doing a reflection for an appraisal, a change in workload, or simply at the end of this article. Trying to redesign our schedule to actually plan time for ourselves without feeling guilty can be challenging. However shrugging off the stigma associated with burnout and supporting each other is the first step.

There needs to be a re-assessment of where we stand regarding burnout and medical profession. Working during the pandemic or working in a humanitarian project in the field are certainly stressors, and it should prompt us to take a look at our mental health, our profession and how we see our work.

Just checking ourselves and finding out our score can help planning ahead and building strategies to cope. 

MBI questionnaire can be found on this link: https://www.mindgarden.com/117-maslach-burnout-inventory-mbi

C. Maslach, S.E. Jackson, M.P. Leiter (Eds.), Maslach Burnout Inventory manual (3rd ed.), Consulting Psychologists Press (1996)