This is an ootd photo I took two weeks ago, but didn’t have the energy or time to post until now. I’m very pleased by the burnt out colors in this outfit. That’s probably all I have to say about it.

There’s been a lot of talk about “burn out” lately, after the World Health Organization added “burn out” as an official syndrome. For years, the topic of burn out has been all over the physician newsletters that I read. I feel like this past year, I’ve been identifying with this syndrome more than ever. It’s very common among doctors. There was a recent article on NPR about it. Burn out among psychiatrists is pretty common but not for the reasons you would think. I think most psychiatrists can actually handle the intense emotional content and interactions they have with patients, and love that part of their work the most. It’s the less obvious stuff on top of that that drives burn out I think, at least for me that is the case. It’s the huge amount of irrational paperwork, bureaucracy, increased responsibility without authority, institutionalized blaming when there are bad outcomes, lack of resources, lack of safety/security, and lack of support staff.

For example, one thing that commonly happens at hospitals is that nursing homes literally “dump” patients with dementia in the hospital when these patients become too agitated. The very settings that are supposed to be able to care for people with dementia say they cannot do it. These patients get admitted to the medical hospital and I get consulted to manage their behavioral problems. When they are ready to be sent back home to their nursing homes, these nursing homes find excuses and refuse to take them back.

Sometimes the patients are ready to move into a nursing home but because of irrational laws in California, the patient must enter a court process before they can enter a nursing home, to obtain a conservator (legal gaurdian) that takes about 1 year to complete, meanwhile that patient is taking up a hospital bed unnecessarily, costing taxpayers hundreds of thousands of dollars, and subjecting the patient to living in a stressful hospital environment for an entire year! It’s insanity. This 1 year process also adds burden to my workload because it requires me to fill out legal forms and attend court proceedings, which would be fine if I had the time and resources set aside for it, but I don’t. In other states, conservators are not a requirement to gain entry into a nursing home, and patients are able to get out of the hospital when the appropriate time comes.

I also often get stuck in the middle of fights between the psychiatric units and medical units that do not want to take on “difficult patients”, ones that are both medically ill and behaviorally agitated. The medical doctors say the patient is too violent to stay with them. The psychiatric staff says the patient is too medically ill to stay with them. No matter where the patient goes, I am to blame for it, and these battles go on over email chains, passive aggressively in the electronic medical records, and in awful meetings. And I’m thinking: if only the city had specialized geriatric psychiatry units that can take care of these patients. But they don’t!

Many of these issues didn’t exist when I was working in New York, where the system and laws made much more sense and there were a lot more resources.

The system is broken. I’m in the process of figuring out if I can see myself working in it long term. I wonder if I will feel better once we are fully staffed. With more staff, my work load would theoretically decrease and I might have more flexibility and energy to deal with the systemic problems. I’m giving myself until the end of this year to make a decision.

I’m torn because I do love the “real” part of my job, being with patients, hearing their stories, solving problems, and figuring out the best treatments, but it’s all the other baggage that comes with it that’s draining. I’ve had several people at work who barely know me, approach me, entirely unprompted, begging me to not leave, because in the previous 3 years, 4 psychiatrists left the job that I am currently holding. It’s an awkward position to be in. I usually thank them and say things are going “OK” even though that’s not entirely true.

Burn out is common among a lot of professions and non professional roles. Whenever I meet up with my siblings for dinner, we all seem to be experiencing burn out. My brother for example is a high school teacher and is under constant stress due to behavioral problems and learning disabilities in an extremely high proportion of the students. 70% of his students have learning disabilities (and this is in regular education classes!). He also has to deal with political issues in the school system and took on the herculean task of forming a union among the teachers and became the teacher’s union leader. The stress took a toll on him. He experienced intense neck pain. Magnesium helped somewhat.

My sister always has a story to tell about her job too; she works in city government finance, and works on reducing the city’s multi billion dollar debt. She tells horror stories about being in endless meetings where politicians with a poor understanding of the city’s finances literally yell and berate her for not approving their spending proposals. She talks about being terrified of making a mistake in her calculations, or making a typo that could have huge negative repercussions. She copes with all this by living a simple lifestyle and going to the spa every weekend.

I look at their jobs and think: I could never do what they do. And they probably look at my job and think the same. It’s comforting to know that we’re not alone in feeling this way, but I don’t wish it on anyone.

How am I dealing with it? I finished my transcendental meditation training. The first few days of doing it were good, in a subtle way. I noticed better focus, better dreams, and more optimism. But I haven’t been able to stick with the schedule consistently, and sort of relapsed back into a state of stress for a few days. Now I’m back to practicing it, and can feel positive changes again.

What about you? Have you experienced burn out? How did you cope with it?