How to Avoid Burnout: Basic Life Support Self Care For Doctors
This article was originally published on Healers Health Collective, a website that offers self care resources and support for and by health professionals.
In healthcare we’re all very familiar with the concept of Basic Life Support and DRSABC. We attend training and simulations every year to remind us of the importance of first avoiding danger in any emergency scenario. We’re told again and again to “put on our oxygen mask first,” before helping others. The problem with this is that we’re also a collective of people drawn to a profession, that by its nature, often calls for us to put others first. If you’re anything like me, you’ll sometimes find yourself feeling the pull of these two apparently competing interests.
I didn’t put my mask on first and after ten years in clinical medicine I burnt out. The lead up to this point really had all the hallmarks of impending burnout — compassion fatigue, rising sense of imposter syndrome, sleeplessness, anxiety, constant feelings of overwhelm. When it comes down to it, most of us ‘know’ the signs. But we’re also by and large a high achieving group who are used to pushing beyond our boundaries to achieve things that others might not think possible of us. It’s almost held up as a ‘badge of honour’ being able to ‘push beyond.’
I’ve had a lot of time to reflect on this since then and while everyone who experiences burnout is very different and the precipitants even more so, I do feel there are some similarities between us. As such I feel that there are some things that we can all do to try and tap into our own innate sense of self awareness to not only sense when burnout may be coming, but also to avert it. After all, burnout comes from a variety of events that litter the path away from self awareness.
So is the current model of didactic teaching and top down reminders to “practice self care” and “look after ourselves” enough to ensure the long term wellness of our healthcare workforce? Or do we need to start looking at different models of education that focus on authentic and holistic self care? Self care models borne of the values of autonomy and intrinsic motivation rather than overly simplistic reminders?
Basic Life Support Self Care is about finding the calm amongst the noise of the modern world. It is a multifaceted approach, honouring our search for meaning and connection with our world and with ourselves. Authentic and holistic self care is about unlocking the very best parts of you so that you in turn can give these to your patients in a sustainable way and continue being the kind and giving people who are drawn to the health professions in the first place.
We need to start looking at self care in the same way we look at our yearly CPR training — compulsory, integrated into our workplaces and practiced so diligently that it becomes second nature.
We all know it, we need some time when our nervous systems aren’t primed and thinking about work. Yet in reality (and in private practice) it can be difficult to do. One part of this is removing ourselves from the environment so we can put some physical distance between ourselves and our work stressors to allow our nervous system to down regulate. The bigger issue however is many of us are unable to place any psychological distance between ourselves and our work even if we’re not there, the ‘tiger’ comes home with us every day.
What does this mean on a systemic level? It means that staffing is done with contingency plans for sick and compassionate leave. We used to think that it was impossible to do, but Covid-19 is showing us that when there is no other option, we can get creative and find a way. None of us are indispensable in this system. It also means that workplace structure integrates and prioritises self care education and practice to be as important as the core clinical competency of Basic Life Support. We need to walk the walk, not just talk the talk.
Perhaps more importantly than this, is the personal level— how each of us feels when we find we need to take some time or focus away from work in order to practice self care. How many of us have been home sick in bed and still be genuinely feeling like we should be at work? We can change the system all we want, but until each and every one of us has the self awareness to truly believe our own right to practice self care how we see fit and not how others tell us we should practice it, nothing will change.
I really want to emphasise that stress is normal, our bodies are designed to respond to it. Too often we are told that to be resilient is simply to be able to shoulder the burden of stress without faltering. But this amazing system is also designed to switch off in order to reset. It’s the return to normal after a stress response that is an often unrecognised part of the definition of resilience.
“Resilience represents the amount of disturbance that can be absorbed by a system before the system changes or loses its normal function, or the time taken to return to a stable state, within the normal operation range following the disturbance”.
Permanent resilience isn’t designed to be a part of the stress response. We need to be able to give ourselves some down time, both physically and psychologically, to allow for the elastic recoil. To make space for resilience.
When we exist in a state of default thinking, everything we encounter is allowed to move unfiltered through to our amygdala (the 'stress centre' of our brain) to start the finely tuned cascade of events that is our stress response. The switch is permanently left 'on' for this amazing system with no down time to return to a stable state. Collapse is a frequent, but not altogether unexpected consequence.
For both creating psychological space between work and ourselves as well as being able to filter out what information actually makes it through to our brain to start the cascade of our stress response, mindfulness is an immensely powerful tool. Mindfulness helps us to notice things without judgement. It helps to hone our awareness and ability to process stimuli so that we're not constantly bombarding our amgdala with otherwise innocuous information. Like the goalie who isn't paying attention, the mind in default mode is letting a lot through to the net that it needn't be. So the control we have over this process is right at the beginning, with the noticing.
For those of us who have become used to ‘healing’ others, it can be very easy to lose the ability to allow ourselves to be helped. While we as humans thrive on connection, to ask for help and to be helped, takes a huge amount of humility and vulnerability. So many of us in the health and healing professions struggle to do it, we struggle to let go of the urge to ‘fix’ things ourselves.
So, why do we find it so difficult? There was no course at university that removed the fleshy vulnerability of humanity from us. Perhaps we need reminding, that in order to be truely self aware we must know that we will all give and receive assistance in this lifetime?
“Somehow we’ve come to equate success with not needing anyone… It’s as if we’ve divided the world into ‘those who offer help’ and ‘those who need help’. The truth is that we’re both”. - Brené Brown
I have a phrase I use often in my work- “you don’t learn to swim when you’re drowning”. Likewise, it can often be very difficult to know and find the support you need at a time in your life when you need it most. In the same way you don’t want to be rummaging around in the drug room for the Adrenaline mid cardiac arrest, holistic self care is about building and maintaining a support network everyday, not just on the ones when you need to use it.
Self awareness is an interesting concept. Most of us think we know who were are. But if I asked you to describe yourself in one sentence- not referring to your job, family or where you live- how would you do it?
Awareness is very different to thinking. You don’t need to think of your foot being attached to your ankle, it is just there and you’re aware of it. Self awareness by the same token is not something you need to ponder or think about. It’s the innate sense of knowing who you are and what you need.
When we exist in a state of constant arousal, it can be difficult to pin point exactly what it might be that is making us feel bad at any given time. So many of us are guilty of filling any down time that we have with a variety of distractions that take us away from this innate self awareness. Social media, alcohol and other drugs, busyness, even exercise when used in excess can all be ways that we are unconsciously taking our attention away from our sense of selves.
It can be a difficult thing to develop true self awareness. When we are confronted with aspects of ourselves that we perhaps wish were different, it is much easier to distract ourselves away from this than it is to look inwardly with compassion and a desire to change. However, our ability to know what we need and be able to practice self care in a truely authentic way, depends on our ability to practice self compassion without judgement.
“Paradoxically, it takes time to become what we already are”.
Dr Rick Hanson The Buddha’s Brain.
The path to self awareness is not one that we can take for granted, it is an attribute that takes daily work. We must be willing to be introspective, spend some time in solitude and contemplation, as well as talking openly with those around us about our struggles in a compassionate way.
Very few things have the capacity to change how we feel so profoundly as how we breathe, the practice of pranayama in yoga is entirely devoted to the breath due to the fundamental importance it has in our health. Over twenty-three thousand times a day we fill our lungs with air, every single day of our lives. The sheer consistency of this process means that even small changes and benefits are amplified significantly.
There are plenty of breathing practices aimed to help calm our bodies and our breath. As with all breathing practices, they will have a paradoxical effect on our nervous system (excitatory) if the breath is unnaturally prolonged. So we are much better to aim for consistency with gentle expansion over time than forcing the breath in any one exercise. One simple practice to master is that of ‘box breathing’. Simply, we breathe in for 4 seconds (or whatever length of time you feel comfortable doing), hold for 4 seconds (or what ever length of time you have inhaled for), breathe out for 4 seconds, hold for 4 seconds. This process is repeated for a few minutes with careful attention that you are not forcing the breath. Gently prolonging our exhalation over time and within our comfort level can further enhance this exercise. When practised daily, breathing practices have the potential to gradually improve our cardiovascular fitness and parasympathetic tone, an important factor in down regulating our stress responses.
Most of the worlds wisdom traditions tell us that when we can look to ourselves with compassion, we can then extend that compassion to others more readily. Practicing self compassion is one of the most fundamental aspects of self care.
True self compassion comes from viewing ourselves with curiosity rather than judgement. When we perceive our failings, we approach gently just as we do with a timid puppy, bringing a tone of guidance rather than retribution. Eckhart Tolle in his book ‘The Power of Now,’ talks about the concept of the Ego and the True Self. Our Ego’s are fragile, turbulent guard dogs that exist to prevent our True Self from coming to harm. It is only when we have compassion for our Ego’s that we are able to thank them for trying to protect us, lovingly strapping them into the back seat to allow our True Self to take over. Our True Selves on the other hand are the calm beneath the deep ocean that we find through a process of reflection, self awareness and self compassion. When we can do this, we are finally freed from the reactionary lives full of indecision, searching and regret that so many of us lead. Self compassion is the key to setting ourselves free and unlocking the very best parts of us to then offer to the world.
There is no one in this world more worthy of your kindness than you.
How can I practice self care and put others first? Like with all things in life, each person must find their own balance. The goal of The Healers Health Collective is to provide a systematic framework for and education around self care implementation within the healthcare professions. So you can focus on continuing to do the important work you do everyday.
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