Working with patients with a life-limiting illness is stressful and may cause burnout. Dr Michelle King advocates protecting yourself by figuring out what brings balance to your life.
Burnout is an emotional state which results from the prolonged care of patients who are suffering, especially those with life-limiting illnesses. It has negative physical and psychological consequences.¹
It can start with the thought that you’re no longer making a difference. You might become disillusioned, and start experiencing feelings of hopelessness and helplessness.² You could lose your belief in yourself and your abilities², or start believing that you’re a failure.3
Burnout primarily manifests as exhaustion. This might be physical, appearing as sleeplessness² and feeling tired all day.³ You might lack motivation, or the energy to do things that you previously enjoyed doing.
The exhaustion can be intellectual.² You might struggle to think straight or make good decisions. Tasks as simple as deciding what to have for supper can feel monumental. You might find your thinking becoming rigid.³
The exhaustion might also be emotional.² You might begin to feel depressed, angry, bitter, or resentful, or lose your sense of humour.³ Your negative mood could cause conflict in your relationships, inside the family and out.³
Some try to cope by shutting down their emotions, or becoming detached.² You might find yourself withdrawn, zoned out, or with a persistent sense of unreality.
The effect in your workplace
Burnout impacts your work ethic, because you’ll be more likely to start using sick leave just to take a break. Worse, it can impact the quality of care you give your patients,3,4 and make you prone to postponing appointments3, both of which can translate into friction with your patients’ families. 1,5
Some people work harder, the more burned out they become. If you feel you’re indispensable², you might feel compelled to work across your days off, and you might have difficulty disengaging from work during your family time.
Severe burnout can require treatment, including therapy or medication, especially if it manifests as suicidal thoughts. Absent this, some will turn to substances to manage the symptoms.² No one intends to become an addict. It begins with justification, “I deserve more wine because today was hard,” or “I can’t switch off, so I’d better have an extra sleeping pill.”
Burnout can be managed, if you’re willing to care for yourself. Begin by understanding that these feelings are normal and even common.
Work on improving your self-awareness. Learn how to recognise the aspects of your work that drain you; try to be aware of them, and develop ways of reducing their effects. Understand how things you believe about yourself may affect your work.
You can process strong emotions by learning to channel them appropriately. Be kind to yourself. Recognise your vulnerability, and understand that some suffering can’t be alleviated.¹ Acknowledge your own losses, and the grief you may feel for your patients and their families.²
Deliberately put time into improving the quality of your personal relationships, and consciously disconnect from work when at home.1,2 Keep a journal of psychosocial successes.² Practice gratitude.
Effective self-care occurs on three levels:
1. Physical self-care
Look after your body. Eat well and drink water. Exercise, sleep enough, and pursue activities that help you to relax.⁶
2. Inner self-care
Create time for your own care when emotionally overloaded.⁶ Find what centres you; some enjoy yoga, others might like reading. Spend time with people that matter to you.
3. Social self-care
You need a personal support system, both inside and outside your work setting, to help maintain your social health.⁶
Working with patients with a life-limiting illness is stressful, and may cause burnout. You can protect yourself by figuring out what brings balance to your life, because doing so will make you more resilient.
- Mota Vargas R, Mahtani-Chugani V, Solano Pallero M, Rivero Jiménez B, Cabo Domínguez R, Robles Alonso V. The transformation process for palliative care professionals: the metamorphosis, a qualitative research study. Palliative medicine. 2016;30(2):161-70.
- Altilio T, Otis-Green S. Oxford Textbook of Palliative Social Work. Cary, UNITED STATES: Oxford University Press USA – OSO; 2011.
- Scutter S, Goold M. Burnout in recently qualified physiotherapists in South Australia. Australian Journal of Physiotherapy. 1995;41(2):115-8.
- Ablett JR, Jones R. Resilience and well‐being in palliative care staff: a qualitative study of hospice nurses’ experience of work. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2007;16(8):733-40.
- Nedrow A, Steckler NA, Hardman J. Physician resilience and burnout: can you make the switch? Family Practice Management. 2013;20(1):25-30.
- Sansó N, Galiana L, Oliver A, Pascual A, Sinclair S, Benito E. Palliative care professionals’ inner life: exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. Journal of Pain and Symptom Management. 2015;50(2):200-7.
MEET THE EXPERT – Dr Michelle King
Dr Michelle King qualified as a psychiatrist in 2007. Since then she has completed post-graduate diplomas in chronic pain management and palliative medicine, both through UCT. She is part of an interdisciplinary pain clinic and palliative care team. Dr King believes in empowering people so that they can take charge of their physical and mental health, and as a result, live their lives to the fullest.
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