Burnout, depression and not wanting to be a doctor anymore

I have been here a few times over the last 9 years of doctoring. Not too long ago I understood what it felt to be sad everyday for no good reason and have no energy. Things were getting strained at home and I wasn’t enjoying my work.

I’d like to share a story and talk about burnout in this post. Most importantly I would like to propose a plan and a framework that I hope may help anyone walking through a similar experience in the next post.

A close friend with who had little clinical experience said, “ I think you might be depressed Rama”. It then made sense. He was right. I thought “How did this happen?!”.

In retrospect every time I’ve circled the sinkhole of being burnt out and approached this nagging sense worthlessness, there are several similar factors working together to lead me here.

Through the help of my GP, a wise counselor and a mentor, I’ve learnt two important things. Every stumble has always involved breaking the golden commandment of rest and not doing activities that “fill up my cup”, and very simply losing sight of my priorities and doing way too much.

Late in my intern year I learnt the consequence of working without rest as I faded in energy and enthusiasm in career that I was destined to pursue. And twice as a registrar did seemingly beneficial and selfless extra-curricular work spiral into being burnt out with nothing more to give.

All these experiences were not pleasant at the time but walking through each has given me the courage to share and also make some seemingly radical but lasting to changes to my life.

So let me be Dr. Academic just for a few moments.

What is burnout?

Two years ago I was on-call for anaesthetics 1 in 7 days, studying for my fellowship exam, working full time in the rooms and theatre, preparing for two presentations at a conference, chairing a state advisory group and sitting on two national general practice committees.

The term burnout describes the emotional, physical and intellectual exhaustion experienced by individuals in the context of a demanding and stressful work environment.

Needless to say I didn’t have much time to rest and had accepted responsibility over a number of seemingly important tasks.

How does it occur?

My work has always been satisfying however the relentless nature of medicine (there are always sick people to see and patients needing operations) coupled with the desire serve resulted in a gradual slide into being burnt out.

Burnout usually develops over a period of time through a working in an environment of a disproportionately high workload, persistent demand and often, poor satisfaction.

Those working in clinical and high care environments such as teaching and social work are often implicated. But any profession with high demand and workload can lead to this.

What are the key signs?

Fatigue – Tired all the time no matter how much you rest

Negativity – You are disillusioned, frustrated and just do not care anymore

Increased conflicts/arguments – You are arguing and having conflict everywhere- work, home, the coffee place!

Lack of self-care – This is substituting for the increased stress by eating more, smoking, relapsing into bad habits, gambling, spending more money, not exercising, engaging in risky relationships

Decreased job performance – With the optimum level of stress surpassed and exhaustion settling in, this is usually the first sign that an employee is hitting breaking point

Preoccupation and intrusive thoughts- Work is always on your mind, interfering with being present with the family or engaging and high-fiving your friends

Dissatisfaction with work – Tasks which gave you goose-bumps and tremendous satisfaction have become mundane and pointless.

The association with depression

I didn’t see it at the time but I was chronically sad. I felt down and didn’t understand why. I’d also started to have some sleep issues and was tired all the time. It felt pathological i.e. like a disease process.

The term burnout has been used interchangeably with depression but they are different processes, but often found along the same continuum.

Studies have shown that there is a marked overlap between burnout and depressive disorders with the risk of developing depression becoming greater when burnout is more severe and prolonged.

What to do if this is happening? 

Take heart! There is hope and way out of this.

In the next part I will share a plan and a framework to approach burnout and to provide some hope to those who need some inspiration!

Live intentionally.

Jonathan Ramachenderan @thehealthyGP