What’s the Opposite of Burnout?

Abstract

W hen considering the epidemic of burnout and physician discontent so well documented in most medical specialties, my colleagues frequently ask, BWhat is the opposite of burnout?^Even those who study burnout cannot agree whether outcome assessment should focus on wellbeing, resilience, work engagement, quality of care, attrition, or burnout itself. While it is tempting to think that all would be related, sometimes they are not. It is possible, for example, to be empathic and burned out when one takes on the suffering of others without sufficient self-other differentiation 1 and to be both resilient and burned out-the walking wounded. BWork engagement^seems too limited. Perhaps the goal should be eudaimonia, Aristotle's word for human flourishing. 2 Aristotle considered eudaimonia a moral virtue and a pinnacle of human achievement because it frees us to work more effectively and effortlessly for the good of others.Eudaimonia, according to Aristotle, comes from within, not merely in response to external motivators; it is a practical wisdom that comes from a Bgood indwelling spirit,^a Bgood genius.^This makes sense to me as a clinician. Eudaimonia is a sense of deep engagement and coherence and a sense that that work reflects the practitioner's deepest values and that he or she has treated others with competence, compassion, and kindness. I would add, eudaimonia-enhancing actions are not merely directed toward others; they also include positive actions and attitudes toward oneself.These values have particular relevance to the current state of discontent in the health care workforce. By now, it is apparent that this discontent is not merely the self-indulgent complaint of a societally privileged class-and not because clinicians lack virtue, strength, or resolve. Rather, clinician discontent is rooted in disengagement from work and demoralization-Ban erosion of the soul.^3 Discontent, disengagement, and demoralization are due to extrinsic factors such as perverse financial incentives, meaningless work, and cumbersome electronic health records; intrinsic factors such as lack of self-awareness, stress-management skills, and resilience; and factors that fall somewhere in the middle, such as low perceived control and autonomy. The consequences are well documented: poor care, medical errors, professional lapses, and poor communication with patients and colleagues. 4 If there were just a few unhappy doctors the public would have few worries, but now the majority of physicians are burned out and the numbers are rising, 5 and the care that they provide is less than it should be. A CEO of a large health care system recently suggested that patients fire physicians who were non-empathic and burned out. 6 Given the statistics, though, where would patients go?In this issue of JGIM, an article by Hyo Jung Tak and colleagues 7 fills an important gap in our understanding of physicians' relationship to their work. Using the lens of Borganismic integration theory,^related to Deci and Ryan's self-determination theory, 8 Tak et al. buil...

Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity

“…48,52 Success will also require efforts to increase flourishing among people who provide health care, social, or educational services so that they have sustained meaning and engagement in their work with families. 53,54 Promoting the specific aspects of flourishing assessed here could increase the level of meaning and engagement that children have in their relationships and activities in their homes, schools, and neighborhoods. Success relies on people who wish to create safe, stable, and nurturing relationships with children and families as the basis for intergenerational flourishing in the face of aging, disease, and other unavoidable challenges across the life span.…”

The impact of mindfulness‐based interventions on doctors’ well‐being and performance: A systematic review

“…Doctor well‐being is reflected by a combination of a doctor's physical, psychological and occupational health, which, overall, are vital for doctors to thrive and achieve success in various areas of personal and professional life . Hence well‐being involves more than the absence of distress, and is reflected by a variety of both positive (eg job satisfaction) and negative (eg burnout) indicators …”

The effects of resilience and turnover intention on nurses’ burnout: Findings from a comparative cross‐sectional study

“…Literature shows that resilience has a negative association with nurse burnout (Epstein, ). Job stressors in clinical workplaces could cause burnout, job dissatisfaction and intention to leave.…”