Monday, July 19, 2021

Veterinary Bibliotherapy: Burnout – A Guide to Identifying Burnout and Pathways to Recovery

“ might suppose that burnout rates would be highest in those whose work simply because they have to, be less evident in those whose work furnishes them with a career, and lowest of all in those who are passionate about their work. We, however, argue that the inverse applies, as burnout rates appear lowest in those who work simply as a job, higher in those who view their work as a career, and highest in those whose work is at the level of a 'calling'.”

(Gordon Parker, Gabriela Tavella and Kerrie Eyers, Burnout: A guide to identifying burnout and pathways to recovery.

Burnout is a hot topic right now, particularly in the veterinary profession due a proliferation of recent studies documenting high levels of burnout among veterinary team members.

When I first heard the term, I can't pinpoint the date but I'm guessing two decades ago, burnout seemed very much framed around the individual. Maybe people who went too hard and, like a candle, simply burned to the wick. When I began my career, people said “don’t work too hard or you’ll burn out”, as if there were a threshold level of work beyond which burnout became a certainty.

In contrast, people were also saying things like “do what you love and you’ll never work a day in your life”, “immersion is the key to success”, and “you need to get as much experience as you can”. People talked about work-life balance, but they behaved according to the mantra that good veterinary team members worked hard.

Since then, there seems to be much debate about the biggest problems in our profession: is our main scourge compassion fatigue? Empathy fatigue? Moral distress? Secondary trauma? Burnout? Which of these are responsible for career attrition or rates of suicide in our profession?

It is against this background that I read Burnout: A Guide to Identifying Burnout and Pathways to Recovery by Gordon Parker, Gabriela Tavella and Kerrie Eyers (Allen &Unwin). This book manages to discuss, in an engaging way, the evolution of the understanding of burnout, what it is, and what it isn't, and what we need to do about it.

Burnout isn't a medical diagnosis (at least not yet). According to the World Health Organisation InternationalClassification of Diseases (ICD-11, 2018), burnout is a syndrome comprising

  • feelings of energy depletion/exhaustion
  • increased feelings of detachment from one's work, or feelings of cynicism or negativity
  • decreased professional efficiency. 

According to the authors of Burnout, compassion fatigue may be a component of burnout, “being part of a broader 'inability to feel' or lack of joie de vievre”.

The authors explain that there is no single magic bullet, no single brain or endocrine pathology to target, no proven pharmacological cure, and no one-size- fits-all plan to treat burnout. They do stress that any strategy requires addressing both the worker and work conditions. The individual and the system they work within. And by work they also mean the work of carers.

Most scientific papers I've read on burnout to date utilise the Maslach Burnout Inventory (MBI) to measure burnout. The authors of this book developed the Sydney Burnout Measure (SBM), and used it to perform a number of large studies on burnout which they argue revealed different features of burnout. One example is the presence of cognitive impairment, which may manifest as difficulty concentrating or poor memory. They also found an association between perfectionism and burnout. Relatable?

The authors talk about occupations at high risk, including doctors, nurses, lawyers, managers, police and veterinarians.

According to Professor Parker, factors increasing the burnout risk for veterinarians include long hours, high university debt, low remuneration, difficult interactions with clients, animal death and euthanasia. High levels of perfectionism have been reported among veterinary professionals.

“Prevention strategies would require addressing salient drivers and handling perfectionism,” he said.

While burnout isn't a medical diagnosis, the authors warn that employers should take appropriate precautions and limit liability.

The book outlines the key components of addressing burnout:

  • addressing work issues
  • adopting strategies to manage stress
  • address the trait of perfectionism

It contains a number of in-depth case studies, as well as mentions of well-known figures who have been alleged to have burnt out over time. I didn't know, for example, that Florence Nightingale and William Osler likely suffered from severe burnout at times in their illustrious careers.

The book's appendix contains the Sydney Burnout Measure, a checklist of workplace triggers and a perfectionism scale.

Overall this is a very readable book. It is based on science, and written by the scientists who undertook the studies it is based on, yet it is accessible and even – I dare say – enjoyable to read.