How to perceive the symptoms before they are obvious to everyone.
By Lucas Briggs, PT, DPT
It was another dreary day in Seattle, Washington.
I had just finished a long day of treating patients dealing with persistent pain, which made up about 80 percent of my caseload. I was feeling exhausted but kept my customary cheery demeanor as I answered a small operational question from a member of my clinical team on my way back to the office. In my mind, I was picking up my keys and on my way out the door, when I was told that there was a patient on the phone who really needed to speak to me. This was the proverbial straw that seemed to break a young manager’s back; my face contorted into absolute rage, I whisper-shouted some choice words, and threw my charts down on the floor. The ridiculous scene I had just made immediately opened my eyes to something that should have been obvious to me for a while: I was burned out.
After a few deep breaths, calmly counseling a patient on her physical ailments, and apologizing to my team, I began reflecting on what felt like a surreal experience. How did I let myself get this far? Since then, I have read and learned a lot about identifying burnout early on in order to prevent it from manifesting. Here I share some of the research and assistance I’ve received along the way to help identify early signs of burnout in yourself or those around you before it becomes too big of a problem. Burnout can be defined as physical or mental collapse caused by overwork or stress. Depending on the author you read, burnout may include physical and emotional exhaustion, depersonalization, and dissatisfaction with personal accomplishment. Symptoms can range from cognitive fog, emotional exhaustion, and apathy/emotional hardening to physical symptoms such as trembling or a heightened awareness of your pulse.
Contributing factors to burnout include inappropriate work–life boundaries, poor self-care, inadequate resources to meet job expectations, perfectionism, and good old training error. In the same way that I wouldn’t recommend a runner to increase their miles by 400 percent in a week, I wouldn’t recommend a teammate to increase their stress load dramatically without significant attention to building some healthy life habits first.
In my example, I did a pretty poor job of managing my stress load. Large increases in stress included a recent move featuring a new group of friends and a messy first homeowning experience, a colicky newborn, a new job/level of responsibility, a caseload with a significantly higher emotional load, the wavering mental health of close friends and family members, and the Seattle winter. Looking back at this list, it’s obvious that I desperately needed to be carving out some intentional time to take care of myself, but I was pretty unaware of what I needed.
To identify early signs of burnout in our lives or the lives of those around us, we need to start with ourselves. Here are a few steps you can take to avoid burnout.
Take Time to Know Yourself
Practice mindfulness and meditation: Build awareness of your bodily indicators, your feelings, your energy levels, and personality. Practicing mindfulness and meditation on a regular basis will not only better equip you to identify the early physical and emotional symptoms of burnout in yourself and others, but it also has an enormity of research to support the positive effects it has on your own happiness and productivity.
In my office, where we serve a clientele of high emotional load, we create playful competitions and wagers to encourage one another to make positive habit changes in the name of healthy self-care. Some of our challenges have included engaging in meditation, daily exercise, and gratitude journaling.*Important note: Mindfulness and meditation are best done without self-judgment, and both take time and practice to develop (for all you folks who are used to achieving success quickly). Palousemindfulness.com1 has free resources ranging from a full, free eight-week Mindfulness-Based Stress Reduction course to a handful of free guided meditations.
Establish a Baseline
Identify emotional, cognitive, and physical norms for yourself, and help those around you do the same. What is your personality like when you’re feeling energized? What types of changes do you notice when you’re not energized? I am typically much quicker to respond with compassion and understanding than with anger, so when I am feeling aggression toward my teammates instead of curiosity, I know that I need to find a way to reduce my workload or take some time for increased self-care.
What kind of productivity do you experience when your self-care is well balanced with your stress load? Do you have metrics for growth or cancellation rates that might correlate well with the reduced job performance that accompanies burnout? Do you have a typical response time, a normative level of cleanliness or clutter on your desk, a typical range of unread emails in your inbox, or a particular length to your daily task list? When things begin to pile up and overwhelm you, it’s time to take stock of your situation.
What does your body feel like? How easy is it for you to notice your pulse? Do you have any minor twitches or bodily sensations at rest? Do you typically have a dry mouth? How does your body feel when you wake up or at the end of a workday? Write it down. Writing down norms for you and your team can really help to improve your self-awareness and that of your team.
Take Inventory Regularly
Set reminders to check in with yourself and those around you regularly. Take notice of physical, emotional, and performance issues that arise. Remember, burnout contributes to reduced patient satisfaction,2 mental and physical illness, higher rates of staff turnover, and reduced productivity.
Several tools are available to identify signs of burnout with significant variance. Some focus solely on exhaustion,3 while others cover aspects of cynicism and self-efficacy as well.4 The Maslach Burnout Inventory has been considered the gold standard for quite some time, though I would personally recommend taking something like the Burnout Test at 15minutes4me.com.5 This test appears to combine aspects of the Maslach Burnout Inventory and the Four-Dimensional Symptom Questionnaire (4DSQ),6 which has been validated for distress, anxiety, depression, and somatization. Including the physical symptoms of burnout or distress can be instrumental in helping peers become more aware of how their nervous system manifests stress physically, even when other symptoms are not being noticed.
1Online MBSR/Mindfulness (Free). Online MBSR/Mindfulness (Free). https://palousemindfulness.com. Accessed April 8, 2019.
2Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care. 2004;42(2 Suppl):II57-II66. doi:10.1097/01.mlr.0000109126.50398.5a.
3Garcia GPA, Marziale MHP. Indicators of burnout in primary health care workers. Rev Bras Enferm. 2018;71(suppl 5):2334-2342. doi:10.1590/0034-7167-2017-0530.
3Terluin B, Smits N, Miedema B. The English version of the four-dimensional symptom questionnaire (4DSQ) measures the same as the original Dutch questionnaire: a validation study. Eur J Gen Pract 2014; Apr 29 [Epub ahead of print].
4Maslach C, Jackson SE. Maslach Burnout Inventory—ES Form. PsycTESTS Dataset. 1981. doi:10.1037/t05190-000.
5Burnout test. 15 Minutes 4 Me. www.15minutes4me.com/test. Accessed April 7, 2019.
6 Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work & Stress. 2005;19(3):192-207. doi:10.1080/02678370500297720.
Lucas Briggs, PT, DPT, is an APTA member and director of the Grand Rapids Performance Center in Grand Rapids, Michigan. He can be reached at firstname.lastname@example.org.