, August 4, 2011, by Shelly M. Reese  —  When Steve Hyman, MD, from Nashville, Tennessee, looks back, he doesn’t like the person he used to be.

“I was a lot meaner then,” says Hyman, an anesthesiologist. “I was a lot less tolerant. I had a chronic depression and I didn’t know what the problem was.” Attributing his malaise to his workplace, he switched practices. It didn’t help.

It wasn’t until Dr. Hyman cut back his work schedule to 3 days a week and started using his newfound spare time to indulge a forgotten passion for piano that he was able to pinpoint the root of his problem: burnout.

Today Dr. Hyman happily splits his time between medicine and music. Three days a week he is in the operating room. The rest of the time he is a concert pianist performing recitals and playing with regional orchestras.

Dr. Hyman wasn’t able to avoid burnout, but he was fortunate to find a way out of the abyss. It’s something that other doctors can do as well.

Burnout: “A Loss of Ideals and Hope”

Stress and burnout are often lumped together, but they are distinct processes. Unlike stress, which is associated with overengagement, burnout is characterized by disengagement, blunted emotions, depression, exhaustion that affects motivation and drive, and demoralization. Stress produces a sense of urgency and hyperactivity. Burnout produces a sense of helplessness and hopelessness.

Archibald Hart, PhD, psychologist, author, and Dean Emeritus of the Fuller Theological Seminary School of Psychology in Pasadena, California, noted that “Burnout can best be understood as a loss of ideals and hope.”

Stress is omnipresent. Underwater mortgages, the economy, job losses, and the mundane stressors of daily living affect many people. Every industry has its own cache of challenges. Doctors may have to contend with healthcare reform, EMRs, reduced rates, medical school loans, and pressure to see more patients.

What puts physicians at greater risk for burnout isn’t necessarily the work-a-day stresses they face but the nature of their role as caregivers, says Neelum Aggarwal, MD, a Chicago neurologist who frequently lectures on stress and burnout. “We have to interact with many people many times a day,” she says, “and the element of having to provide care for someone — the personal responsibility for someone else’s health — that’s an unconscious element that feeds into everything.”

It’s a role that many physicians — unlike professionals in most other fields — internalize, notes John-Henry Pfifferling, PhD, director of the Center for Professional Well-Being in Durham, North Carolina. “The greatest risk for burnout comes when the doctor identifies being a doctor as who they are.”




“Delayed Gratification” Puts Doctors at Risk




Part of the problem, Dr. Aggarwal says, is that doctors are in constant motion. They’re also very purposeful and, thanks to their protracted medical training, masters when it comes to delayed gratification. Those qualities, especially if they’re mixed with characteristics such as perfectionism, conscientiousness, a need to be in control, and difficulty relaxing, can put physicians at risk, she says.

“When you are always doing, you can’t step back and see the big picture,” she says. “Often people know something is wrong. They sense it. But the way they try to work through it is, ‘Maybe I’m not productive enough or efficient enough’ and they go back and try to do more. Figuring out what’s wrong really requires stepping back.”

The workplace often exacerbates the problem. It’s not just long work hours, demanding postcall schedules, and administrative demands, notes Pfifferling. Physicians aren’t taught how to work in teams and support each other, and there’s a stigma associated with reaching out for help.

What’s more, although they’re very good about preaching self-care to their patients, they often don’t internalize those messages.

“When I talk about burnout I used to start with the medical aspects — diet and exercise — for preventing it,” says Dr. Aggarwal. “But I realized that just put them back into ‘doing’ mode. Now I start with, ‘You have to learn to sit and be at peace with yourself.’ That hits home with people because most doctors can’t just sit quietly.”

Dr. Aggarwal herself spends an hour in quiet each morning. Quiet sitting might involve meditation, inspirational reading, listening to relaxing music, or just doing nothing, she says, and it’s a skill that doctors need to master before they can move on to more active tactics for combating burnout, such as breathing exercises, walking, improving their diet and — most important — adding joyful pursuits back into their lives.




The Importance of Meaningful Pursuits

In February 2008 asked 1200 physicians how they avoid burnout. The answer: They aren’t couch potatoes. Respondents listed participating in sports, travel, and outdoor activities as their top 3 burnout busters . Many mentioned volunteer and humanitarian commitments as well.

A recent posting on the Medscape discussion board posed the same question. “Exercise every day,” advised one physician. “I’m not a gym rat or fitness freak. I’m just talking about a 20-minute walk. Leave the cell phone at home.” Another advised, “Buy a small vacation house in Sarasota and go there for 5 days every 4-6 weeks. I did, starting 4 years ago before I sold my practice, and I came back refreshed and recharged.”

Diet, exercise, and rest are important components to health, but wellness is a holistic pursuit with physical, emotional, psychological, and spiritual components.

Physicians need to remember — or discover — what brings them joy and fulfillment. It might be making dinner with family or friends, listening to music, bowling, traveling, volunteering, or participating in spiritual or religious activities. Whatever pastime they find fulfilling, Dr. Aggarwal says, doctors need to purposefully reintroduce it into their lives.

As easy as it sounds, it can be very difficult to break out of the cycle of perpetual motion, Dr. Hyman says.

“When you have a really strong work ethic and take time off for yourself, you feel guilty about the free time. It takes you a while to get over that,” he says. It was only when he brought music back into his life that he was able to accept and embrace the difference between “what I want to be doing and what I do for a living.”

Although it definitely falls in the “doing” category, finding a long-term way to deal with burnout means addressing workplace issues as well, says Gabriela Cora, MD, a psychiatrist and author of Leading Under Pressure: Strategies to Avoid Burnout, Increase Energy, and Improve Your Well-Being. That means finding a way to take control over your environment and workload and learning to say “no.”

“Don’t just look at yourself,” she advises, “Look at your practice. Is your nurse practitioner or your office manager stressed out? Look at your turnover. What’s the mood? Burnout often happens when there is a lack of processes but also a lack of lifestyle balance. You need a combination of organizational skills and lifestyle strategy to tackle it.”

The Cost of Stoicism

Finally, Dr. Hyman says, doctors need to understand that in ignoring the symptoms of burnout, they aren’t being stoic; rather, they are doing a disservice to themselves, to the people around them, and to their patients.

“In the field of medicine, particularly for people who trained 20 or 30 years ago, the mindset was that you really needed to forego everything to practice medicine. But when you feel so bad about yourself and your workplace, to go there and be cheerful and give 100% is very difficult,” he says.

Fortunately, he says, that’s not a problem for him anymore.

“Now when I go to work I’m ready to be there. I like my work and I do a really good job. I don’t think the fact that I have other interests and that I don’t love my work makes me a bad physician. It doesn’t make me less empathetic to my patients. You have to take care of yourself.”





Doctor On Vacation Gets Creative and Wins Additional Recognition


Harry Moulis MD




This photo of a yellow-crowned night heron, shot on the Tomoka River, will be featured in Audubon’s 2012 calendar. (Dr. Harry Moulis)
, July/August 2011, by Anne Geggis

ORMOND BEACH (FLA) — A camera with a fiber-optic lens is Dr. Harry Moulis’ main tool for gastroenterology practice, but it’s what he’s done with another camera that’s winning him national acclaim.

His photo of a yellow-crowned night heron, shot near his home on the Tomoka River, has been selected for the 2012 Audubon calendar, according to officials with the national conservation society.

The photo was chosen from among 8,000 entries for the top 100 Audubon Magazine Photography Awards. Those top photos were further winnowed to 12 that will be used for the calendar, which raises $1 million annually for the society. His photo will be the bird for July 2012.

“This is just amazing — a big surprise,” said Moulis, 50, who has been practicing gastroenterology in this area for nearly 20 years. “It started off as a little hobby.”

He took a photography class his junior year in high school and was enchanted with the images he captured during his family’s time living abroad in Iran during his high school years. Now, his photos have graced the cafeteria walls of Halifax Health Medical Center in Port Orange since it opened in 2006. And in September, he’ll exhibit his bird pictures in the Museum of Arts & Sciences in Daytona Beach.

The Audubon calendar, however, is the first national recognition for the doctor, who practices at Borland-Groover Clinic in Port Orange.

David Kubrick, director of constituency development for the National Audubon Society, was part of the team that picked the photos for the calendar. It will not be available commercially, going only to members and prospective members.

“We want something that conveys a personality or something that’s going to create some kind of emotion,” Kubrick said, recalling the bird’s “bad hair” look. “I’m hoping it brings a smile.”

Also, the team tries to match the photo to the season of each month. “That photo spoke of summer,” he said.

Moulis was floating down the Tomoka River in a kayak in June 2010 when he froze this moment in time — the climax of a long period of getting to know this particular family of yellow-crowned night herons nesting near his home.

His willingness to wait hours just drifting in front of a nest of his favorite birds is what earned it, he said.

“They were used to me,” Moulis said with a smile, revealing his technique of allowing the wind to catch an outstretched paddle so he wouldn’t need to move his arms. “I know the parents very well.”

Cynthia Duval, chief curator for the Museum of Arts & Sciences, said she started thinking “museum show” after visiting the doctor’s Port Orange office and seeing the art there. She said she was immediately struck by the uniqueness of what he had captured, which will be exhibited at the museum starting Sept. 16.

“We are all bewitched by birds, but he has a sensitivity that makes you feel he captures the bird’s personality,” she said.

Ann Martorano, administrator of the Port Orange hospital, said she picked his pictures for the cafeteria walls because of the way they bring nature indoors.

“It’s like you’re right there with him,” she said.

Moulis, a native of Long Island, N.Y., was photo editor for his high school, college and medical school yearbooks.

His wife, Debra Moulis, said she doesn’t mind the time his hobby takes him away from her.

“He lives it and he loves it — it’s a great release for him,” she said. “These guys are under the wire a lot with treating patients.”

Even if he’s spent enough time observing birds that he can anticipate their moves, Moulis said he’s no “bird nerd” — photographing any wildlife is a thrill for him. The collector of hats and canes — now looking for the astronaut’s topper — took his wife tent camping for their third date. No boat he owns is gas-powered, and the dock behind his house has been redesigned as a riverside porch. He resisted going digital until he saw how quickly he could see the results of what he had captured.

But capturing greater quarry beckons, he said.

“I love all wildlife,” he said. “If I could find alligators, otters and panthers, I’d photograph them.”



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