9 August 2021 – Women’s Day – This year I penned an article dedicated to the special South African Women Doctors on the frontline. I like to call them the “bravest of the brave” because like women globally, they are not only juggling their lives but also saving lives …. This makes for a really stressful daily grind and one where almost all of them have experienced Burnout in some shape or form. Some of these brave ladies were kind enough to take a few minutes from their crazy lives to share some thoughts and their experiences of “Burnout in the Workplace – Finding one’s voice when the world’s not listening”.
“Burnout” it’s a word that is getting much airtime right now in almost all professions and rightfully so. While healthcare professionals battle it out on the coalface, they too succumb to Burnout. However, there is a worrying trend that female physicians globally, with South Africa being no exception, are bearing the brunt of Burnout during COVID times on a far greater scale than their male counterparts.
“Women physicians report more problems with Work Life Integration (WLI) than men. At work, women physicians may spend more time with patients and more frequently address psychosocial issues. At home, women physicians also spend more time on both household and childcare activities and on completing work from home. This combination of increased burdens for women vs men physicians both at work and at home may explain much of the observed gender disparities in WLI.”
“The incidence of burnout and depression among physicians has been a concern for years, and the pandemic only made a bad situation worse,” said Leslie Kane, senior director, Medscape Business of Medicine, in a statement. “This is especially true in frontline specialties and in female physicians, who we know have borne the brunt of at-home schooling and other disruptions,” Kane added. Source
udging from the above, this is not at all about the “fairer sex” being “inferior”. Indeed, she is able to handle pressure in just the same manner as her male colleagues. It is unfortunately the byproduct of the age-old adage that a “woman’s place is in the home”. The reality is that a female physician simply has that much more on her plate and is stretched that much further than most of her male colleagues. Again, COVID reminds us that the persisting social injustices relating to gender are very much real, and extremely damaging to society as a whole.
In the spirit of Women’s Day, Zebra Medical conducted a survey this month amongst ±100 of the female doctors in our network. It was designed as a quick dipstick into the minds and hearts of these brave ladies on the frontline who juggle a million balls and answer to several names ….. Mom, Wife, Sister, Daughter, Girlfriend, Friend, Colleague, She/He/Her/Him/They /them …. and Doctor.
Here’s what we found out about Burnout amongst our South African female doctors with specific reference to how they are coping in the workplace. Please bear in mind that we had ±25 participants covering all manner of specialties, which makes for a small sample. This is therefore is a commentary on the common threads that are so overwhelmingly compelling among all of our participants that they stand out as worthy of mention.
Unsurprisingly, some 99% of the participants indicated that they had suffered from Burnout in the past 12 months. It seemingly manifested itself both physically and mentally. Physical conditions included the likes of insomnia and exhaustion, which dominated most responses, but some even mentioned panic attacks and “shingles”. From an emotional perspective there appeared to be a far wider range of experiences. My summation is that it’s been a year of mainly many quiet tears that have been shed in private, but also uncharacteristic outbursts of anger and irritation. A constant state of feeling overwhelmed has become the new normal such that many participants indicated that they felt disengaged or had “mentally checked out”.
I quote one sentence that really struck me: “I aim for empathy and am finding only apathy. There’s nothing left.”
Some commentary from a well-respected counsellor in Cape Town, who we will refer to as CC, on this sentence reads as follows: “Once this level of depletion, a ‘running on empty, is reached, it requires emergency action, just in the same way someone arriving at a hospital A & E bleeding profusely would need urgent attention. However, many people, especially women, who have chosen a caring profession, see it as a failure to admit their own needs which may clash with the needs of others. Being overwhelmed means you can’t think straight so you can’t work out what is best for you and how to go forward. We are all finding our way with the new norm, we don’t even know what the new norm is because we’re still in the crisis, we get new information daily. Right now, we can learn what works and what doesn’t for our own mental health. We are in survival mode, some of us, such as frontline workers, even more so and more often as they witness the distress of people fighting for their lives compounded with the grief of their loved ones. When so depleted it is absolutely imperative that we fill ourselves up with whatever feeds us. It doesn’t have to be anything fancy, literally it can be looking up at the sky and breathing deeply until you find you can carry on; I’m not saying this is enough, but it could clear your mind to think more about what would be good for you to fill up more. It’s terrible for a person in the care profession to feel apathetic; it’s also a sign that empathy for oneself has slipped out of vision and consciousness.”
A number of participants also engage in other behavioral traits that may be considered warning signs for Burnout at work. (Source https://theundercoverrecruiter.com/need-break/) Some 25% said that they deliberately set their alarms too early so that they can use the snooze button more often. Per CC again, “This is an attempt to feel in control when in fact the opposite is the case.” Similarly, the “Sunday night angst” i.e. absolutely dreading Monday mornings also rated very highly at some 25% of participants. Per CC, “This is the stress of going back into battle when you are so battle weary, the anxiety of “will I survive this/will I cope with what I have to face again?””.
Undeniably, the single most common emotion felt by participants was feeling antisocial. Some 60% of participants indicated that that they had absolutely no desire to socialize at all. CC commented as follows: “When we are in survival mode, socialising is not high on the list of needs; I think of it like a sort of hibernating, in the sense of shutting down our system to get through the winter. Every bit of us has to be put to good use for seeing through the winter with limited resources.” This was followed closely by feelings of anxiety, being overwhelmed and a growing indifference towards their career. CC had this to say: “Anxiety, is normal and necessary when we need to look out for danger, the trouble with being overwhelmed is that we can’t distinguish between what is dangerous/not good for us and what it is we need in order to support and keep ourselves going.”
Coping mechanisms varied but “R-n-R” (aka “Rest and Recuperation”) was by far the most prevalent amongst participants. Some 64% indicated that sleep, or rather catching up on sleep, accounted for their best coping mechanism. Some insight from CC, “I would see this as, to state the obvious, exhaustion, but maybe the less obvious, sleep is when we are unconscious and therefore not troubled by all the thoughts that fill our minds when you’re awake. Having said that we of course dream and if our dreams are doing their job properly, they keep us asleep – which is a whole other conversation.” Other important tools included participants leaning heavily on personal support networks (like church, friends and family etc.) as well as physical exercise. There was a marked absence of formal psychotherapy and/or counselling (but please do remember the sample size in this regard).
When specifically asked if participants had engaged with their employers / business partners regarding their Burnout, some ±60% indicated that they had. Of the balance, some 30% indicated that they had not, and the remaining 10% felt like they simply did not know how to broach the subject for discussion. It was encouraging to see that of the 60% that formally engaged with their employers / business partners on the topic, a few felt that their concerns were taken seriously and demonstratable steps were taken to assist them (for example, in the form of seeing an assigned psychologist and such like). However, the vast majority felt that no real steps were taken although the freedom to raise concerns and share their experiences with colleagues (and superiors) formed a very important part of dealing with their Burnout.
The above findings resonate with some of the latest research and articles published internationally. If it is by means any consolation that female doctors the world over are enduring the same stresses and strains. However, it might mean that with this critical mass, we may see a shift of resources in the workplace (and the home?) aimed at acknowledging and alleviating the disproportionate burden of Burnout being felt by our female doctors.
CC has some deep insights into this. “There has been lots written and spoken about in private conversations regarding what we can learn as we go through this pandemic; about ourselves in a personal way and about us as part of humankind. A main theme coming out of these thoughts is that we’ve been getting it wrong in fundamental ways, that going forward it is imperative we make links between cause and effect, and raise our consciousness for ourselves, our loved ones, our community and our world. As a therapist (and as a person) using the psychoanalytic method, I look for the start of the trouble, in other words “where is the suffering?” I ask how did we/you/I get here and what’s keeping us stuck, even though you can see what you need to do? This is to do with what is unconscious in us and what defenses we employ to stay unconscious. So a shift of resources in the workplace and home to alleviate burnout is without doubt imperative (if possible – think single mothers), however this needs to be seen in the context of a society that still, even if it’s much more subtle now, expects women to hold the bulk of the care work; it’s systemic, written into the fabric of our way of being. Sometimes we can’t figure it out by ourselves, we do need another mind to think with us, but when we can and do know, we can start to gather what we need for ourselves to feel stronger. My guess would be that the doctors who answered this questionnaire are the ones doing slightly better than the ones who did not; taking part in a questionnaire is having a voice, even if a small one, someone is asking you about you, what it is like for you? As pointed out above, when people spoke to colleagues there was some relief in being heard and then getting some support. The truth is that we are living through a time where everyone, to varying degrees, is under duress. We need each other but we also need ourselves in the sense that we need to give ourselves whatever it is that keeps us going and makes us feel strong and alive.”
I cannot deny the distress that I personally felt in simply reading some of the responses. And again, perhaps this points to the giant blind spot that we all have vis-a-vis Burnout viz. the physical manifestations are the last ditch efforts of our bodies crying out for help. None of us are built to cope with a pandemic of this nature. Yet some of us must not only cope with it but endure the full devastating effect of it on a daily basis in their workplace. Notwithstanding whatever is going on in their personal lives, we ask our healthcare workers to go to work every day and bear witness to the excruciating pain – in every form – that is COVID. This is not what they signed up for. It violates every code of being human and it’s a wonder that they possess the wherewithal to continue. The cost of simply having to continue from a mental health perspective is immeasurable and a I dare not trivialize that by simply calling it Burnout. For now, bear with me, let’s just call this global mental health crisis Burnout, because at the very least we can acknowledge it by naming it.
If we can put a name it, then we can start the process of truly understanding it. Our healthcare workers are tired of being portrayed as superheroes. They are as broken as the rest of us, yet they are denied the headspace to “feel” because they have this massive job to do and only they can do it. It’s time we started really listening to them. It is vital for all healthcare workers, and especially for our female doctors, that their voices be heard …… by their employers, their colleagues and indeed all of us. We can all be part of their (and our) healing if we simply start listening. Our lady doctors are strong, no doubt. However, we need to acknowledge that they are human too and each of us in their respective networks can contribute to making them stronger by simply, as a starting point, listening.
In summary, I leave you with some quotes from the bravest of the brave fighting this pandemic for all of us, in our names, for our families and for our country.
This was their advice to other doctors who are suffering from Burnout. Let’s start listening right here, right now…..
“It is okay to say no”
“Ask for help! You are not alone. And it is OK and normal to feel this way, these are unprecedented times.”
“I see you. Why are we subjected to so many roles without the option of work support, having to outperform our male counterparts”
“Ask for help before you become overwhelmed”
“It is very real, very common and nothing to be ashamed about. We need to talk about it – something small systemic changes can alleviate the risk for burnout”
“This year has been extraordinarily difficult, and everyone seems to have unique burdens and stressors, you are not alone!”
“Take time out! Put yourself first! You cant pour from an empty cup!”
Indeed. Nobody can pour from an empty cup.
Author
Anjé Gregory
CEO Zebra Medical
22 August 2021
