October 6, 2022

My burnout is born of a health system that treats the emergency department as a panacea | Stephen Parnis

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“Physician, heal thyself.”

This proverb has been in use for at least 2,000 years, but it is relevant today, and it applies to me.

I am dealing with burnout, and it has taken many months for me to realise it.

The combination of a few years of a heavy workload, of ever-increasing demands, and limited opportunities to rest and recharge have taken their toll.

The advent of a global pandemic has clearly contributed to all these factors. The scramble to ready our hospitals for a disease of high infectiousness and severity. The privilege and pain of caring for many who I watched die in 2020. The angst of dealing with vaccine refusers, and wave after wave of Covid cases, and new, often overwhelming demands on myself and my colleagues.

They have laid siege to my energy and my empathy.

The demands upon many of us in emergency medicine and nursing have to be seen to be believed. Their origins lie in a health system which treats emergency departments as a panacea for all its shortcomings: a disastrous aged care system, a general practice system which discourages the care of complex patients, a mental health system that is woefully under-resourced, and a federal/state health funding system where cost-shifting and finger-pointing are the reality.

Emergency physicians have been talking about hospital overcrowding for more than 20 years, and burnout is nothing new among many of my medical, nursing and allied colleagues who have given so much to caring for people in the worst moments of their lives. But the overcrowding, the delays, and the adverse impacts on patients have never been as profound as they are now. Unsurprisingly, morale among my colleagues has taken an enormous hit.

Burnout has not happened to me overnight. Rather, it has been a progressive erosion of my usual coping mechanisms, to the point where my physical and mental energy have become so much harder to find. Decisions and procedures that are usually second nature to me, now require considerable effort and cause more angst than they should. Joy has been hard to find, not only in my work – which should be very satisfying – but in most of the activities of my daily life. I cannot be unaffected by seeing people suffer on waiting room floors and ambulance stretchers, when I know I could help, if only I had the space and staff to do so.

I am aware of the data that clearly shows that clinicians with burnout are impaired. We are less efficient, and we are much more likely to make mistakes. In my role, mistakes have the potential to be very serious .

While many colleagues have been surprised to hear of my situation – I may be good at hiding personal distress – I have come to understand the impact of burnout on the people I love most. My family. I have often been irritable, distracted, and unable to give all of myself to them in the ways they need and deserve. That is probably the trigger that led me to take the advice of my psychologist, my GP and my emergency physician wife. To deal with my burnout before it deteriorates further.

I have been advised to take leave from my clinical work for three months. That has been hard to accept, but I am so grateful to my colleagueswho have been supportive and understanding and sought to assuage the guilt I feel at the prospect of not being there to help with the extreme demands we are experiencing.

I have chosen to speak about my circumstances publicly, because I hope that it will give permission to many healthcare workers to give a higher priority to their own self-care. In that, they are being professional and ethical, doing their best to be safe and effective in their work and making their careers sustainable.

I speak out because the most enduring solution to healthcare worker burnout is to address the daunting problems in the Australian health system which cause it in the first place. We are in a federal election campaign and yet the offerings of our political leaders for health system reform and enhancement have been evasive or superficial. I hope that changes in the weeks ahead.

As I step back from the frontline for a while, I look forward to the rest and reflection that I need. I don’t know how my time away will change me, but I hope to be able to return as a wiser, better man, able to care for many. Including myself.

Dr Stephen Parnis is a Melbourne emergency physician, and a former vice-president of the Australian Medical Association



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