Aug. 12, 2021

#48: Burnout: Identification, predispositions and solutions. With Professor Gordon Parker

#48: Burnout: Identification, predispositions and solutions. With Professor Gordon Parker
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Season 1

Thanks to Heska Australia for supporting this very important series of episodes on mental health, resilience, and burnout prevention. Go to https://www.heska.com.au to find out about ways to re-imagine the way you run your in house labs and digital radiography. 

 

Professor Gordon Parker AO is Scientia Professor of Psychiatry at the University of NSW. He is, amongst other things, founder of the Black Dog Institute, and Director of the Division of Psychiatry at Prince of Wales and Prince Henry Hospitals. In 2004 he received a Citation Laureate as the Australian Scientist most highly cited in Psychiatry/Psychology, and in 2018 he was a finalist for NSW Senior Australian of the Year. Oh, and that little AO that I read after his name is short for 'Order of Australia', which is awarded for distinguished service of a high degree to Australia or humanity at large.  He has published 20 books and over 1000 scientific papers, with his most recent book publication 'Burnout - A Guide to Identifying Burnout and Pathways to Recovery'. This book encapsulates groundbreaking new research and clarifies what exactly burnout is, what it isn’t, what the risk factors are, how to spot it, prevent it, and fix it. 

And these are exactly the topics that we cover in this conversation with Prof Parker. We’re well aware that our profession is one of the highest risk professions for burnout, so arming ourselves with a better understanding of this nemesis is critical. 

 

Burnout: A guide to identifying burnout and pathways to recovery: https://www.allenandunwin.com/browse/books/general-books/health-fitness/Burnout-Gordon-Parker-Gabriela-Tavella-and-Kerrie-Eyers-9781760878061

 

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Have you met Stephen Fry?Or did you publish have?You have really?Yeah.Well, I went backstage because I've been set up to meet him.He was giving a performance at the opera house.And as we drove there, there are fireworks going off.And in The Green Room afterwards, he said, oh, he said, I wonder what those fireworks were all about.
And I said, no, there weren't fireworks.They were fry works and he looked at me as if I was an absolute sort of his fur.So, to his the conversation, I'm Gerardo Pollard.
I'm you became chat and this is the bait fault.Before we jump into this episode, just a word of thanks to our friends at Hast cast, raelia for supporting this, very important series of episodes on Mental Health, resilience, and burner prevention.
If you are trying to reimagine the way you run your in US Labs, as well as your digital radiography and you really should go to his car.com.A you to find out what is possible.Now back to our guest Professor Gordon, Parker AO is a professor of psychology at the University of New South Wales.
Now if we had List his awards and achievements, it would be a long introduction indeed.But here are a few, he's the founder of the Black Dog Institute and director of the division of Psychiatry at the Prince of Wales and Prince, Henry hospitals, in 2004, he received a citation, Laureate as the Australian scientists most highly cited in Psychiatry psychology and in 2018, he was a finalist for New South Wales, senior Australian of the Year.
Oh, and that little arrow, that I read, after his name, I had to Google.One there, one stands for order of Australia which is something that is awarded for distinguished service of a high degree to Australia or Humanity at large is published 20 books and over 1,000 scientific papers.
And now in 2021 is a guest on the vet felt podcast.The other exciting thing that happened to profile.Current 2021 is the publication of a new book on burnout, I say a book on burnout, but I think it's more appropriate to call it the book on Bernard.
Burnout a guide to identifying burnout and Pathways to Recovery encapsulate.This groundbreaking new research and clarifies.What exactly?Bernard is, what it isn't, what the risk factors, are how to spot it prevented and fix it.And these are exactly the topics that we cover in this conversation with Professor Parker.
We are well, aware that our profession is one of the highest-risk professions for Burnout.So, arming ourselves with a better understanding about this Nemesis is critical.So, please enjoy Professor Gordon Parker Welcome to the VIP felt podcast.
We are thrilled to have you.Thank you.It's a Hot Topic burnout and in our profession and veterinary science, it is something that's discussed a lot, we have high rates of career, attrition of people, joining the profession and then, you know, five years in.
They Chuck it all in and leave the profession.And a lot of people are saying burnout is playing a role and in that.So we want to have a conversation Find out what you've learned through your experiences, and what you can teach us, how to identify it, how to fix it, or at least how to prevent it Gerardo you wanna jump in with our first question.
Yeah, man.But was, it's interesting to hear that that you experienced burnout.Is that right?Yes.I was aware of some symptoms of burnout, but they crept up on me and I wasn't actually sure what the hell was going on.
And so I suspected burnout and I decided that I'd start Reading on it, and then start researching and that tripped me up immediately.So you felt so amazing after reading about burnout that you will know, this is what I dis is that one of your strategies to enter the pathway for our no, not quite like that.
In fact, it's probably not the ideal strategy to pull yourself back into the same field, which has been burning your art, but I guess you remember the king of Corinth Sisyphus who would pull out show Rock up the cave and it would roll back down again.
And then you do another and after Decades of being a researcher in Psychiatry, you know, writing 30 papers a year and a book every couple of years I really got to a stage where I was feeling as though here's another rock being pushed up and it's coming down.
Again, here's another one and so on and so forth but I think what what took me out of it was essentially finding a new field.My career as a research to cartoonist, has been generally to say, what's the model that operates here?
Is it valid?Can we improve on it?But should we reject it?If we can improve on it, then how do we do that?And then how do we measure what's under inspection and then, how do we manage it?And I've done that for the mood disorders over the years and I essentially did the same for Burnout.
I'm just curious going the first thing that I personally struggle with and again, because we talk about it all the time and I am a veterinarian and I know it's a relatively high risk area for personal reasons, I'm aware of it.Like, I'm on the lookout for these things sneaking up on you, but I'm still not sure what it actually looks like and it's maybe a good place to start in your experience for you.
Why did it look like specifically versus?I'm just tired or I need a holiday or I'm overworked or something.Well only if you wouldn't mind just starting with the dominant model and then expanding on what our research has led us to in terms of how to define burnout so burnout, under the sort of auspices of us psychologist in the 1980s, was defined by three features and the same three features used by the World Health Organization to Define Bernard, which they basically say, is a syndrome, reflecting workplace stressors and The u.s. researcher, basically said that burnout is dominated by exhaustion.
A lack of empathy and thirdly compromised work performance.And she and her colleagues then developed a measure called the maslach burnout, inventory, or the MBI and that's been used in over 80% of Publications to Define Bernard in our research, which your time, the experiences initially, have some 1,200 people with burnout.
And then a second study of over 600 We give a big tick to exhaustion.Secondly, the loss of empathy, which is sometimes being called compassion fatigue.Sounds as though people have lost the capacity to care for others and therefore it sounds a bit judgmental.
It's actually a broader construct than that.It's a loss of feeling tone where you lack the joy to V in life.Even in socializing, you find only superficial pleasure, you find it difficult to be cheered up.Many people become quite insular and they avoided So it shouldn't I think they say in his loss of empathy.
Certainly I know many doctors who are experiencing burnout and because they experience with the first time, they're actually more empathic towards their patients because they realize for the first time what people are suffering.So I think we need to challenge that loss of empathy and just so it's a loss of feeling to it, okay?
Of course, there's compromise work performance.That goes with the territory fourthly, there is impaired cognitive functioning and what we found.And these people say I can't memorize things as I used to and I find when I read, I can't read it.
I tend to scan And if we look back at the early descriptions of Bernard and in the ancient days was called a tri Dia, a CED is a, and it was one of the then eight cardinal sins, because the monks would wake up, this is 300, 400 years, ad one day and say, the sky is no longer blue, I've lost my faith in God, I've lost my interest.
In looking, after the flock, I feel that life is shallow And I feel a terrible person as a consequence and as I say, it was regarded as a sin and punished only later.Did Pope Gregory come along and join a cheetah with Trista which was depression to create.
One composite bonus, which then confused depression with Bernard to create the seven cardinal sins.But the point I'm making is that cognitive impairment was there in 300, ad is a key component of burnout.And yet it's missing for the modern Triadic description.
In addition to that people, when asked about burnout, basically say they use the word lack.I've got a lack of pleasure.I've got a lack of energy, I've got a lack of sleep and so on and so forth.So, despite feeling absolutely exhausted, most people have burnout find, it's very difficult to sleep.
In addition, there's emotional dysregulation so that they're much more likely to experience, anxiety and depression.And Ability, and they can be increased physical symptoms.So, in our book, we describe people who end up in one of our final vignettes is a woman who just collapses, when she gets to the hospital, their blood pressure is about 60 over 40.
The pulse rate is 160, and the doctors have no idea.What's going on, Arianna, Huffington, when of that Huffington Post, when she went down with Burnout, she just fell to the floor heating head against the table.Some people have burn up become incontinent, so there's lots of physical symptoms, flood things going on in the brain, obviously cortisol is involved the sympathetic nervous system, but numerous parts of the bay and shut down, your Genesis gets compromised, the telomeres get affected.
And that I think it counts for the cognitive impairment that we see all, which sounds pretty horrible, but I guess we'll get The fact that these changes are correctable.So the point I'm making is that I think Bernard has been inadequately Define for over 40 years with just this triadic definition, it's much broader than that and then that leads to the risk of Falls positive diagnosis.
The other aspect is that Bernard has generally been considered to involve those informal work.And what we found is that Bernard is just as likely It has the same phenotypic picture in those who are caregiving and caregiving an extremist.
So, at one stage, I saw a woman who had two intellectually challenged children.They scream for 22 hours a day.From the moment of birth, the husband had left her.She was just exhausted.She had burnout.So caregivers, those who are looking after young children, those who are looking after elderly parents, who have limitations those who are sandwich, carers caught between Demanding children and parents can also get it.
The other aspect to our definitional model, which we obviously take people through in the book is that there is a predisposing personality style and basically, the key component is a burnout generally affects good people, people who are reliable, dutiful conscientious and perfectionistic and it sort of makes sense.
I used to say, you know, we don't treat Thickness.We employ them because they're such great employees.They work hard and long.Yeah.But because they're so dutiful and because they're often, so caring, they are much more likely to get burner, which is why somebody at golf the other day said to me now go and understand why Psychopaths never get burn up.
So if you are in a career that requires you to be carrying and requires you to be reliable dutiful, if not perfectionistic, then you are at home.Risk and I think that goes a long way to explain why doctors teachers vets.
The clergy are so distinctly overrepresented.I mean, we look at the figures for doctors 30% or having burnout at any one time 60% of their lifetime.Rates are probably even half of the clergy, that's really good because of their, the empathy, and the care, the compassion, and the connection and need for unrelentless caring.
Yeah, the clergyman you have to be prepared to be called out anytime of the day or night and always be supportive and caring and dutiful and reliable.You almost if you just look at veterinary science for the way they select, who gets to study Veterinary.
By default, you have to be dutiful responsible hard-working and generally, I think you will have people who are more empathetic or caring because we're at the caring profession.So we're basically saying, let's put on our selection criteria, people at high risk, for Burnout, and then we work them really hard and let's see what happens.
Well, I think, I think there are two ways of getting there, I think there's some careers that demanded, our view.I think the law is a good example.Mean you have to be perfectionistic to be There's four and there are other careers where you can start off with no particular personality stabbing overrepresented but the career makes you perfectionistic and again medicine.
Yes you Sons.Yeah, whole series of other particularly the caring professions, if you are going to be successful in the profession, if you are going to do a good job, if you are going to avoid litigation, if you go to avoid errors of omission and commission, you have to be reliable Also, the career can make you more and more perfectionistic and then there can be some nuances.
So, for instance, were doctors the biggest nominated cores in the last 10 years has been the electronic medical record and as a doctor, and having been exposed to the EMR.I can tell you, it would drive you Bonkers and I'm sure you've got similar pressures in vet science coming from technology in addition to some of the nuances such as looking after I do.
Is it an animal where it has to be euthanized?And being a carer, as a vet and being involved in having to put an ammo down?That's, that's a huge stressful event.So, in addition to your personal stress, if you have an owner who you see is distinctly, distressed or maybe angry and you having defend yourself that is a huge Condition specific stress that you people go through our youth.
I don't know if you believe in the personality types and social Styles and things things, like they got the driver or the expressive the analytical, the aimable that kind of probably common, but maybe not so accurate constructs of people's personalities, but kind of what you're describing there is what I would consider be like, amiable would be caring, encouraging kind of compassionate cooperates and You know what to provide support and in surveys close to 80% of veterinarians.
Amiables, is that something that would like it's is that in itself potential there?These us as veterinarians are at higher risk or is that the environment that we're in or I don't think it's a mobility of itself.
Yeah, I think it's the other component that I was talking about that.The caring aspect.Yeah.So most caring people are amiable.Yeah.So I think that's where the link comes from.It comes from the caring aspect.Yeah, of constantly putting out and putting yourself out to look after people and of course, if you are, you know, interpersonally skilled as a professional, you should be amiable cooperative and effective but the more you're giving out the more you're draining away from your intrinsic energy To the you mention K, and you mentioned that lack of empathy earlier I want to dig into that a little bit.
I do feel like To be able to do a catering job.Well, it really helps to be empathetic but then there's a common phrase and you mentioned earlier, The Compassion fatigue thing.Is that a different thing to burn out?Or is it a component of burnout?
Because we have certain experiences myself where you work, too many hours, you get to a point where you've seen 200, sick animals in the last week and you go, I actually don't care about this next dying animal.While say at least, you can't master the emotion for it.
Another one.Yeah, it is that a component or is it a separate thing, or whatever?It's a component.The the term compassion fatigue introduced by a London nurse in, about the 19 in the 1980s and she was describing nurses on the front end of a heavy-duty Relentless pressure.
Usually emergency department nurses and they would just describe a loss of empathy as well.As usual exhaustion.So, I think it's a component of burnout, but it's not in and of itself.The definition of Bernard.Yeah, I think from what you said earlier it sounds to me like because I've certainly had that when I lost that empathy and work but I still had this right over here that you said I could still come home and be happy at home or go for a walk and feel joyful, maybe just not in that situation.
So is that where we draw the line to say?Well if you feel that at work but you go home and you still don't give Shit about anything is that when you start saying, well maybe this is a case of burnout, it's hard to know what's actually going on there, but my speculation would be that people go through stages of burning art, and of being burnt out.
It's a bit like hookes law of elasticity, you know, stretch something within its elastic limits and it will come back stretches Beyond its elastic limits and it just won't bounce back.If you've had a really heavy day, but you can go home and you can unwind and you're going to have your 12 six glasses of wine and you know, whatever and you're burning out process across the day.
May well be attenuated.But if you know, and this is what I see more commonly.If you're a lawyer who spent 12 to 15 hours a day in the office, doing their six-minute billable hours, you know?And then they go home.
And they start working on their brief for the next day to two or three in the morning and they don't have the downtime.Then I think you're driving the burnout risk much, much higher than what we know is from folklore talking to people with burnout, what do you find helpful?
And they say talking to others?Having a holiday exercise and distressing strategies like, mindfulness meditation yoga.So your description of coming home and relaxing.Think is automatically decreasing the burnout diaphysis.
Okay, hmm.I'd really like that picture of the elastic band that that's a really good way to think about it.There are sorry interrupt.Yeah, hooks.Laura, I put it in the book but one of the editors didn't like it, they thought was far too technical but I actually think it fits quite nicely.
I think it does like it.Because I think the point I wish to make group of people are burning out then, in fact, their whole series is strategies to reverse that process.If they are burnt out often than they really have to rework the whole life, often changing their job.
So the difference I think throws comes through to actually management as well.So it's a question that I would be interested to know if if if this is if this is real thing.So my experience over the last 10, 12 years in the profession, is that things come through.
And then things just Pierre.It's like five to six years ago, compassion.Fatigue was the thing.And then and all of a sudden just disappeared and then all of a sudden now it's burnt out and it's like specialist burning out and then I don't know, two years time.
Is it going to just be like, like so I my my feeling is and I don't know if this is real.Is it there these like catch conditions that people go?I take three of the ten boxes.I have that.Now, I am this person, that has compassion fatigue, I'm this person who's burning out like is, is Is that a thing or or is?
And what percent of people who think they have burn?It actually have burnout?Yeah, yeah, I think that's a very reasonable cynical positioned rather to hold, I mean, we've seen that in medicine, having we with repetitive strain injury, an epidemic of it and then it moved on.
There is a real risk of over diagnosing burnout by Healthcare professionals and by individuals themselves.So in the book we have a measure, we've developed called the Sydney burnout measure and it has high sensitivity.
So if you have burner you will get a decent score but its specificity isn't that impressive and we would hold that the same operates for all The burnout measures but most people don't admit to that.So for instance, if you turn a high score, you might have primary depression, you might have primary anxiety, you might have anemia, you might be on anti-cancer drugs, that are causing fatigue, Etc.
So what we attempt to do in the book, which is silicone, backing question, is to say, consider the symptoms that we have described.And then we take people through a clinical reasoning approach of considering other issues, whether their psychological or physical because they can create for positives, even further in support of your concern, I gave you some data earlier about the prevalence of burnout in doctors.
But if you look at the actual data and there was a big meta-analysis looking at the prevalence rate of burnout in doctors the prevalence rate in differing stay These range from naught point five percent to 85 percent.Well, I do.
Yeah, the reason largely again comes down to the major.Use the MBI because it has three scales but has no cutoff scores has no rules, how you doing the scales together and so therefore you can sit the cut-offs, very low.And then, so many false positives will come into the story but despite those Those measurement errors that are replete in the literature.
I don't share your concern.Cynicism that burnout is just a passing 21st century affectation.We know that burnout isn't limited to Western societies if you go to any third world country, you'll see it in Asia.
Every Asian region has a category of death by overwork with people die from heart.Attacks and strokes is a consequence of burnout.It's been around a long period of time.It's just that it's been poorly diagnosed poorly appreciated and other things have been put up to explain it.
So, chronic fatigue syndrome, probably captured many with burnout, depression, captures, many people etcetera, but all the evidence suggests that burnout rate is increasing.The prevalence is increasing has been so for at least 20, if not 30 years and I to be reflecting the 24/7 model where we're constantly on called and having to be available.
So I share some of your concerns, but I believe that it is a true phenomenon and that the rates and genuinely increasing and they're actually increasing more in women than in men, which goes with the well-being literature.
The world being literature you know basically said that when all the 20th century devices came into action, we'd all be happier and blah blah blah, blah.Over the last 30 years every study has shown well-being levels.Haven't changed in men over the decades but in every country they have decreased for women and so well being has gone down and that that I think is the other side of burnout.
It's fascinating.I'm interested.Why?Why is there any theory on why that is the case?Well, in the old days was a stay at home and their husbands went off to work and their job was to run the house and look after the kids.Now, the requirement is that there are out there working and they're having is just as successful career as a husband, they are also expected to come home and be, you know, partner to their husband and they're also expected to look after the children.
And if there any elderly Relatives particularly failing or flailing their was expected look after them.Yeah.So the general model is that women are having to have two if not three careers in comparison to their to, their husband is so explaining, you know, the burnout phenomenon increase further and why its more common in women and why it's extremely common in.
Those are highly, highly, highly caring.I just make another point about the well-being Paradox, if you read positive psychology and I followed it fairly closely for the last few decades, it was held that having a job was better than having no job.
Having a career was better than having a job.Having a calling was better than having a career.All sounds very good, the higher you go up the hierarchy, the better.But basically what you find is a higher you go up the hierarchy, the greater the level of Bernard And so in the book I look at carers in particular and as part of that, I decide, I look at the Ultimate Care at Mother Teresa.
And after she died, they found some letters that she'd written a few years before her death, where she talked about how she'd lost her faith in God.And, you know, the sun no longer shown.She had the old fashioned, a cheetah she had burnout, but she did not know.
It was burnout, she thought that she had lost her faith in God and that she was a Sinner.Now that is so pointedly tragic, but the point I'm making is Those who get more and more involved in high carrying are at risk of Bernard.
And women are more likely than men to fall into that description and they're more likely.If they're carrying people and is Gerardo said, amiable people.It's a very, very important conversation that I'm not sure if you're aware, but veterinary, science is becoming increasingly female dominate.
There's more and more.There's what would you?What would they be?To say just the same - yeah.So it is it is it used to be a hundred percent male then it was maybe three decades ago when humid graduated.He was maybe 90% male but now it's flipped completely but it wasn't just 100% Mary had to be mayor of and also play for the wallabies.
Oh yes, it was mild and pay rugby.I'm fairly certain Port that 100% certain.That was it.He gave mail and you pay for Rugby because not one place Cricket in and and I and I grew up in a family like that.
My mom is a both, my parents are medical doctors but it was exactly that scenario was still the 1980s in South Africa because so Mom had a full-time job but was also made to be mom and they have primary housekeeper and was in charge of us and and and and miraculously did it and to my knowledge and event burnout but maybe she never admits it.
Did you play rugby?Yes, but I wasn't you play wrong but you re rugby human yeah badly though I'm just gonna die.I did it for the social side but it is I was researching with a an academic vit 40 years ago.
And I remember going to the University of Sydney Gala day one weekend and they had competitions where you had to milk a wild cow you know and There was a sort of a lot of each case where a lot of these were hidden under mu poop and then there was a Nefertiti event where you had to eat three cold pies and drink six glasses of warm beer, run 5 km and then leap over a long jump, which was full of mu poo and it was a male then.
So there's been this huge change, obviously, in your Action.Huh, Billy.But it's changed that much regarding that.There's still there's still rituals of first year.Vet students.Blue devote, five identified, the electronic medical record is one of the key drivers.
Doc, what do you guys think of the key drivers for Burnout in the profession?If you say electronic Gregor, do you mean record-keeping on a on a computer that basically electronic medical record means?When a patient comes into the hospital, you then have to fill out field after field.
Of information.If you're a psychiatrist seeing somebody for half an hour during that 30 minutes instead of looking at the patient you on the computer the whole time.Yeah.And you having to put in information that takes 20 minutes out of the 32, get it in.Yeah, it just drives, creep people crazy.
And of course lawyers love it because if you miss one field and something goes wrong, yeah.In your then your difficulty.So other equivalent technology aspects of being a vet that Drive the burnouts in her.That's really just take your bait in the note-taking dry?
Sorry, I interrupted you, but I, yes, we have exactly the same.It is, we have to keep notes and it and it'll come back to a theory that I have and not necessarily.I've never thought of it in terms of burnout, but certainly in terms of lack of jobs and career enjoyment.
But yes, we have that and interestingly enough, one of our previous guests when we spoke to Ivan Jurado and we talked about burnout as well.He's done some research into Veterinary.Burnout specifically, and when he talked about his career as a young vet and how he explained it, I have the quote, I said you sitting there you're doing this to work and then you sitting there for hours afterwards doing these effing notes that nobody's going to read.
But when they rented, you're going to end up in court and you build this resentment and you go.Why am I doing this?This is not veterinary science.This is just a note-taking, we would we have out of it.So we used to do, I used to 18 20 hour shifts a long has shifted a 22 hours and seven hours of That was no talking goods and I can understand why, because we sing other people's patience.
So clearly you have to have good good nodes but it does reduce my enjoyment of the job for sure.And I have this theory that I building about heart-based Veterinary practice.So doing it for the love of or for the enjoyment or for the servers, versus the way we can practice, which is more fear-based where we practice from what's going to go wrong.
If I stuff up or I've got a cover A up by doing this this thorough notes and it's to me there's definitely a link there with how much I enjoy my work and my doing it because I want to help somebody on my all am I thinking about how can I stop this out, but how should I cover myself?
Basic 000?Are you actually spending the time doing the things?You'd love surgery diagnosing and treating patients communicating with clients or that, but then knowing that the back end of that because if I see so many patients is going to exponentially increase the number of hours going to see a typo.
Notes for up falling asleep.What about other factors?Dorado is other things that you think of, when I type of hair dye, I think there's just a higher expectation of.It's even in the 20 years of my career 20 years ago.Our clients were a lot more, you know, that's alright, something went wrong.
There's no worries.We'll get a new dog versus.Now, there is an expectation of, it's a family member, you're treating it and they are much quicker to get on your case if it's not done perfectly.Oh we feel that way.By the nature, be working because we work in emergency, maybe emergency like they want their their stress, they want their pets fixed, they come to you.
We have fees are higher and that they want resolution.That's finally got to the point where they want to something fixed.Right.Whereas if we said oh, we're not too sure.Go back to your primary bed and they do an x-ray, they see your body, all the sudden like wine.
I went to many Mirchi last night, why then do I think there is an extra layer of I'm thinking this may be for a certain layer of interest in a specific area and patients more litigious, whether they are away that we think they are vote and I'm not sure I certainly have not experienced a lot of it in my career, but certainly I think the fear of it is more, but certainly we talk about it.
More later is more, and it emergency, it's not uncommon.Like our complaint rates are higher than referring beds and yeah, but I've worked in GP as well gee and I wouldn't say it's vastly different at least the fear of it is.I don't perceive it as well as massively different to my GP is one other thing.
I've sorry you go now it's just going to stay golden root.She been, I will take this offline.We'll fight about another fact that if you asking what's changed, I think we the Advent of social media and we all have our Facebook pages and our webpage.And that is another Big Driver of fear because, because Appliance use that I can use as a weapon Even if they don't say it, is this fear of, what are they gonna?
They're gonna badmouth me on social media.I think it's taking me down.I think that adds a lot of stress to the job.There's our I would say there's probably some vets who have suicided over that, that component of it.So fear from social media is social media in and of itself, putting incredible demands on, you know, that an owner can sort of get you on the phone at any time and what an immediate answer, another other aspects.
I mean, certainly that's what we're finding in most of the professions where burnout rates are increasing.Its the 24/7 presence.Not officially, we're not officially on there, but I do think again when you go on the socially then there's a lot of comparison again and Gerard has got a very popular social media accounts and he probably stresses people out because he puts all the good stuff on there and makes us feel it fear not.
Go ahead and I think it's more the threat of its They Don't Really access us and get and expect us to be available on there, but it's more that.Hey, look, if you don't fix this, if you don't give her money back, I'm going to go on social media, right?
It's, it's the use of right?Social media to the detriment of either you or the business.That's the, then you get the interaction with personality style that I was talking about being I represented in the successful professional to be perfectionistic.
The problem with being perfectionistic is often, you just see binary options.So either go left or right or either, this situation is going to work out.It's going to be a disaster.So, I've certainly seen doctors who've had completely false accusations about the surgery or whatever, just go overnight into a suicidal mood.
And I've actually seen suicides as a consequence where they have, Taking this bind review in the world and not being able to recognize that there's always a third option or A fifth or sixth or whatever.So I think again, personality style is probably part of the equation Gordon our business.
There's a question for you wanted a school little while now and it's something you said in that the Sydney because I did a burnout scale, I'm fairly certain.It was the the MBI one, the the Mosley burnout index and I'm really super Keen.To see the burnout scale, the measure that you because it seems more bit more comprehensive or you.
Can we be more calm encompassing like us as veterinarians where we're all over the whole sensitivity specificity thing.So, so should my mind sensitivity, is that if you have burnout, it will pick up that you have burnout.But if you, but the sensitivity is not so low.
So it could be something that is similar to burner but not been at.What are the common things that like not bone?Differential diagnosis here that they would see what your differentials for himself.I'll just respond to the first part of your question.
First of all.So, our measures got 34 items.There are three appendices at the back of the book.The first one is a template of workplace.Stresses that allows people are going through and see what may be, the particular nuances that they're facing and they can be long.
As they can be a toxic bias, they can be conflict with values, blah blah blah blah.Then there's the 34 item measure of Bernard and then thirdly, there's a measured perfectionism to the second part of your question.The most common and full of positive diagnosis would be somebody with a depressive condition as against burnout.
After that would come anxiety.And after that, there may be a whole tale of differing psychological conditions.But again, as I mentioned earlier, any number of physical conditions, could account for it, for instance, On a related topic.
Chronic fatigue syndrome was said to be very high in China, but so is hookworm.Induced emia which will make you meet all the criteria for chronic fatigue syndrome, but it wouldn't be, it wouldn't be the true post-viral CFS.
Yeah, and that's one of the problems.So, again in the book we invite the reader into clinical reasoning approach, The problem with saying going, see your doctor is that most doctors have never had as part of their education, any training on burnout.
How to diagnose it.How to manage it.Okay, I certainly never in my years as a medical student as a trainee and Psychiatry at the decades are being as a psychiatrist never ever had a lecture on burnout.So in a sense we're all a bit in the dark people with burn out here in the dark.
They don't worry.We've got it or they have something else.They go to health.Practitioner, the health practitioner knows a bit about burnout may know something about depression and so on.We try to encourage the reader into a process of clinical reasoning, where they can take, what you can get from a general practitioner, but also employ their own nails to determine whether it's likely.
Yeah, so if when you explain the the quiz of Gordon, it sounds super comprehensive.Does it take three days to fill out?Well, if you're burnt out at my, if you really burnt out, you probably won't get to the end.
That's how you diagnose.I'm sorry, can't do it.Take anybody about one to two minutes.Okay.Oh shit.Okay.Alright, okay.
That's a pretty quick squeeze.I'm just I'm just thinking if you're a practice art and one of your employees comes to you and says son, I think I've burned out how would it go down?If you said, are you sure you don't have a hook worms?Have you checked?I didn't, but I love it.
I love the whole thing of comparison.The clinical science Okay, so we're here we go.Let's talk about.So we should we go prevention or treatment, let's talk about prevention.
So let's say you you do the quiz or you think?Well, if this happened to me earlier this year, I had major changes, we've sold a business started, new jobs, moved into State, trying to start a new business, a hundred things and they were days when I thought.Okay, I'm at my, I'm at my age, I don't think I'm burned out, but I'm really at the edge of I think what I when I can take some of these going to give, if I don't change, what can you change?
What you do, what state?What are the practical steps to go?We are in this career that puts us at risk.We know that.What do we do to rent it?Well, the book has inside out information by that I mean the lived experience of people who've had burnout and what they have found helpful.
And there we got outside in information where we've looked at the mature and we extrapolate we look at how well it informs is.And then we try to join the two worlds together. if you're wanting to prevent burnout, Then the issues would obviously be what are the scenarios that are putting me in a burnout risk.
And they obviously have to do something about work.Whether its formal work or work at home and then you knew insert.Is it?The hours?Is it the demand characteristics of the work?Is it that I'm on my own?
Is it that I've got a toxic environment?You work that out and then you consider, How you may be able to modify that or not?Secondly, you need distressing strategies and they are talking to people exercise.
Yoga, mindfulness meditation as I said before, but in addition, looking at how you live your 24 hours a day?Existence, what time do you go on your computer?What time do?
You turn your phone on.What time.Do you turn them off at night?I made in the book, we have Americans describing how taking a pee for longer than two seconds, drives them crazy.And how, you know, people read bedtime stories to their kids while they're on their emails and their phones at the same time.
So that 24/7 pressure, which can be relentless and can be encouraged, obviously, by multinational corporations that even amongst the professions we've been caught up in it too, as it aspect of prevention, and also an aspect of management if not treatment.
You have to look at all those components and And say, what do I need to cut back?And we've got a wonderful vignette there from Patria, King Patria, King extraordinary, human being who set up Quest For Life organization, where people go, who are dying or people who are dealing with dying relatives or who have cancer or have anxiety have depression, or burnout, and they get great interventions, but trade tells her personal story.
How she had faced all sorts of incredible pressures growing up then she developed cancer was told she'd be dead in a couple of years.She went off and meditated and came back and found the cancer was gone.And then she decided she'd try and save multiple people with multiple conditions at that stage HIV was coming up to being a big epidemic.
She was seeing people from 7 in the morning to 7:00 at night.Not having time to have a glass of water.She was seeing people at night.If there was somebody dying, she'd often go to their home, just to be with him to console them.And on the weekends she was going off and visiting Woods where people were dying of HIV.
And she got burnt out.So she tells the personal story and then she decided how to restructure her life.How do you say that?I shouldn't be doing things to trying to save, everybody.
I've also got to save myself and she reprioritized many objectives.That also takes us into the territory of perfectionism.Because perfectionists always want to have everything, right?Good enough is not good enough.And if you gain to prevent burnout and if you are a perfectionist, then you really do need to see how you should modulate your level of perfectionism.
What everything pasta syndrome?No, I don't think so.I gave I think imposter syndrome or comes from where you have a sense of inferiority.Yeah.And somehow you've written higher on the hierarchy than you think you deserve and you carrying a sort of level of guilt in pasta whatever.
So I don't think there's a correlation there.No.Okay.Because some people will talk about perfectionism being an aspect of impostor syndrome where They feel like is he if they're above where they should be so that they have to know more do more and that they won't do anything until they know enough and then they come perfectionist around that kind of.
Yeah but I think there's another 50% that the other direction where they don't think they're good enough and therefore, they have to work harder and harder.Yeah.So desserts is a strategies that tools.They have, I don't know ways that are more effective at reducing burner.
Like you've talked about like holiday, Sighs mindfulness, yoga relaxing.Drinking 126 wine wines for night that they're all talking to others.Yeah.Okay.But but are they are there which one of those do you know, which ones are better?
Or do you have an idea which ones are better?Or is it?Well, there was a meta-analysis of treatments with burnout and they looked at several hundred papers a held them down to those that met basic criteria, the only 14 studies and basically those studies really weren't sufficient to come to any conclusions K.
So I what we've done is I've mentioned earlier, we value the lived experience.What people with burnout found to be effective and we build that in And then we also have looked at some selected literature.For instance, there was a very interesting book written by Sydney journalist who had burnout and she did mindfulness for a year, and she had a self hooked up to everything.
You could think of measuring cortisol levels brain, MRI all sorts of things and basically over the year, all the structural and functional changes in her brain settled with Annotation mindfulness meditation including the length of her telomeres which were going to dictate her longevity.
So mindfulness meditation looks really good on the other hand.I know people who say it was me crazy and they'll say, well no yoga is better for me mindfulness doesn't fit with my personality but if I got in a golf course, I think I get to a degree of mindfulness there.
I'm completely unaware of anybody on the team.Next me and nature is all around me.So I think that you again have to tweak your personality to the distressing strategy.Again, a key point in the book is not a one-size-fits-all more model, if you look at, go on Google and look up books on Bernhard, you'll see 70 books.
Add the great majority of my written by somebody's had burnt out.And they've got a simple model they drop over it and it comes through as a sort of preaching type statement.Yeah.So I think we've got to say it's a horses for courses model, where you have to factor in, what is possible, what is changeable, where your personality is and then take the best of the wisdom.
So for instance, for decades, I've gone up to Just because I'm no good at treating perfectionists I've never been greatly successful and I go up every couple of years and say to a good psychologist.What are your strategies?And I've never been persuaded over decades but in the book we abstract from to really good u.s. text with practical strategies for handling perfectionism, and then we've asked a Sydney psychologist Rock Ocarina to write his template And for the first time, I say common sense, as to how to manage perfectionism, and it's not too ambitious, it gives people goals that are achievable, how to tweak things, practical strategies.
So, as I say, I think the key thing is to reject a one-size-fits-all model and more except that is horses for courses.So it would be like someone has to try things.They have to try different things.Awards works for them.
It's kind of like like their performance formula.This is their burnouts avoidance formula and absolutely absolutely.And I think that you've got a preamp people feeling with their failures.So if you're a prostitute iser for meditation, you say to a patient or anybody, you must meditate, you must meditate and they find it doesn't work for them or they can't do it.
They're going to feel like a failure.So basically I think it's better to say these are the options Ins.Try one of these first and see if it works for you.If that doesn't try this, then try that.And that's not being nice.I don't think it's being too loose.
I think it's pragmatic and it's practical and it's realistic because some people love mindfulness.Some people can't stand it.Yeah, yeah.I can't stand Hubert but he seems to think that I should be part of its relaxation and burnout strategy.
Gordon, how are you for time?I have one fun.You're okay to cater to get it on.I'd like to go so these are great for prevention and it sounds like for treatment as well.What about when we get to filming a burnout in mind in my head, I look at once.
Something's burnt, it's burnt, you're not getting it back.It, let's say somebody is listening and they are burnt out or all you have a colleague or a friend or an employee, who's burnt out, what are the practical steps?What?Step one do I go to, do I go speak to somebody?
Do I have to quit my job or can I work around?Around and what?How do you how do you handle it?What would be your strategy?Let's start with the first part of your sentence that you sort of see it as a times irreversible.Yeah.If your fire is going out, then you give it a bit more oxygen in a bit more fuel and it will come up again.
If it's gone out you put a match under it and started up again.Hmm.So I guess by that I'm trying to say is I think that there are differing strategies for when you're burning out and also for You're actually burnt out.You have got there are for those too far scenarios for those.
And I should also make another comment when I started all this research.I was more pessimistic about helping people with burnout, then our Studies have revealed, most people with burnout can recover from it.If you get to a stage where absolutely burnt-out, then sometimes people do have to change their life.
So I've seen surgeons who've taken up a totally different career.Some people, it's a matter of, you know, changing moving from the big city becoming, you know, a see changer or whatever.So, sometimes it does require cataclysmic change in people's lives, but that's only actually a small percentage.
The people that do that, and all the literature on, see, She is actually quite Illuminating 80% of people.They do a sea change will say, it's worked out well for me.I have less money, but in fact, quality of life is better.So it's a more optimistic scenario than one might imagine.
And most people are in a stage of burning up where I get difficulties where I get public servants, usually from Canberra, and they're in a department where their boss is, screwing them, and it's toxic and they're reliable, and they're conscientious and they've contacted HR and HR is working for the boss.
Not working for the man and every step they take their being screwed, right, left and Center.And if that game goes on too long, not only are burned out, they're horribly depressed and they end up on a Disability Pension.
And to my mind giving somebody in that situation to Disability, Pension is a metaphor for saying your life is over.So what I try to do in those scenarios is to get them out of the game, the toxic game, tell them to cut their losses, and that's really hard.
If you've got a reliable dutiful Unchanged is person who is generally done a good job and they're being screwed, but in toxic workplaces then I think frequently that is the best strategy.Otherwise it goes, downhill, downhill downhill, so I'm not sure there would be equivalent scenarios in the veterinary science World.
There may be where you have to actually encourage the person to be priced out of the toxic environment.Maybe gets the point that you You are burnt out, then you leave the place where you're at and then go elsewhere and have time out or whatever it may be.
I would say that their environments that peep that some of our profession or e in that are causing them to answer your question Gordon.Absolutely, as the case for many people in our profession unfortunately being in practice owners aren't trained to believe is so they by default often we do end up in It's exactly what I think needs good counseling.
Because sometimes when they get to that cataclysmic stage, they can make a disastrously poor decision whether it's to go on the pension or whether it's to walk out of the place and lose all their entitlements, whether it's to take no job at all.
So good counseling and and you is the counselor being an advocate.So, you know, frequently when I get some of these being screwed in a burnout situation.And the employer start sending me a formal letters.I get back with fairly simple message.
This page, this person has Bernhard, which is entirely due to the work scenario, and I go through ABCD that this person is experiencing, if you genuinely wish to help this person, then you need to do a b c and d.
So I try to get it back to the people who are doing the shafting rather than let the patient be.Constantly sidelined, or denigrated or exposed other?Toxic forces sometimes.
Sometimes I think you need to be an advocate and many times you need to prevent the Safra from making a impetuous decision that they may regret for ever.Yeah man.This is amazing.I'm quite a I'm mindful of your time.
It sounds like your book is going to be something that possibly we all have to read definitely owners and managers of our veterinary clinics need to read.It is there is anything that we've missed for this conversation that you think is important to mention to Peak an interest or a final message to get out there to our listeners.
I think we've covered everything very well but just another practical aspect from the book is that we have a series of resources.At the back of the book and it has apps for just about every contingency that you think would be relevant for Burnout, you know, whether it's for reducing stress, whether it's feeding something, on your phone that will prevent you being harassed.
Whether it's for perfectionism, there's a whole series of these very practical apps.So even though I've argued that technology is infiltrating our existence.Yeah.We're sort of coming back by saying, but also their aspects of technology that can help you out a burner.
Yeah, I often look at that dichotomy going.That's, it's a big part of the problem, but they are some solutions in there as well.Yeah, Gerardo, will you give us the title of the book again?I will definitely put it in the show notes as well.I'll give you the title of the book because I'm currently buying it right now, I'm literally on book, Topia, buying the book.
It's called burnout a guide to identify and burnout and Pathways to Recovery.Hi Gordon.Parker was a guest tonight.That was incredible.That was really pretty good.
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Professor Gordon Parker