Dentists aren’t a happy bunch. Almost half say work stress is exceeding their ability to cope and nearly a fifth admit they have seriously thought about committing suicide, according to BDA survey published in January. What’s going so wrong? We interviewed Dr Sonia Hutton-Taylor, former eye surgeon and founder of Burnout Geese, an online learning and support service for medics and others struggling with burnout, to find out.
Sonia, what is burnout?
It’s a psychological and physiological state that comes from ignoring long term stress. Stress and burnout are closely interrelated: stress can be good and it increases performance in some respects, but at excessive levels over a long time it causes performance to drop off considerably. Everybody likes to blame their workplace, culture and country, but it’s a global problem. The factors include your work, your personality and lifestyle, but there are wider issues too such as smartphones making it harder to turn off and destress. When you are suffering burnout you are completely and utterly mentally and physically exhausted. You become cynical and lack engagement at work. In your social life, you drop your hobbies, and you become resistant to change and start to feel that you’re not achieving anything and there’s no point to anything you do. Some psychiatrists say burnout is depression. I think it’s more of a psychological and life condition.
The recent BDA survey of 2,000+ dentists suggests at least a quarter of dentists have burnout. It’s been claimed to be 40% in GPs and as high as 90% in the legal profession. It depends on the type of report you’re looking at and how the studies are conducted as to the precise figures quoted but it is true to say that there are appalling levels in many industries.
Why does burnout seem to be on the rise?
I think we live in a culture where it’s “do more with less, get less, feel less”. Owners of SMEs want control of their own time but they often get less and less, until they start to feel numb. In terms of the big picture, this is affecting everyone, even students, and now research is coming back from the developing world showing burnout is happening there too.
If your cup is empty you have to fill it, and if you’re only draining it you are going to be a shell at some point — people do describe feeling like empty vessels. It’s about recharging the batteries. Downtime is getting cut back in many professions. I’ve had a lot of conversations with private and state head teachers, and their problems are almost identical. In dentistry the pressures are similar in NHS and private. The most common sources of stress found in the BDA survey related to threat of litigation (79%), dissatisfied patients (75.1%) and concern about the GDC (72.8%) but each profession has its own cocktail.
What’s your advice for preventing burnout?
The good news is it’s completely preventable, reversible and curable. Not dealing with it has potentially huge financial implications such as selling your practice, splitting up with a partner who has had enough of your burnout behaviour, or a year of psychotherapy. The cost of addressing burnout on the other hand is irrelevant in the face of these huge losses. Not just the financial ones but costs to your mental health, physical health, life satisfaction and career. Burnout for you or one of your team members means your staff turnover can rise… with more financial implications: you lose people, there will be early retirements and prolonged sickness absences too. You’ll be working in a dysfunctional environment and profits will be affected.
It’s not ethical or helpful to attempt to give someone guidance when they have burnout, because they’re thinking in the wrong way. They need to get out of that first by talking to someone and accepting their predicament. There are four steps to recovery: talk to someone, learn about burnout, see your GP, make time for a plan to beat burnout. I have a system where I ask my clients to first of all watch a four minute video on our homepage. If they can’t do that there’s something very serious going on. Then I ask them to join my free starter kit. I’m pacing them very gently.
I believe a lot of advice about tackling burnout is well meaning but has started to take on a lay approach, for instance there are lots of articles on the internet, written by journalists, that say things like: “Make sure you get a good night’s sleep.” Yet one of the consequences of burnout is lack of sleep. So to tell someone who hasn’t slept well in months or years to sleep better merely compounds their sense of desperation. They can’t, their physiology has changed.
The first step for addressing burnout is the hardest: admitting you have a problem. Until you’ve accepted it you can’t improve the situation. Visiting your GP is a really important step, even if they don’t have a lot to offer. Burnout can be masked by or coexist with other conditions like thyroid problems, myalgic encephalitis and depression, so it’s important to have these excluded.
It’s important to talk to someone who isn’t judgmental and can just listen. Facing up to it is a big step, whether that means booking that first appointment with a therapist or opening up with a best friend. Talking to your spouse or parents might be too much. They may be too close and want to interfere and exert pressure, whereas someone further away will be more objective. One thing suggested in the BDA survey and by the BDJ is that a service is set up for GDPs similar to the practitioner health programme for GPs. I think a psychotherapeutic service like this to pick people up at the far end of burnout would be great, however it’s too little too late. In my view we should also look at prevention and earlier intervention.
Raising awareness is the way we can take this forward, and that’s the approach I’m taking. If someone you know might be suffering from burnout you can encourage them to talk about it, but even if they won’t you can go to Burnout Geese to learn about it yourself and understand more about how difficult it is for your colleague or spouse. The catch 22 is when someone is clearly ill, so they are not yet in a place to be able to learn about burnout, yet they’re still going to work. In that case if the people around them understand what is happening it can really help.
Why did you choose the name Burnout Geese?
The name comes from an experience I had with Medical Forum, a careers advice service I set up 30 years ago. A GP called Chris Manning was concerned about stress among GPs and created a self help group which I worked with, and one evening he produced a drawing of geese flying. They fly in a v, so the tired geese can move to the back where there is less wind resistance. If a goose wants a break or feed, two of the other geese will drop down and wait with it. I kept this drawing in my filing cabinet for 30 years because it struck me how we don’t help each other in the caring professions, yet a simple goose does better. Burnout Geese launched last year.
What’s your story?
I was an eye surgeon but gave it up in my late 20s because I felt I wasn’t well suited to the role, so having jumped through an awful lot of career hoops including FRCS I walked away. I felt angry because I had received £250k of training yet no one from the NHS asked me where I was going, so I got a bit fired up and set up my first company Medical Forum. It gives career advice to doctors and dentists at any age. I’ve seen thousands of people over the years who I think, looking back, had burnout. Back then the word “stress” was used. Around 40% or 50% of my client base now has burnout, so I’ve designed courses to help people face up to the fact they have it. Clinicians often say “I don’t have burnout”. There’s denial and resistance because people don’t want to let the side down, and they don’t want to face the issues behind the burnout. To anyone who thinks they may have burnout, watch the four minute video, ideally with a friend, or just tell someone you trust how you feel. But do something. Don’t just keep suffering.
