Are you heading for burnout? Part 2

We're not done yet with burnout.
In this episode, we're going to expand on it and tell us our best ideas on how to prevent it
and how to get to the point where you can avoid it.
My name is Mike.
It's Yuen.
Welcome to The Imperfect Clinician.
So how do you, for example, distinguish feeling tired and burnout, and when is that trigger,
when is that moment that you say, I've had enough, and when is it true, I've had enough?
Because we often say I've had enough, but we don't actually mean it.
Yeah, I think we need to first rule out medical reasons, you know, whether you have low iron
or low thyroid or whichever reason that might contribute to the tiredness.
But if it's not because of that, usually with tiredness, we have a bit more resilience.
Let's say if we eat better, we sleep more than we can bounce back.
Whereas if it's chronic, where it's ongoing, where we feel continuously tired, doesn't matter how much I sleep,
I am still feeling that.
And then adding on to that, it's very rarely just a singular symptom.
You add on all the symptoms that we talked about previously, for example, a motivation, feeling quite defeated,
feeling quite overwhelmed and all of that.
You are in that state majority of the time.
I think that would be a clear distinction between the feeling tired and feeling burnout.
And you asked whether, when do you think you've had enough?
I think sometimes we say, sometimes I say I've had enough when I'm reacting, like I'm angry or I'm fed up.
Whereas I've had enough, especially from the physical perspective where I don't have the energy to carry on anymore.
That is the stage where you think a red flag.
When you have nothing in your tongue and you have nothing to give.
I think that's a fair point.
I think we often, from tiredness, from stress on a daily basis, we are able to pick it up
and we are able to bounce back with a little bit of care and self-compassion.
We can, you know, we can bounce back and start a new day fresh, but those days can get progressively worse.
And if it's prolonged, then when we can, yeah.
I want to compare burnout to the immunity system or the threshold for burnout.
OK, so you have a certain level of immunity and you are constantly attacked by all sorts of different germs and bacterias and viruses.
And that's when our immune system is able to shake it off, provided those triggers are not exceeding the threshold of our immunity.
If they're exceeding the threshold, if they just peep just above the line, that's when we can become symptomatic.
So that's when you can become poorly.
OK, so I think that there is an analogy to a burnout threshold.
So we have got some sort of barrier, that's the threshold that we can withstand.
And there is plenty of things that are, you know, workload, colleagues, management, whatever it is.
And in most cases, we are able to fend it off, to understand it, we have capacity to recover, to bounce back from that.
However, that threshold, similar to the immunity threshold, we can work on it.
We can make sure that it serves us a bit better.
We can make this empty cup that we have a little bit bigger so that it empties a little bit slower.
When your immunity drops because of you not looking after yourself, for example, properly,
or because of other underlying conditions, sometimes medications,
then there is a bigger chance for those normally, triggers that wouldn't bother us,
that they can become more prominent and they can make us even more poorly or start another infection.
OK, and it's a bit the same with the threshold for burnout.
Sometimes the threshold is quite low because of the situation you're in,
because of how you've been looking after yourself, because of people around you,
like your family and other situations that are not necessarily dependent on you as well.
So there is a way that we can try to boost this level to make sure that the threshold
for becoming poorly in the immune system and becoming poorly in the burnout system,
becoming overwhelmed by the situation, that we can make ourselves better prepared for it.
And surprisingly, some of those things with immunity and burnout are quite similar.
When we look after ourselves in terms of eating well, sleeping well, resting well,
finding time to play, finding time to recover, moving, what else have you got there,
darling, to do for ourselves to make us better organically, somatically?
I would say be kind to yourself in terms of self-talk and what you say to yourself in your head,
and to ensure that you have support system both professionally and personally.
And the other thing would be setting boundaries, so saying no.
Saying no, not just at work, but also from a social perspective where,
no, this is a night where I need to recover or I need to just rest and be, so I'm not going to go out.
The other thing I would say is breathing exercises.
To sum up that thought on how we can stretch this threshold and build it a little bit
so that the burnout is maybe never achieved or maybe we have, you know, like a breathing
bit of air above how we feel.
We need to learn how to say no, to set boundaries, move,
because that keeping us active is going to make our body feel better.
Yeah.
Whether it's exercise, whether it's just going for a walk,
it doesn't have to be where you are completely out of breath.
We have to get those endorphins going.
We need to sleep well, try to make sure we sleep well.
We should nourish our body, make sure that we drink plenty, eat
healthily because that has an impact on how body is going to say thank you to us.
I think also part of it should be reflection.
We should be able to reflect on the day, on situation, on the progress, all the regress,
whatever we are, we have to have a habit of reflecting of the things that have happened
so that we can put it to rest.
Yeah.
It doesn't build up.
Yeah.
It doesn't build up.
Be kind to yourself.
Also in terms of how we, how you talk to yourself.
This is very important.
There is a difference.
We were talking about it in previous episodes.
There is a difference between saying, oh, I'm stupid and I've done the stupid thing.
That there is a huge difference in how you perceive yourself and how your ears are listening
about yourself because you shouldn't put yourself down your brain, your ears and your brain.
Yeah.
Evaluating support system is very important as well in both settings, professionally,
but also personally make sure that you have got the right support at the right time
with the right intensity.
Ewan, are there any quick fixes?
We can have a bad day.
We can feel like, right, this is heading in the direction where I'm going to say I've
had enough.
What can we, can we do something quickly?
Can we increase that threshold quickly?
Breathing exercises, something that you can do regularly in small chunks.
It doesn't have to take 30 minutes when you sit down and meditate, but it can be something
that you incorporate into your daily practice.
And I think creating those daily habits is important.
So trying to do it proactively instead of reactively will have a better impact because
reactive is more short term.
So when you feel unwell, you eat and sleep better.
And you learn how to do it better as well with breathing.
I mean, you know, I thought that through my 40 odd years, I'll be able to have a general
idea of how to breathe, but I'm still learning.
And anyway, how do we breathe?
A few ways, so you can, this is one of the most common one that I say to my patients,
four and five out.
So you count to inhale.
So do it with me.
So inhale and I'll count you in one, two, three, four, and then breathe out in five.
One, two, three, four, five.
Oh my goodness.
I haven't got that much breath.
Can I do three and four?
Yeah, you can do three and four, but essentially you are trying to make your exhalation longer
than your inhale.
So you are activating your parasympathetic nervous system.
So your body is calming down.
Okay.
Should we do it again?
Yep.
So maybe you, the listener can do it with me.
Okay.
Let's learn together.
Come on.
Okay.
Do you want to do four and five?
Yeah, you count four, five.
Yeah.
Let's risk it.
Okay.
Let's have a, you know, phone ready for the ambulance just in case.
Okay.
So inhale one, two, three, two, one.
Inhale one, two, three, four.
Exhale one, two, three, four, five.
So that can be one way of doing it.
Excellent.
And doing it just two, three times just help you reset.
These are little reset.
I think focusing on the breath also takes your mind off things and allows you to reassess,
come back clear to the problem.
On the counting and focusing on the breath.
The other thing that you can do is breathe normally, but you start an internal scan.
So for example, you breathe as usual, but you have your eyes closed.
Both?
Yeah.
Okay.
Gotcha.
And then you focus on your breathing.
Just keep an eye on it.
Don't fall asleep.
New listeners can try do it as well.
Not when you're driving, of course.
And then you focus on relaxing your jaw, focusing on relaxing your shoulders and your arms and
your neck and moving around and you can feel your chest moving up and down, focusing on
the air coming in and out of your nose, focusing on the sounds around you.
I have your calming voice.
That's good.
And then you open your eyes.
So it's like a very quick check in just to see where you are because we tense muscles
up unconsciously.
And unless you have the practice of just closing your eyes and checking that it's helpful for
you to do that.
So these are two of many, many different ways that are available, but I find these two are
quite easy to do on a, you know, if you have 20 seconds.
I felt like I've fainted.
That's my idea of, no, but listen to this.
I felt like it was my idea of fainting.
I don't think I've ever fainted in my life as far as I can remember, but that's how I
feel because fainting is essentially resetting the system.
It's the nature way of, you know, switching off and switching back on because, you know,
you land on the floor that you usually have, you usually faint because of the blood pressure
dropping.
Okay.
Oh, a few other reasons.
There's a few other reasons.
But you know, when you land on the floor, all of a sudden all the vessels and all the
heart and everything else is in the same level and the pressures balance out around the body
and you come back fresh as a daisy.
Will you explain fresh as a daisy as well to our listeners?
I know what you mean.
Fresh as a daisy for those people listening in English countries is fresh as a fresh.
Yeah.
Yeah.
I don't know how else to explain it.
Yeah.
So it's having different ways, whether you're focusing on your breathing and the counting,
to just take you out of it or focusing on how your body's feeling now, relaxing the
muscles that usually are tensing up, you know, eye muscle, jaw muscle, neck muscle, shoulder
muscles, for example.
But you also talk about the feeling the cup.
Can you tell us a little bit more, go back to the feeling the cup?
Because I think it's important in the context of preventing burnout.
Yeah.
And, and I did this the other day and it worked really well.
Now I'll share a little bit more.
So filling in the cup.
So there is a cup where you fill it up before the day takes some of the energy away.
So this is when you feel completely refreshed, rejuvenated, your cup is full and what you
do every single day that fills your cup.
So do things that you enjoy, your daily habits that are really important.
So we talked about moving, eating, sleeping, all of that fills your cup and those little
daily practices, those fill your cup as well.
So making sure you have that.
And I did that the other day with the children because they were upset about who was sending
them to school.
And so I gave them a hug and say, is your cup full or is it half?
And she said half.
So I gave her another hug and I said, is it full now?
She said, no, a little bit more.
And I gave her another.
And then at the end she said, it's full.
And I said, I'll give you another just to give you something extra because some days
can be really hard.
And so this is the first time that I'm doing it.
This is also the first time she then walked out of the door without any cries.
Usually that conversation leads to a cry in terms of who's sending me to school.
I want you to visualize that and be able to fill your own cup with the things that you
surround yourself with and with the things that you are doing, choose to do and how you
speak to yourself.
Because the day can be hard or maybe it's already hard and it doesn't help when you
are draining your own cup by not practicing self-compassion or kind words to yourself.
Wise words, wise words.
Now I'm going to flip it on its head again.
I'm going to ask, can burnout be good?
Because we were talking about it in the concept that it's very destructive and it's a symptom
and it's a effect rather than symptom of things that are going wrong.
So my thinking, I don't know, what are your thoughts on it?
Cause I have thoughts on it.
I am torn.
I'm torn because I feel in some ways I would like to avoid getting to that stage.
So I will do everything that I can, but maybe for some people that is the only way to elicit
change.
Yes.
Sometimes it's this radical moment in life that can lead to change, to revamp the situation
completely.
So you could potentially play the burnout card to your advantage.
Maybe it's the sign from the nature that, you know, sometimes it could be just one time
in a lifetime.
There is this need that you want to scream and shout and you want to rebel from what's
going on around you.
It's usually very difficult to propose a change when you are not at your best self and it
feels like a change that you are forced to do, but it can be a good change.
We could, in some circumstances, I think there is capacity for embracing burnout.
Hopefully it's not going to lead to any mental health problems and long-term effects on the
body and the people around you, but if it's recognized quite early, it might be the sign
at least for some of you.
Maybe for me, I don't know.
I've not reached that point yet.
I think, but I think it could be also an idea for a change.
And you've not reached the point yet because you're trying very hard to do the things that
you enjoy.
Without them, I have a feeling that, like you said, the threshold would be lower, like
for me.
I think I'm trying to do everything I can to look after myself because I think I'm scared
of getting down because of work.
I really enjoy what I'm doing and I'm very passionate about, well, whatever I start doing
and I don't want to lead to the point that I'm going to start hating what I'm doing because
I chose to do whatever, you know, my work, this podcast, for example, because it was
the need from the heart and I don't want, don't want it to defeat me.
I don't want my passion to overwhelm my ability to cope with the stress that it generates.
Agree, and the feeling of dreading to go to work is completely unpleasant.
I don't know.
I think that to some extent, people should be a bit more mobile in terms of their ability
to adapt to a new situation, to change, but I think that we are deep inside the creatures
of our habit and not all of us feel comfortable with, you know, waking up in the morning today,
I'm going to do something else because I couldn't stand what I was doing yesterday.
Because it feels to me like you're still searching.
I mean, you're still on the go for the things that are going to drive you and you're still
looking for your purpose.
Yeah.
And I think change is difficult because we are, like you said, habitual creatures.
But I also want to say that it doesn't mean that once you have found your right balance,
that you don't need to evolve.
And I'll share this with what I was doing before in terms of waking up in the morning,
meditate, and then doing any form of movement practice and then starting work.
And then at the end of the day, stretch, meditate and go back to sleep.
That works for me, but with additional responsibilities and additional roles that I've
taken on, I have to, which really annoys me by the way, because I was just like, I've
got a good system.
Why do I need to change it?
But with time and also with additional roles, I need to evolve and I need to adapt.
So at the moment I'm trying to relearn how to set my boundaries.
I've added walking before starting work in the morning in nature.
And I think nature is always a healer for everyone.
However long that walk is, it's helpful to let me regain my balance.
I might need to do a bit more journaling.
I might need to check in with myself more frequently than before because I have more
on my plate.
And so if you have a good system, great, be prepared to constantly evolve and reconnect
with yourself.
And I think from my perspective, I just, I got a bit complacent with what I've got and
I thought, oh, it works for me with additional things that I take on.
It should work for me again, but it wasn't the case.
So it was a little bit of reflecting and a lot of kindness to myself to say that I will
get back to that equilibrium again.
We are imperfect and we are changing.
And I think that's what makes it exciting, I guess, is that we have to grow to stay level.
We can't slow down.
We have to look for new things that are going to make our cup full again or bigger or filled
with something nicer.
Yeah.
And they always say balance is the hardest thing to do because you, you don't get to
balance and then it stops it.
You constantly trying to juggle and constantly trying to balance.
It's like standing on a piece of wood or a log and you're trying to balance with one
feet.
It requires consistent effort and attention and it changes every day.
And so it's now I've learned to accept that it's a working progress for me.
So try not to get used to.
Okay.
I think that burnout is a big thing for a lot of people and it's very important thing.
It is like being dead when you're alive.
Sometimes it feels, it feels really like you're drowning and there is no help.
I trust there is a lot to do from leadership point of view in the organizations and it
can be done despite the pressures from all around us.
And we need to take part in looking after ourselves to make sure that our burnout threshold
gets us out of the bushes and make sure that we stay on track to balance.
So these last two episodes were our take on burnout.
But what do you think about it?
Have you experienced burnout?
Are you getting to that point or maybe you've been around someone who needed support because
of burnout.
Let us know.
Get in touch on Facebook.
You can search the imperfect clinician and we want to hear from you so we can take this
discussion further because I believe it's not the last time we're going to mention burnout
in our podcast until next week.
Bye bye.
It's about time for Yuen Reads.
In today's Yuen Reads, I am talking about Bessel van der Kolk book called Body Keeps
the Score.
This book was written quite a while back and I felt that he was well ahead of his years
because he was reflecting on what he observed then based on at least 30 years of experience
and looking at what we know now, it is mind boggling because this book, besides helping
people and patients, this was one of the books that unlocked my barrier to explore
trauma from my past.
I weathered past the stress, the anxiety, fears and tears and after that felt liberated
in relief beyond imagination and this is something that I can gauge the difference but people
around me notice that I've changed in every way, the way that I carry myself, the way
that I learn, the way that I progress afterwards.
It feels like the barrier was previously slowing me down and after removing that it's as if
you've got weights on you, ankle weight or a heavy backpack when you're walking.
When you remove them, you finally realise that you are much lighter and you can walk
a lot quicker.
That was I think the closest analogy to how I felt after I've emptied some of my heavy
baggage.
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