Moving past burnout

The Ontario Medical Association’s Prescription Progress Report 2023 has revealed burnout as one of the top issues facing our health-care system, with rising burnout among physicians exacerbated by the pandemic.

We spoke with Dr. Harry Zeit, a Toronto-based physician with a full-time practice in psychotherapy and trauma therapy, to learn more. Dr. Zeit was an emergency department physician in Ontario between 1983 and 2005 before pivoting to individual and group psychotherapy. He also co-facilitated the Caring for Self while Caring for Others series from 2012 to 2019 through the OMA Section on Primary Care Mental Health – then the Section on General Practice Psychotherapy – alongside his partner, Irina Dumitrache. The series focused on creating a space where physicians and other health-care professionals and administrators could discuss the intimate aspects of their work and outside lives.

Dr. Zeit shares his advice on how he coped with burnout in healthy ways and how physicians can identify the symptoms in themselves.

“There are some crucial common factors to identifying burnout, and one of them concerns the principle of embodiment. If you don’t know what’s going on in your body, you’re not going to notice your burnout until you’re very sick. And often, unfortunately, that’s what happens.”

OMA: Describe what you know about physician burnout.

Dr. Zeit: Burnout is very connected to factors involving stress in our environment. Stress can be all kinds of things: inability to care for our patients the way we want to; breakdown of community; expectations; paperwork. And when we don’t have the protective factors of safeguarded time off, the ability to go home and disconnect, a good circle of friends, those kinds of things to keep us in balance, it often leads to burnout.

OMA: How has physician burnout impacted you personally?

Dr. Zeit: I have had ER shifts where I was just so shut down and so tired, and just put one foot in front of another. I definitely got very tired towards the end, working in emergency medicine. The system was changing and because of those changes, we weren’t able to continue providing people with the same level of care as before. That impacted me in terms of my sleep quality, my relationship quality, the things I wanted to do, the level of stimulation I needed to engage myself. I’m very fortunate that, because of where I was going in life, I caught burnout early and chose the right interventions for me. Unfortunately, in the physician world, many people don’t identify it until quite late, when there’s already other issues like addiction or family discord, and so forth.

I caught myself early partly, I think, because I had a good group of friends who gave me great feedback. But most importantly, I had started doing a lot of yoga, which very much brought me into my body. But there was still a long way to go because I felt, in many ways, that I didn’t know myself as much as I wanted to. I started going to retreat centres once or twice a year, starting around my 40th birthday. I started to drift from being involved solely in yoga to being involved more in personal growth, in psychotherapy. I also signed up, during those years while I was still in the emergency department, for a one-year psychotherapy training.

OMA: Tell me about moral distress and how it’s different from burnout.

Dr. Zeit: The term moral injury comes from American psychiatrist Jonathan Shay, who worked with Vietnam veterans. He defined moral injury as being a soul injury which originated in the failure of leaders to act with integrity in a high-stakes situation. The term has expanded in the meantime and in medicine we’ve lost some of that important foundational definition and now focus more on the pain of being unable to provide the care we feel morally obliged and trained to provide.

At its heart, Shay described moral injury as having betrayal at its core. It is a deep wound of the soul. The outcome of moral injury is corruption because sufferers no longer believe that their leaders or the system have their best interests or the best interests of those in their care at heart. This is different from burnout in the sense that burned-out people start off angry and reactive and gradually become more detached, indifferent and then shut down.

Moral injury, burnout, traumatic stress, shame-based injury and so forth exist within a dense web of psychological, spiritual and physiologic derangements. Because all these conditions create isolation, we need to create spaces where sharing – at a level where the soul can recover and people can feel witnessed, heard and safe – can occur. There is some reassurance in knowing you’re not alone, that you’re not crazy, that a lot of this is just your nervous system being your nervous system.

OMA: How can physicians identify and begin to address burnout in themselves?

Dr. Zeit: There are some crucial common factors to identifying burnout, and one of them concerns the principle of embodiment. If you don’t know what’s going on in your body, you’re not going to notice your burnout until you’re very sick. And often, unfortunately, that’s what happens. Sometimes people don’t present until their marriage is falling apart, or they’re having major issues with their children or they’re developing an addiction or have already developed an addiction. Once we recognize symptoms, we also need a sense of safety, a place where we’re relaxed and breathing easily, tend to be very collaborative, draw a lot of connection from people and where it’s easy to emotionally relate back and forth. We want to establish that inner sense of safety, first and foremost. And as well, we need to experience safety and trust at a social level. We need a sense of community, and that means just having people we can meet with in person who get us, who we can spend time with.

OMA: How can the system improve for physicians?

Dr. Zeit: Based on my experience, we need to create more intentional community. Safe places that invite connection and authenticity and closeness that are available to all physicians and to create the opportunity for genuine dialogue and witnessing between leadership and the many thousands of physicians working every day to make the system work, many of whom do not have a voice.

I also believe that if we could universally adopt a trauma-informed care approach, not in a performative manner, but in an honest one that upholds the basic principles of the model, we would have a much healthier and engaged health-care system. To achieve the goal of community and a trauma-informed physician environment certainly won’t come easily. It will take effort and courage.

This interview has been condensed for length.

Jessica Smith is a staff writer with the OMA.