In this episode, NPS MedicineWise medical advisor Dr Caroline West speaks with Associate Professor Lisa Lampe about burn out and the high cost for health professionals and patients.
Further reading
Boundaries Research www.boundariesresearch.com.au
Dr. Caroline West:
Hello, and welcome. I'm Dr. Caroline West. I'm a GP and medical advisor for NPS MedicineWise. Around the world, health professionals are facing increasing demands on their time. Many chose medicine to help others, but somewhere along the way, exhaustion, disconnection, a feeling of a lack of accomplishment can creep in. Burnout is a global issue for health professionals with reports coming in from India to the UK and the USA. Not only is the cost high for the health professional with increased risk of depression and suicide, but patients can suffer too. Burnt out health professionals can make more mistakes, prescribe the wrong medications or doses and fail to arrange follow up. So what can we do to turn this around? Joining us today is Associate Professor Lisa Lampe, who's a psychiatrist working at the school of medicine and public health at the University of Newcastle. Lisa has a special interest in burnout and is researching the role that boundaries play in the mix. Her research is sponsored by the Avant Foundation. Thanks for being with us today, Lisa.
Prof. Lisa Lampe:
Pleasure, Caroline. Thanks for having me along.
Dr. Caroline West:
Look, this is a fascinating topic. Can we just start off with the basics though, perhaps. What exactly is burnout?
Prof. Lisa Lampe:
That's an interesting question because people don't entirely agree universally on what it is, but I think it's pretty generally accepted that it arises in the context of prolonged and chronic work stress of some sort. And it has a number of dimensions, one being exhaustion, which can be both physical or all of physical, emotional and indeed even cognitive, something that used to be called depersonalization, but is really now probably better thought of as an emotional detachment, cynicism about the whole job and maybe the organization the person works for. And the third component is a sense of ineffectiveness or lack of accomplishment. So it's quite a complex syndrome.
Dr. Caroline West:
And as a health professional, would you be aware that you are actually suffering from burnout or is it one of those things that just creeps in gradually?
Prof. Lisa Lampe:
I think it almost certainly creeps in for most people, and you can be experiencing one dimension more than another, which might also make it hard to recognize that perhaps you are actually now suffering from burnout. And a further complicating factor is that for doctors particularly, but I think probably for all health professionals, there's a culture of keep going, no matter what. So people are reluctant to acknowledge that they're not managing very well and indeed might even see it as a kind of weakness. So I think probably most health professionals are now aware of burnout as a concept, but I'm not sure that they as readily make the connection with themselves personally.
Dr. Caroline West:
And sometimes the scene is set during the training process, isn't it? If you look at the culture of health and you look at the way that junior practitioners, I'm thinking of junior doctors in particular, are overwhelmed often with the responsibilities at hand and the lack of support, I guess it's not a surprise that they in particular are very vulnerable to burnout.
Prof. Lisa Lampe:
Well, indeed it starts in medical school. There's been a number of studies that have actually shown that burnout is identifiable in medical school. And you've probably heard the term hidden curriculum, and that refers to all the things that aren't necessarily explicitly taught, but that we learn from our mentors and supervisors. So that includes that culture of work until you drop, go the extra mile, put yourself last. So medical students are learning that. They are actually manifesting higher rates of burnout already as medical school progresses. And then that can reach very high levels in the intern year and indeed in specialist training.
Dr. Caroline West:
I think my first year as a doctor was probably the roughest I've ever had in that the rosters were just crazy and I just felt as though I didn't really know anything and I was so exhausted because I was often doing night shift and then nobody turned up for the next shift so you do another shift. And I found it possibly the most challenging year of my professional life and I just felt so alone as well. It's fairly alarming to think that the culture hasn't shifted enormously and that junior doctors are still exposed to such a sort of onslaught.
Prof. Lisa Lampe:
Well, I know. Some things have improved. I mean, you'd think that awareness has improved and the need for support has improved, but Simon Willcock, who is a prominent Australian researcher in this field who's been researching this field for least 15 years, I think, in an editorial not that many years ago in 2018 in The Medical Journal of Australia noted that we really still haven't made any significant inroads on the stress that's associated with internship. And I'd agree with you. I think it was probably the worst year of my career as well.
Dr. Caroline West:
And so do we know the numbers of doctors and other health professionals, do we understand that the numbers are going up in terms of burnout?
Prof. Lisa Lampe:
Yes. It looks like the numbers are going up. There's a few studies that have repeated burnout measures, like the Maslach Burnout Inventory at two different time periods that have shown some increase in the prevalence of burnout symptoms, and that was pre-COVID. All the research that I've seen suggests that during COVID, those rates have really gone up significantly once again.
Dr. Caroline West:
Well, COVID has challenged everybody in the community, but frontline workers in particular had to bear the brunt of just, I guess, a pandemic that was seemingly... Well, it was a very scary time and we didn't really know what the outcomes were going to be. We had a group of people in the community who were fearful, anxious, often angry, and you had to wade your way through that.
Prof. Lisa Lampe:
Yes, I think that's very relevant because there is some research that links higher emotional expression from patients, expression of negative emotions like anxiety, depression, anger with higher rates of burnout. So yes, doctors at the frontline were also dealing with patients who were probably experiencing a lot more emotional turmoil than usual. And I guess the other factor to remember is it's been fairly unremitting for more than two years now. So there's sort of been no real let up in the demand, both emotionally and physically.
Dr. Caroline West:
And the interesting thing with the introduction of telehealth and access at all times is that that's been fantastic and very welcomed, but at the same time, it means it's harder to switch off as a clinician because you can always do one more consultation or you could always check one more batch of pathology. It's really hard to draw a line at the end of the day and say, oh, my work is done, I'm going home, especially when your mobile device has everything diverted to it.
Prof. Lisa Lampe:
Yes, indeed. I mean, it's much more difficult. And I would add that if you are trying to do clinical consultations by telehealth, there is an additional level of stress that's associated with that because you don't get all the usual cues that you would and there's also some research showing that it generates a reasonable amount of anxiety in both the clinician and the patient about whether the technology is actually going to work. So there's all these extra layers of stress.
Dr. Caroline West:
And if we look at the bigger picture in terms of, I guess from the clinician side of things, does personality of the health professional play into how they manage stress and how at risk they are for burnout?
Prof. Lisa Lampe:
Yes. I mean, personality is known to be a very relevant factor, not just for burnout, but really for emotional wellbeing, and it indeed to some extent actually, physical health as well. So we've known for a long time that if you look at the five factor model sometimes called the big five, which looks at what probably as doctors, we might think of more as temperament rather than personality. So these are factors that have a fairly strong genetic contribution to them and we all have a point on each of these factors where we sit, if you like. So it's a spectrum. And we know the people that are constitutionally or temperamentally high in emotional reactivity are more prone to anxiety and depression. We know that people that are higher on extroversion tend to be more resilient. So extroversion is actually a protective factor as is lower levels of emotional reactivity. So not un-reactivity, which is not ideal either, but not being prone to get depressed and anxious about things, if that makes some sense.
Dr. Caroline West:
Yeah, it does. It's a really interesting point. What about people that are perfectionistic? Because I guess there's this sense that a lot of health professionals are actually quite obsessive with their work and they're perfectionistic, which leads to good outcomes because they always want to make sure everything's done, but there's probably a flip side to that as well.
Prof. Lisa Lampe:
Well, again, perfectionism is one of those personality traits that we know can predispose to more stress, but also more anxiety and more depression. So again, not specific to burnout, but certainly a factor. I mean, one good thing about a trait like perfectionism, it is modifiable. You can learn to be, as Donald Wincott said, good enough rather than perfect. But when you are for perfectionism, because it's essentially unattainable, it's almost like having a series of little failures every day, which can be quite demoralizing. So being too obsessional, being over conscientious, being perfectionistic, it's all those extremes of the spectrum. So remember, there's kind of a spectrum of where we all sit, but those extremes tend to be unhelpful.
Dr. Caroline West:
I really like that expression, Lisa. Good enough. That's something I think that all of us could do with taking on board. And if we look at actually what the cost is for a health professional, I mean, is burnout something that we can just sort of shrug off and go, okay, well, this is just the price of dealing with the health system and dealing with patients and all of the complexities that exist, or what is the downside? Do we need to think about this in terms of actually, this has very consequences? Where do we sit with our thinking?
Prof. Lisa Lampe:
Well, we really do need to take it seriously. In fact, it's been described as a crisis in some reports because it can have really a number of flow on consequences. I mean, firstly, the individual. There's associations with depression, anxiety and suicidal thinking. So that's a big cost. It's also, some aspects of burnout are particularly associated with giving away your medical career, deciding that it's all too hard and dropping out. And that is potentially a great loss for the individual, but also for society because educating doctors is expensive. Yes, I know people pay fees to study, but it only covers a proportion. And also there is a limit to the number of doctors that can be trained. So every doctor that takes place as a medical student, that's one less we can train. And if they're dropping out prematurely, then we're not going to keep up with demand. So that's a problem for the whole of society. Other consequences you've mentioned, there are greater risks of errors, errors in decision making, which includes prescribing, but keeping records. And I guess quite apart from the risk of medical error, the patient experience is suboptimal. Rather than experiencing that engagement and that sense that the doctor is totally focused on them and their individual needs, it can be a very unsatisfying consultation where they're perhaps not sure that their specific needs were taken into account or they didn't feel like they had the doctor's full attention. So that can have a number of consequences. Patients can become disgruntled and put in complaints, but of course at the same time, they can have a bad experience of that medical consultation, which might make them reluctant to seek the follow up care that they need. So I think we recognize that the consequences are serious, but the problem is we don't seem to have come very far in solutions.
Dr. Caroline West:
Yeah. We'll come to that because I think that that's something that everybody's curious to know about, what can we do to start to spin this around? I mean, you've talked about how there can be serious consequences for the individual and then also that the patient really senses that there's not a great therapeutic alliance happening there. I mean, they're very clued into understanding that their practitioner has compassion fatigue. I think there are plenty of cues that you give off when you've just got nothing left in the tank. And the other thing that I think is interesting from a practitioner's point of view is that the knock on can be that people self soothe with things like drugs and alcohol, relationships fall apart. There's a social consequence and a context that extends beyond the the workday.
Prof. Lisa Lampe:
Oh, indeed. Can take a very heavy toll in relationships and as you say, in risk of using substances as well. So yeah, that's right. There's a lot of additional costs.
Dr. Caroline West:
And you mentioned about mistakes are made and NPS MedicineWise obviously has a very strong interest in the quality use of medicines. And I know that burnt out doctors are way more likely to just prescribe the wrong stuff, give the wrong doses, not follow up on pathology. I remember working with a colleague a long time ago, and I always knew when they were struggling because their in tray would just start to overflow. You procrastinate, you think, oh, I just can't get around to writing those medical reports. You just put things off again and again and the tsunami of paperwork just gets on top of you. And it's quite a horrible feeling to feel as though you're sinking underneath the weight of all of these extra bits of red tape and...
Prof. Lisa Lampe:
Well, indeed. And in fact, there's a recent study that has nominated the increase in bureaucracy around the practice of medicine as actually quite an important contributor to burnout, which is interesting. So particularly I think in the United States where there's an awful lot of scrutiny or patient satisfaction, and that can actually have reimbursement consequences for doctors, but also the advent of the electronic medical record. These are all things that take more time. And actually that time tends to come at the expense of the interaction with the patient. So the patient is less happy and really the doctor is less happy because most of us went into medicine because we like the interpersonal aspect of helping people and working with patients.
Dr. Caroline West:
I'm really interested in your area of research, Lisa, because you're looking at burnout, but you're also looking at this very fascinating realm of boundaries and where it fits into the picture. Can you take me through what you are exploring there?
Prof. Lisa Lampe:
Yeah. So we decided to look at boundaries as a probably under-recognized contributor to burnout. And indeed there's a couple of studies that have sort of said, this is kind of one of the pieces that hasn't been identified in terms of relevant factors for burnout. Now, all health professionals and even our medical students are aware of the big ticket boundary violation items, as I call them, things like sexual relationships with your patient, financial exploitation. It's a rare occurrence. Very few doctors are going to violate those sorts of boundaries, but what I think flies under the radar a lot and what we don't really get any explicit training in is more subtle kind of boundary challenges, I call them. And often they're not recognized as being relevant to our professional boundary. So what is the professional boundary? Well, it's been defined as the kind of edge of appropriate clinical care. And I guess the guideline is, is this interaction I'm having with the patient required as part of their treatment? So if I'm making contact with them, if we're having a meeting, is this all confined to my role in providing medical care and advice to them. And stepping outside of that role represents a potential boundary crossing. Now, a boundary violation is by definition harmful to the patient, but a boundary crossing may not necessarily cause harm. Why would we worry about it? Well, because many authors now really have described a slippery slope that if I become more comfortable about crossing professional boundaries, so crossing into having a bit of a social relationship with a patient in person or on social media or something that is starting to cross the therapeutic line, then that could start to lower my threshold for other types of boundary crossings that could put the patient at risk. But the other type of boundary crossing occurs, actually not with patients. These are things like corridor consultations, requests for advice from medical or non-medical colleagues, or requests from non-medical colleagues for a script to tide them over. Things that probably do make us a bit uncomfortable and can be a bit challenging to manage, but not something that probably rings alarm bells for us and certainly not something that we actually get much training on. So I'm particularly interested, my team and I, we're particularly interested in the cumulative effect of all these little boundary challenges that we think are probably quite frequent and the kind of interpersonal stress of having to negotiate these challenges could be a contributor to burnout.
Dr. Caroline West:
I mean, I think that most health professionals would've had that experience of being asked to write a script. I was approached by somebody just yesterday. He said, "Oh, have you got your script pad with you? Could you just do me this script?" And it was like, "Well, no. You actually need to see your GP." But they can be awkward conversations to have because the expectation is, oh, well, there's no skin off your nose to just quickly do this favor for me and people can have quite a strong response to you declining that and explaining, look, you really need to have it documented, you need to be examined and it needs to be done properly. And people often don't respond to that as you'd like and then you have to sort of put up with that sort of emotional feedback, which is tense and some people can even get a bit miffed.
Prof. Lisa Lampe:
Exactly, right. And as you said, I mean, this happened to you quite recently. These things, we think they're very frequent indeed. And within, there's actually a whole range of different types of boundary challenges that happen. So clinical favors, being asked to maybe step outside your clinical role a bit and do something that is changing the nature of the relationship. Those sorts of things can really be quite challenging to negotiate. And we can fall into boundary challenges in other ways too. And this comes out of what we were talking about before, the desire to kind of help people and go the extra mile. We can find ourselves kind of unwittingly getting painted into the corner of making somebody a special patient or a VIP because we feel sorry for them or their circumstances, or we over identify with them because they're a medical student or a busy colleague, and we might do things that are outside our usual practice. So we have a consultation, but we do it after hours or we do it in a cafe near the hospital or the practice because it's more convenient. And if you actually do that, it is a kind of a boundary crossing, in fact. So it raises the potential for harm. Now, the harm might not just be to the patient because as our medical legal insurers have pointed out repeatedly in a lot of their educational material, there's also the potential that that can be misconstrued by observers. Why are you meeting this person in this setting? What's going on here? Are you grooming them? Is there some sort of special relationship? So the other aspect of it is there is some research to suggest that we start to make less objective decisions when we treat people as special patients. And of course, that's one of the recognized risks sometimes of dealing with medical colleagues as patients, not that there's anything wrong in doing that. I mean, we have to treat each other, but we need to be particularly careful to keep it very clinical so that we maintain our objectivity.
Dr. Caroline West:
Yeah. So basically you're saying that there are harms potentially to the patient, there are harms to that individual as well, the individual practitioner. And then sort of pulling that back to burnout, what you are saying if I'm hearing you right, is that these boundary crossings repeatedly incurred lead to, I guess, an emotional exhaustion or you're constantly having to expend all of this energy and you're more at risk of burnout. What's the sort of link back there with the burnout?
Prof. Lisa Lampe:
Well, we think it's actually the managing of the challenges. So not so much the crossing itself necessarily. The crossing may exposure to harm. And of course, that can be stressful depending on what happens, what the consequences are, but actually deciding what to do in that situation, it is actually quite stressful. So the thing with burnout is we know that, I guess what's particular about burnout is it's really been described in context where there's a lot of interpersonal interaction, which is why it's so common in health professionals. So it's the interpersonal stress associated with having to decide how to respond to that request or how to deal with that situation, where you are feeling particularly sorry for somebody and motivated to try to do at me a little extra for them, but you know that that would be crossing the boundary. So you have to actually manage your own kind of emotional disappointment or maybe even a sense of guilt that you should be doing more or you want to do more. So that's where we think the stress and therefore the relationship with burn out is coming in the stress that is caused by having to negotiate or find a way to manage these interpersonal stresses.
Dr. Caroline West:
Can we go to sort of a practical end for this and really explore some of the language that we could possibly use around this? So obviously, training would help us all if we at medical school were primed with the sense that you are going to have these difficult conversations, how are you going to navigate those? But if I just throw a couple of examples at you, Lisa, maybe you could give us some language around how we could start to think about it. So say you're approached by somebody for a script. I mean, the one I get often asked is, oh, can you just give me an antibiotic script? I've got a cough. This is somebody that I'd never normally see. They might be somebody in a local exercise group, somebody that I barely know. They're certainly not a patient, but they expect that I'll be able to deliver this for them. What would you say in that instance where somebody says, can you just give me this script?
Prof. Lisa Lampe:
Well, unfortunately there is probably not a solution that is going to have a totally happy ending, because as you said, there is probably a mismatch between expectations and what is reasonable to provide, because the wider implications of supplying a script are not appreciated by that individual. So I've seen various recommendations in the literature from just saying, look, sorry, but our code of conduct doesn't allow us to do that, versus actually trying to explain why you're not comfortable doing that. I suspect that no matter what answer you give, when it's a no, most people are not going to be very happy about it. And you see, that's part of the reason why it's stressful, because it's a bit of a lose, lose situation dealing with those things. Depending on how potentially inappropriate the request is, some authors suggest not just hiding behind the, it's against the rules, because that could sort of imply that if the rules were different, you would do it, rather than the fact that you agree that the rules are there for a reason and that reason is to protect both patients and doctors. But you see, to me, context is quite important. If is asking you something that is asking you to cross a boundary and you are sitting in your office and you've got a bit of time and private space to engage in a discussion around that, that's one thing, but somebody coming up to you after your aerobics class in a busy corridor, I think that's a different context that may call for a different response. And maybe that's where the, it's against the rules, response is actually a lot more convenient.
Dr. Caroline West:
Yeah. I've found since I've sort of held firm with having those boundaries, that it's made it easier to be consistent. I think part of the stress used to creep in for me when I had to sort of make the call on an individual basis about the merits of the argument that was being put forward about how I could help somebody out. And it's been much easier since I've just had a blanket, actually I don't prescribe scripts. I'll do it for patients in the context of consultation and I will document a consultation. So there's a record of what's happened and what medication you were given in case there's an issue. And that makes me more comfortable, but it's taken me quite a few years of medicine to get to that point where I can do it, and it still can be uncomfortable at times, but I feel a lot safer feeling that I'm constantly sticking to guidelines that I've put in place around boundaries.
Prof. Lisa Lampe:
Yes. And as you say, you've rehearsed it. You've done it enough times now that it actually comes much more readily and more easily to you. And we were talking before about initiatives that might help. And certainly some of the initiatives that have been trialed have been role play based. Providing scenarios, so for example, there's some studies where they provide short video snippets of interactions that then stimulate discussion, because the other thing about it is it's not black and white, particularly these more subtle boundary challenges. They often have complexities and contextual factors. So the chance to have some discussion around it and potentially do role play, which rehearses a response that you might make, all those things are really useful. But I think your experience really does illustrate that something that you do consistently and repeatedly gets a lot easier to do and you feel more comfortable doing it as well.
Dr. Caroline West:
And so just on the question of boundaries, another area that I wanted to dip into to was really how you maintain boundaries when you live possibly in a rural or remote area with a very small community. I've been working in remote parts of Australia through the COVID times and some of the towns I've been in have had as few as seven people in them. Everybody knows everybody and it's kind of hard to sometimes have as boundaries in place because in a small country town, you might be on the sports team with some of your patients, you might have family members that are all intermingling. So how do you manage boundaries when you live in a very small community?
Prof. Lisa Lampe:
Yes. I mean, that's a really important point and there's quite lot of recent that's been done in Australia on this actually. And I guess it's managed in a number of ways. First of all, practitioners that practice rurally and remotely recognize that it's just not possible to maintain as strict boundaries as is possible to do in larger metropolitan areas. So in practice, there tends to be a greater tolerance for having what's called dual relationships or multiple relationships, i.e, I'm someone's doctor, but I also sit on the PNC with them and we're both a member of a network club or whatever it might be. And when rural health practitioners are interviewed about this, they generally have developed some strategies around it. So they might actually have a fairly clearly articulated policy that they can share with people about how they're going to manage that. They might have a policy that varies a little bit from patient to patient on how those dual relationships will be managed. And not forgetting that a lot of patients manage it themselves by not seeing the local doctor about some particular issues. We know, for example, particularly when it comes to psychological health, a lot of people are not that comfortable seeing the town doctor that they also in the supermarket and their kids go to the same school and whatnot. So it's a more challenging situation and the smaller the area, the greater the likelihood that you are going to have these multiple relationships, but it sounds like both the local population and the doctors that practice in those areas and indeed psychologists, because there's been some studies done of psychologists as well, find pragmatic solutions to try to manage those boundaries, but also tolerate a little bit more boundary crossing.
Dr. Caroline West:
And so how can we do better on this? Do you have a sense of a map we could be following that would improve the situation?
Prof. Lisa Lampe:
I think what always makes complex and ambiguous situations a little bit more comfortable to manage is some advanced warning of them. If we are confronted with situations that we never anticipated, then we end up having to think on our feet. And that's stressful and it might not lead to optimal ways of managing them. Although, as I mentioned before, I think it's important to bear in mind that some of these boundary challenges are just inherently uncomfortable and there's no solution that leaves everybody feeling happy and comfortable. But the more we've thought about them in advance, the more we've developed some policies around how we're going to manage them. And ideally, I think we've had a bit of a chance to maybe practice saying some of those things, then that all is going to make it easy. So easier, not easy. So I think there's definitely an initiative around education, but it needs to be education that's meaningful, probably not just going to a lecture on it. At the University of Newcastle, our medical students do an MD research project now, which actually goes over two years. They spend the first year planning a project and the second year implementing it. And a group of students that I supervised chose to explore awareness of boundaries in medical students. And they compared first years, third years and final year, fifth year students in terms of their kind of confidence about managing certain situations that were portrayed in scenarios and also their views about whether it represent boundary crossings or not. But they also asked students, what kind of educational initiatives would you find useful? And a lot of the feedback they got from that project was this sort of thing would be really helpful, present scenarios and give us a chance to talk through them and discuss them. In fact, an interesting scenario that they portrayed was having a senior consultant ask a medical student to run an errand for them. And it was very interesting that none of the students in the study identified that as a boundary crossing on the part of the consultant. They varied in whether they would agree to run the errand or not. And the first years were more likely to agree to do it or said they were more likely to agree to do it than the fifth years, but nobody sort of said, well, this is not something I should be asked. So I thought that was quite significant in itself.
Dr. Caroline West:
That's really fascinating. You've had a very interesting work life. You've worked as a psychiatrist. Now you're working as a researcher at university. Do you have any things that you've learned along the way that have helped you on a personal level with preventing burnout or managing it or surviving a career in health and enjoying it?
Prof. Lisa Lampe:
Yeah. Look, I think self-awareness is probably the most important thing because if I'm not aware that I'm getting burn out, I can't do anything about it. And then there's the risk that it will get worse. There's certainly associations with depression. So I think good self-awareness has been helpful and then really taking a problem solving approach. The thing that is wonderful about a medical career is you really don't have to leave it. You can take a different direction. I took a different direction. I was doing fairly full-time clinical practice, both public and private, and I changed direction. And I had a break and I thought about things, and then I actually took on a full-time academic role, which was partly based on a long-term love of teaching, but also a feeling that I was feeling a little bit burnt out and I needed to change direction. The other thing that I think has driven my interest in this research is I hope the humility to acknowledge that I have not always managed boundary challenges well myself. I have found them stressful, and I certainly think that there are times when I didn't manage them in a way that was probably optimal for either myself or the patient. So I think perhaps personally thinking, gosh, it would've been nice to have had a bit more education about this, that might have made it easier is one of the drivers. And I think clinical research is often driven by our own clinical experiences and I guess that's a similar case here as well.
Dr. Caroline West:
Well, thanks for sharing that because I know that as health professionals, we are sometimes not so great or comfortable when it comes to talking about our own experiences, but I can relate to what you were talking about with that sense of moving in a slightly different direction. I started off as a clinician in HIV at a time in the eighties and nineties when it was really an incredibly challenging and sad time, really. And I got to the end of that and knew that I was burnt out and I zigzagged into media and have spent my whole professional life building on my skills, but sort of shifting slightly along the way and having a really rich and wonderful career as a result, but recognizing that I can get saturated and I get exhausted and I have to do something that's a little different. And as I get older and wiser, I've learned to pick up on that and change tack when I can. And the other thing that I think has been highly protective with having a very long career in health is that collegial support, because I think professional loneliness is a great contributor to burnout because you're not really sharing anything. And certainly in general practice, although you're with people all day, you're often with patients all day. You're not necessarily with colleagues and sharing stuff with colleagues. And I think that if you have some professional alliances where you can genuinely be yourself and talk about what's going on can make such a huge difference.
Prof. Lisa Lampe:
Absolutely, because that social aspect of our lives, both in terms of collegiate relationships, working with other doctors and health professionals, but also good social relationships, they are protective factors. So I think that's actually really important that we know that that is one of the protective factors. I mean, we can identify a number of factors that can be protective, but that's not the same as saying we know how to intervene and kind of fix burnout when it's happened. But the sooner you recognize it and do some things that work for you, I think that's the other thing is probably what works for one person isn't automatically going to work for somebody else because we do differ in our personality and our effective coping strategies. But knowing when it's time to maybe get some distance, think through things, have a bit of a break. I don't think doctors take enough breaks.
Dr. Caroline West:
No. Especially through COVID, none of us have had holidays. It's terrible. But look, it's been a really fascinating conversation, Lisa. I'll certainly go away with a lot to think about there because it's a very interesting topic and I think it's very relevant to where we're at at the moment with healthcare, especially with the challenges of COVID and a changing landscape.
Prof. Lisa Lampe:
If I'm able to mention, our study is ongoing. We're doing it by means of an online anonymous survey, trying to find out about people's experiences with boundary challenges. Anyone who is interested in finding out a bit more about it can go to our website, which is boundariesresearch.com.au.
Dr. Caroline West:
Fantastic. Well, hopefully some of our listeners will follow that link and participate. Fantastic. That's all we have time for today. Thank you once again, Professor Lisa Lampe for your time today. And it's been great to hear about how boundaries may influence our risk of burnout and what we do to ensure that we preserve boundaries where possible. And if you'd like any more information on any of the material that we've covered today, please go to our website, nps.org.au. Professor Lisa Lampe has declared in her conflict-of-interest statement that her boundaries and burnout work is sponsored by the Avant Foundation. If you'd like more information on CPD points, follow the links on our website. I'm Dr. Caroline West. Bye for now.
