Cynthia Ackrill M.D. is a leader in the field of stress management and an expert in the critical relationships between lifestyle choices, performance capacities, and leadership effectiveness. As the only physician trained in neuroscience and wellness and leadership coaching, she travels the world to teach better ways to lead and thrive in the face of stress and constant change. She heads the Workplace Stress Board for the American Institute of Stress, and is on the faculty of The Physician Leadership Institute.
What do you see as the leading cause of stress for healthcare professionals?
Let’s see. We can start the discussion by going back to 1908, when psychologists Robert M. Yerkes and John Dillingham Dodson developed what is now called the Yerkes–Dodson law. It states that for optimal performance, some stress is beneficial. But if you are overstressed, then performance suffers. The chart looks like a bell curve: too much stress, and performance suffers. And, in the middle, you have the zone of optimal performance. Research in peak performance shows that a certain level of stress (or arousal) in necessary for performance. We don’t do our best when we are bored. But neither do we when we are overwhelmed or pushed beyond that point of perceiving that we have everything we need to meet the challenge.
Burnout occurs when we are overwhelmed.
Most of us know our “achilles heel,” that part of us that is most vulnerable under high stress. For me, it is headaches–push too hard/too long on my coping systems and I get a headache. My colleague reaches for the Tums. But the bigger challenge is recognizing stress before this stage, before distress is manifested so profoundly, especially before it becomes a silent killer.
Waiting for a big symptom to appear to know we are out of balance is no different than a diabetic waiting for blood sugars to rise off the charts before taking insulin. And unmanaged stress does the same inflammatory damage throughout our brains and bodies that high blood sugar does. We have to learn more accurate ways to measure where we are on the stress curve–to improve our performance and prevent damage.
This is especially hard for many high achievers who have learned to disconnect from the more subtle signals, to focus on the goals. Achievers often don’t really “feel” stress anymore. They can even be addicted to the adrenaline state it creates. (And sometimes they are the ones causing stress for others!) Some of us need to ask colleagues and loved ones what they notice and re-train ourselves to reset earlier. We need to learn a new metric to stay on the top of the curve.
We’re not built, physically and mentally, for constant stress. Often, high achievers are simply unaware that they are experiencing burnout. They just try to work harder and harder.
And that’s often a disaster?
It can be. In Japan they have a word for this - Karōshi - death from overwork.
At the Physician Leadership Institute, how do you help these physicians cope?
It starts, like most things, with awareness. One of the biggest symptoms we see is a high level of irritability. Are you irritated by your co-workers, your staff, your drive home, your children? This irritability may mean that you are on the edge, experiencing burnout, but perhaps not acknowledging it. In our profession, we often don’t connect the dots for ourselves. Physicians are sometimes most likely to exclude themselves from asking for relief. It’s our culture, our modus operandi, to be tough and not ask for help. That can lead to physician burnout.
I have an exercise I do with physicians called “clean up your plate” which helps stressed individuals find their balance.
Clean your plate?
Here’s a quick look at how it works. I ask a physician to take a clean paper plate. I ask them to write down all the things in their lives that suck up their energy. Write them down on your plate. These are all the activities, interactions, and responsibilities–at home, at work–that take energy out of you. Next, on the flip side – the base – I ask them to write out what gives them energy. What supports you? Renews you?
And then we do an inventory check. Step three is to clean your plate. What things are worth doing? What can be deleted? Delegated? Deferred?
You’ll be surprised with the things people want to cling to and not let go. Of course by not letting go, the stress just keeps on building. This all comes down to physician resiliency–a term that’s gaining traction in some circles, but not nearly fast enough. In so many ways, what we do is resiliency training. Helping the physicians, staff, and administration understand that it all begins with yourself. I don’t want to say you can just clear away all the stress of life- that’s unrealistic; but you can learn to manage it and find effective ways to cope.
How should institutions build on this knowledge to prevent burnout?
We have all heard that awareness is the first step to change, but making lasting changes in thought and behavior patterns turns out to be much harder than we like to think! And stress makes it even harder! As far as institutions go, most are still barely acknowledging the problem. As burnout and turnover increase, there is a growing awareness, particularly with forward thinking executives, that much more can be done in the way work is designed, policies implemented, coaching and training offered.
I’m not saying that to fight burnout all you need are classes. Even when we become truly conscious of some incongruence in our lives–a choice we make in thought or action that does not support our values or goals–we still really struggle with using that information to drive behavior change. For example, only 1 in 9 people make the appropriate lifestyle changes after cardiac surgery! 1 in 9! Apparently the threat of death is not the easy button to change! We operate with a bias that if we just know enough, that will drive change. But this premise is wrong–personally and in business. Consider obese doctors, accountants in debt, or some choices made by well-educated C-level leaders. Knowledge is necessary and powerful, but… KNOWLEDGE ≠ MOTIVATION. Combining awareness with a curious, mindful mindset and the science of both individual and organizational behavior change, it is possible to greatly improve the odds of success.
So it comes back to the values and culture of an organization?
Yes, and mindsets. The physician leader knows how to deal with stress at every level. That’s something that’s a day-to-day practice. What we do is help them develop this practice.
For more information, contact the Physician Leadership Institute >>