Daniel Binus, MD
Compassion, Care, and Burnout
During my psychiatry residency I observed two basic types of practitioners. One group was empathetic and caring. Their faces expressed genuine concern and kindness for their patients, but they also looked tired and worn out. Helping people with serious mental and emotional needs was taking its toll. I wondered if these doctors might eventually need psychiatric care themselves.
The other group seemed to handle stress better, but they were also more aloof and calloused. Psychiatry can be very draining. These doctors were good at guarding themselves, but it didn’t seem like they connected as well with their patients.
Neither of these practice styles appealed to me. I didn’t want to be wiped out emotionally but I did not want to become hardened to suffering either. I wanted my practice to be different. I wanted to experience joy in caring for my patients. I wanted to pour myself into helping these people and allow healing to occur without destroying my health or my relationships with God and my family.
These observations led me to study the life of Jesus. No one has ever had to endure more stress or strain than He did. Despite the constant demands of the multitudes, He was able to balance the physical and emotional demands inherent in a healing ministry.
But how? To outward appearance He worked so relentlessly that his family feared He would die from overwork. They tried to get Him to take a break. Yet, amazingly, Christ didn’t suffer from compassion fatigue or burnout (as an aside, compassion fatigue and burnout are related but they aren’t the same).
How did Jesus manage to stay mentally well under such intense demands? He prioritized “temple care” of His body and mind. He lived to bless others each day, but even more important was the time spent in communion with His Father in heaven. From those quiet hours of early morning communion He received instructions about how to spend His time each day. Christ is our example in all things. And if there is one thing we should prioritize over any other, it is having a daily, living spiritual connection with God. We cannot compromise on that. And that is what I have done chosen to do throughout my career. “The Saviour’s life on earth was a life of communion with nature and with God. In this communion He revealed for us the secret of a life of power.”—Ellen White, Ministry of Healing, p. 51.
Spending time with God recalibrates me day by day. When I get off kilter, I spend more time with God to regain balance. That is the only way we can have wisdom to say no or yes to different demands and then strength to carry out His plans. Most physicians and health care providers tend to be people pleasers. We need that divine strength from outside ourselves to live our lives in full surrender to Christ.
Spending quality time with God is one of the eight laws of health, and it is imperative that we incorporate the other seven, including Sabbath rest, going to bed early and waking up early, and making sure to get enough sleep and exercise. Diet is really important, too, and I’m blessed with a wife who is a great cook who prepares healthful meals.
Most doctors are not aware of these simple strategies that help prevent burnout. And unfortunately, physician burnout is at an all-time high of 63% according to a January 2023 report by the American Medical Association. With such high rates of burnout, more and more doctors are simply choosing to retire early. But this poses a larger threat for the entire healthcare industry.
There are 12 factors that were identified in 2020 as driving physician burnout. They can be summarized in four categories as follows:
1) Regulatory issues. These include standards, laws, charting, health care insurance, coding and documentation, HIPPA, and prior authorization. Doctors carry a huge burden of administrative responsibilities.
2) Reluctance to seek treatment. The requirements for board certification and being monitored by state medical board for licensure make doctors less likely to seek treatment for burnout.
3) Malpractice. With changes in the health care industry, more doctors are working for hospitals now instead of private practice, which leads to less control over the work environment.
4) Shifting values. Our society is also experiencing huge shifts in values. These divergent interests lead to a loss of control and autonomy, and these changes have also impacted the patient-physician relationship. Sometimes doctors find themselves in the difficult situation of being controlled not only by their employer but also by their patients demanding what they want from their doctor.
How can we manage our lives in such an environment? Here are a few suggestions.
1) Control/autonomy. Do as much as you can to control how you practice medicine and how you manage your time. Treatment decisions should be between physician and patient and God and should not be externally controlled. Insurance companies want to dictate the lowest cost strategy. That can be really frustrating. As much as possible, develop ways to share your work load by employing people who can help free up your time. Use extenders and hire personnel to do paper work. Ideally, own your own practice. I wouldn’t have it any other way. We are answering to God. We can mold it to His plan. That’s a big deal.
2) Priorities. Rank in order the things that are most important to you: God, spouse, then children. We know this but how does one implement that priority list? We need to schedule sanctuary time with our families. Sabbath provides the perfect opportunity for this; however, sanctuary time during the week with your spouse and your children is also needed. Also, your work environment should be congruent with your philosophy of healing.
3) A sense of fulfillment. This is very important. Being busy and stressed in and of itself may or may not lead to burnout. Research shows that it’s not always stress that makes people’s health worse, it is the perception of that stress. Gallup conducted a poll looking at the levels of stress around the world. They found that the happiest people are stressed but not depressed (by family, work). Work can be unfulfilling if you are only treating symptoms. Conversely, if a doctor can get to the core issues and help patients find emotional and physical healing, then work is meaningful and fulfilling.
It’s important to practice where you can be creative under God’s guidance rather than just stuck doing a job. I have not experienced burnout in my practice even though I work very hard. It’s rewarding to see positive changes in my patients as they cooperate with our care and treatment plans.
Other areas of fulfillment include spending significant time with family outside the office—enough time to experience recharging. It’s also fulfilling to connect with your colleagues.
Research shows that patient outcomes are impacted by the interconnected relationships between patients, employees, and colleagues. To nurture meaningful relationships with colleagues, we meet together each Tuesday morning to read and discuss the Great Controversy or other inspirational books such as the Ministry of Healing or the Desire of Ages. This is a wonderful way to set the spiritual tone of the office.
We try to be intentional about doing other healthful activities that foster a sense of team spirit. Last year, we had a goal to walk around the world by keeping track of our miles. I walked or ran 2,551 miles in 2022. As a team we walked around the world with 0.5 miles to spare!
Burnout is a complex condition with more than one cause, but it is curable. Becoming aware of the factors contributing to burnout is a first step; and adapting specific lifestyle strategies can facilitate restoration and healing by God’s grace.
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