Most of us can likely relate to this experience: you put all that you have into your work for prolonged periods of time and feel physically and mentally exhausted by the end. This common phenomenon is known simply as stress, a natural reaction to facing increasing demands without the necessary resources to meet them. In moderation, stress on our bodies and minds can elicit beneficial responses that enhance well-being, such as increased memory formation. However, as most of us know, there is often an imperceptibly fine line between advantageous stress and toxic stress from being exposed to too much for too long. Sadly, we often cannot control the balance between the two.
Whether it is on social media or our go-to news channels, we hear a lot about stress and deteriorating well-being in our country. In fact, this reality has become so pervasive that some of us probably normalize much of it, writing off the downstream effects of stress as just part of modernity. For adults working in fields associated with above-average levels of psychosocial stress, a vicious cycle can manifest wherein unmitigated chronic stress breaks us down, drains us of our resilience, narrows our perception of what makes life worth living, and leaves us feeling hollow. This whole process is often encapsulated in a single word: burnout.
For some: burnout, schm-urnout! Critics of this concept tend to point out how nebulous it sounds even when someone offers up the definition. A different, more integrated way of understanding the long-term effects of chronic stress on the whole person is a principle called allostatic load. While there is a lot that happens to our bodies when we experience prolonged stress, the central idea of allostatic load theory is that, if you apply enough force for long enough on someone without destroying her, you will fundamentally change the way she functions and responds to future stressors through a process called maladaptation.
As a medical student, I see this problem of maladaptation frequently, both in trainees and trained physicians. Research demonstrates this trend in the alarming number of physicians who quit practicing medicine every year. I think it is because we are so deeply focused on trying to carry out a complex mission of providing care to patients. In our efforts to do this, we often focus on one large goal after another, not allowing ourselves to have much latitude. Whether it is taking a standardized examination or meeting documentation requirements, setting and pursuing less diverse goals like this is problematic: any barriers to goal attainment will cause much more stress than it would if we had other irons in the fire.
Recently, major news sources and professional organizations have cited emerging evidence of epidemic levels of burnout among physicians in the United States. While this is not unique to physicians, there is perhaps a pronounced susceptibility in this population because of how purpose-discordant tasks like navigating electronic medical records hinder progress toward meaningful goals like direct patient care. While much work is being done to streamline these systems-level processes, not enough is being done to examine what goals are not being achieved and why they exist on a cultural level.
Doing what is in the best interest of the patient is at the heart of the Hippocratic Oath, which represents a major theme in physician culture. The oft-overlooked connection between personal well-being and quality of patient care has an empirical basis: physicians who experience chronic stress and burnout are more likely to make errors that result in disease, disability or death. What is ironic is that physicians who push themselves to deliver the best care possible may be doing so at the expense of this goal!
So, what do we do about this?
We are making strides toward rectifying issues ingrained in health care systems, but progress toward shifting the culture to uphold our mission of optimal care is less robust. Research in positive psychology and organizational dynamics has shown that goal diversification is associated with subjective well-being. This means the act of setting and pursuing different kinds of goals that are meaningful to you is associated with less stress, which decreases the impact of allostatic load on the body and mind. Studies on intervention strategies to promote goal diversification have included mindfulness meditation, hope building and active self-reflection activities.
Hope theory describes how thinking about one’s motivation and perceived capability of attaining a goal and about the pathways leading to that goal influence how we set and go after what is important to us. It also suggests that goals, especially smaller ones, can serve as pathways to other larger goals. This theoretical framework is further supported by research showing that goal setting promotes behavioral change, which can improve well-being even in the context of major depression. Moreover, the act of setting goals, particularly those that are diverse and of high personal value, increases productivity at work, which may subsequently help alleviate stress by decreasing the demands of one’s work environment.
One of the most significant hurdles in health care is that clinical practice generally has a substantial workload and numerous legal constraints that force clinicians to stick to a script. So, if the current practice environment largely opposes personal goal setting and goal diversity, how do we work around this? National research on health care quality offers some ideas: decreasing daily workplace activity, adopting collaborative care models and allowing employees to work on quality improvement projects. A common thread in all of these ideas is that health care providers can focus on more than just the same repetitive goals, which allows them to feel that they are fulfilling their professional purpose more often. Additionally, this method can limit stress and prevent much of the maladaptation that comes with it.
People can break their cycles of stress and even flourish outside of the work they regularly do by incorporating new and different goals in their day-to-days. Our best shot at getting ahead of the problems stress produces in our country is to look at where our finite energy is going and ask the tough questions: “Why?” and “At what cost?” We are not machines; it is not sustainable for us to push ourselves at the cost of our well-being. Whether it is in medicine or any other field, we must ensure that our cultures nurture goal diversity and being more than just your work because, at the end of the day, stress occurs when we feel that we lack the resources to meet the demands around us.