S1E29: Burnout in 2nd Years

Leen: If we're going as Katniss, I'm going to go buy a suit. I'll buy the whole costume.

Bushra: Doesn't she wear . . .

Margaux: A beautiful dress?

Leen: Oh my god. Oh, I was thinking the armor.

Bushra: She wears jeans and . . .

Harjit: She does wear jeans.

Margaux: You're not allowed to speak about "The Hunger Games."

Harjit: Yeah. You don't even freaking know.

Leen: You have no right.

Bushra: "You don't even go here."

Leen: Katniss is like Cardi B to me to you, so don't even.

Bushra: First of all.

Harjit: To me to you.

Margaux: Hey, everyone. Welcome to the "Bundle of Hers." Margaux here with Leen, Harjit, and Bushra. And it's spring already.

Bushra: It doesn't feel like spring, to be honest.

Margaux: I know. And we are four weeks out from the end of our first unit. But how are you guys doing with studying? We have boards coming up.

Bushra: I have literally no motivation.

Margaux: Yeah. I hear you, Bushra.

Harjit: I just am struggling because we have class, but then everyone's like, "Oh, let's study for Step." And then a part of me is like, "Oh, Harjit, you should maybe listen to everyone this one time and start studying for Step." So I'm trying, but it's really hard.

Margaux: Yeah. How about you, Leen? How are you doing?

Leen: Ironically, I'm getting the med school butterflies again, because the thought of after boards makes me really excited. And I'm like, "Can you imagine being done with boards?" It's like wow, that's a milestone. That's what we call them.

Margaux: Oh, totally. No, I'm totally with you in that boat too, but like Bushra and Harjit, I also feel a lot of stress with Step coming up.

Leen: Yeah, I'm in denial.

Margaux: And I think that's a really important segue into the topic I wanted to talk about today, which was burnout. So, technically, burnout is a long-term stress reaction which is defined by emotional exhaustion, depersonalization, which means you just don't feel like yourself or you're de-associated from the things that you like. And the other criteria or defining factor is a lack of sense of personal accomplishment.

Bushra: Oh, girl. That's me to a T.

Leen: That's a horoscope, but a really good one.

Margaux: So, overall, it's just this really dark thing that's a product of the stress that we are exposed to in medical school. And I think in popular media, usually we hear about physicians having burnout, but I think it's important to address that it also affects medical students, like we all just acknowledged.

So is there anything else you guys would want to add to the definition of burnout?

Bushra: I have been noticing that it's getting harder for me to get up and go to class. I'd rather just be in my bed.

Leen: Seriously, I slept 15 hours yesterday and the day before.

Bushra: And sleep forever and literally . . . And then, ultimately, I regret it because I have to go and re-watch the lectures. But I've just been sleeping a lot more than usual lately. And then it kind of Fs up my schedule and all that stuff.

It perpetuates itself every single day, and then it's like, "Oh, shoot, I have to get all this stuff done." I create this environment of acute stress because I've been putting things off. Ultimately, my own fault. I've been getting better, though.

Harjit: It kind of ebbs and flows. It's like a thing that you need to check in on and catch early so that it doesn't become a long-term burnout.

Margaux: I think you're right, Harjit. There is a transient nature to burnout. Right now, we're maybe two and a half months away from Step 1 exam for most of us, which, for the pre-med listeners, that's our board exam, the first part of it, which determines where you basically can go to residency. Essentially. Not really. We can have a different discussion about that later.

But it's a very stressful time and I think we have a lot of stress right now from that. And that's part of the transient nature of burnout, is we're trying to finish this last unit of our second year and study for this big exam. And so I think naturally, a lot of second-year students do feel burnout right now.

And then it may go away, like Leen was talking about, feeling excited about after boards. So there's balance to it. You can feel a little bit of burnout, and then come back from it. I think that's important to recognize.

Harjit: I also think it's important to make that distinction that all because you're burned out doesn't mean that you're giving up or done with something. I think that's a very different type of feel, and you get this whole other host of feelings with that.

I think it's more just you can still have that passion, but like writer's block or if you are an artist, sometimes it's just you have those points in your life where you're like, "Oh my god, this is weighing down on me."

Margaux: Yeah, totally.

Bushra: Yeah. I mean, if you just think about it, we've been in the classroom setting for almost two years now. And every two weeks you take an exam, and then you have a final on top of that. And so we've been at this for a really long time. Now that it's towards the end, it's just like ugh. It's just like, "We're still doing this?"

And so I can understand why, Leen, you're excited to be done with it and actually start seeing patients and moving on from this part of our medical education.

Leen: It's kind of a mix of denial as well as a fantasy kind of idea where you're thinking, "Oh, yeah, I'm actually doing the stuff I need to do," but you're more procrastinating. I think procrastination is a big part of it.

Harjit: I would agree with that.

Leen: Yeah. I think I noticed when I study with people, they're like, "Wow, it sounds like you really hate the material." I'm swearing off my chairs, I think. And they're like, "Why are you so mad at the material you're learning?" It's like, "Oh, no, I'm not mad at it. It's actually really interesting. I'm just so tired of being forced to kind of get at it in ways that maybe I don't personally find it fascinating." That's why I'm kind of excited for the patient aspect. It's like now we can finally see what we're learning.

Margaux: Yeah, I think that's what I was going to say off of Bushra's comment. We feel burned out, maybe not passionate, like you were just talking about, Leen, about doing this studying, but we know that we have to. It's something we just have to do, so we push through.

And I think that contributes to the burnout, is feeling like you have to do this, but your heart may be not in it because you just want to get to third year and get to the patient interaction. But there's this huge hurdle in front of you, and so you kind of are just . . . Maybe mindlessly isn't the right word, but you're kind of just doing it without empathy and without . . . Not compassion. Without passion. And so that I definitely think contributes to burnout.

Leen: It's kind of like you're a candle and the flame went out, but also the wick broke off. So you've got to dig around the wax to get the wick back out, and then you can light it up.

Harjit: What an analogy.

Bushra: So this is you digging . . .

Leen: Yeah. So you have to just kind of . . .

Harjit: You're digging the wax.

Leen: . . . dig your way out. Yeah, exactly.

Margaux: Yeah, totally.

Bushra: That's so funny.

Leen: And then you can re-light the flame.

Harjit: What an engineer's mind.

Margaux: I love that analogy.

I also find myself withdrawing from social things, and I feel like it's important to recognize that maybe I'm starting to feel burned out, and it is important to schedule time or make time to hang out with you guys or make time to be with my husband.

Leen: I'm the worst at this.

Margaux: Yeah, but contribute. Do you feel like maybe you're even . . .

Leen: Not the husband part, but just in general.

Margaux: Yeah. What other things do you guys notice maybe right now that you're not doing that you normally do?

Bushra: So my mom was in town for a couple of weeks and that kind of showed me how much I actually do spend studying, and just being by myself studying and not necessarily interacting with her. And then when she was here, I put more effort into doing that.

Looking back at it, I felt like I was a lot more miserable when I was just focused on solely studying, and then everything else became secondary. Now that I put the things that I enjoy back into my life, the other stuff doesn't seem as bad.

Margaux: I think that's a very good point, Bushra, is how can we combat and how do we combat burnout right now? And like you said, you maybe have to be more intentional and conscious about making that social time.

And same, I signed up for this exercise. It's called Class Pass, so you get to go to different studios, just to force myself to work out every day. What I realized is that exercise is studying because I'm way more clear-headed after I work out and if I take that time to just go move my body, and then I can come back and refocus and bring more efficiency back to my studying.

And so it's important to realize that those things, like being social or working out, are definitely part of studying.

What about you, Harjit? What are you doing to combat burnout right now?

Harjit: I think I kind of have a little bit of a different experience. When I first started med school, this sounds so insane to me, but the first month or two, I think I had all those feelings of burning out and I was depressed. We've actually talked about this in a past podcast.

Margaux: Episode 6, mental health.

Harjit: Yes. What that made me realize was that there's a reason I'm here. So there's always this balance between understanding, "Oh, I'm getting tired of this. I'm burning out," and then reminding myself, "There's a reason I'm doing this. There's a reason why I want to do this and why I want to be happy with what I'm doing."

So how I'm trying to live life is . . . I think I grew up in a family that was very much, "Let's work, work, work, and then we'll have fun." We'll make the money, then people have fun when they're in their 60s and 70s. I realized I didn't want to live like that.

So I think one positive thing that I've acquired, a skill, is I feel like I don't feel the burnout, because I'm, as I said, constantly feeling it. But I'm also at the same time making sure I have time for everything.

So I will say even though Step 1 is nearing closer, I still think I do the same amount of things like I always do.

Margaux: Yeah. And I think, like you said, Harjit, it's important to keep in mind why we're doing this, why we're subjecting ourselves to this awful test and stress in these first two years of medicine. And it's to know that we came to medical school for a reason. Each of us has our own unique reasons for wanting to become physicians, and it's very important to keep that in mind.

And for me, what I have found to be very helpful is to actually go and shadow. So once a month or every other week or something, I've been going to the OR to shadow in pediatric orthopedics and that just . . . When I leave there, I am so motivated. I'm like, "This is why I'm studying renal physiology, is because I want to do this, and I have to study this to get to what I want."

And so I think it's very important to have a clear visual to help get you through the tunnel.

Harjit: Even though things are coming closer, you know what I think the key point is that we're doing? We're having a conversation on this and I'm constantly thinking about this. And because of that, I think I'm not reaching the point where I crash and then I don't have any looking back, because a lot of people reach that point.

Margaux: Yeah. I think that's super important not to get to the point where you're completely burned out and you can't come back from it.

Harjit: Right.

Leen: I think I didn't even hear about what burnout was until medical school. And so in undergrad, I also had . . . I mean, I chose a difficult major. What am I trying to say here? Basically, I had a lot of hard classes, and so I did feel burnout then. I told myself I never want to sit in a classroom again, and then surprise, I get into med school, and here I am two years later.

And so I think for me, moving to a new place, losing all social context that I had before on top of not having time to sing or have time to write, I think that's why I was really, and still probably am, bad at managing burnout in medical school.

It's different when you've been . . . on top of adjusting to a new place, it's like, "Wow, I'm stuck 24 hours around medical students, and this has never been the population that I ever socialized with."

I don't know. For me to combat burnout is kind of a new thing. It's just newly been introduced into how I have to do it, and so I've been trying to integrate more time for singing, more time for writing. Even at midnight, I'll be like, "I'll just sleep at 1:00 a.m., but at least I'll get in . . ."

Margaux: Some you time.

Leen: ". . . something to write." Yeah.

Harjit: That's really good.

Leen: And for me, I haven't been able to do it all the time. It's kind of hard to adjust to making that schedule.

And also, I think it's more difficult when your social support system doesn't understand what it's like to be in medical school. So my social support would be like, "Well, if you're so burnt out from the people in med school, just back away from them." And it's like, "You don't understand. We know everything about each other, and it's the weirdest culture ever seen."

And then on top of that, when you are burnt out, they're like, "Oh, well, maybe you want to change your major? Maybe you want to change from medicine?" And so it's like, "No, it's not like that at all." You're just super sick of it.

Margaux: Thank you for being honest about it, Leen, because I feel like maybe . . . I didn't want to give the impression that I know how to handle burnout. I think for me too it's a new feel that I'm navigating, and I think we're all going through that at the same time.

I think the first step is it's so important just to recognize that you are burned out. If you're sleeping more or something is just off, like you don't feel passionate about studying, no motivation, or you just constantly want to procrastinate, I think it's important to be like, "Maybe there is some bigger factor that's affecting this."

And then just maybe try little things, like you said, like singing. Even if it takes you up one hour later, that helped you in the end. And so don't be afraid to try something to help.

Leen: Sometimes just backing away completely, right?

Harjit: Yeah. You just need the space.

Leen: You're like, "I don't know anything about medicine. I'm just going to back away for a day, and I'm fine." But yeah, it's just coming back, tackling it with a new passion, I guess.

Margaux: Totally. We have stress right now from our tests, but I think next year in third year, we're going to have a different kind of stress that maybe leads to a different kind of burnout.

One of the articles I was reading, and I'll post it on Facebook, was saying that medical students usually come into the patient experience wide-eyed and bushy-tailed and so excited because that's why we're here, is to work with patients. But then by the end of third year, you maybe start to get burned out because the patient experience is not always what we romanticized it to be.

And so a lot of doctors, throughout the progress of their career, tend to lose empathy and compassion. Not because the patients, but because of the workload that they're exposed to. You only get 15 minutes, and then patients with super complicated cases cannot be managed in 15 minutes. So then you have these very complicated patients and I think it can become very overwhelming.

I kind of wanted to talk about what we think about empathy burnout for physicians and how we might protect ourselves from that next year and in our careers.

Harjit: I actually love that you bring this point up, Margaux, because I think that a big thing I'm noticing that might happen to me next year is, one, I think our schedule is going to be completely different. We're going to be required to be up and working for more than 12 hours a day sometimes.

And the physical burnout that you feel, the feeling of fatigue, I'm pretty sure we're all going to be feeling fatigued. I wonder if that's something that we will acquire in our third year or something that's more long-term.

I think one thing that I always need to remind myself is I think the biggest reason I wanted to go to medicine was, yes, it combined my interests of science and working with communities and stuff like that, but I'm also very much always interested in a person's life in the moment. And then just having that awareness that you can learn something new from everybody, even if it's an interaction that didn't go well.

I feel like I recognized that idea when I was in college of every single interaction means something. So I hope that I don't have to go through that burnout, because, for me, every interaction is there to teach me something. That's the way I've developed my mindset. So I hope that's something that will help me.

Leen: I think I'm going to burn myself out with anxiety of, "Am I acting the right way? Am I getting the good portrayal of what . . ." I think I'm new to medicine. I didn't know there was a whole hierarchy or how you're supposed to act and how you're supposed to portray. And there's a whole intricate system to . . . there's just a whole culture of behavior behind it.

Harjit: I actually love that you bring this up, Leen, because I think the key point is that we can spend hours and hours trying to change ourselves so people can be okay with what we're talking. We can be afraid of a million things, and the truth is there are a billion permutations of things that could go wrong.

I think another thing that I want to really work on next year is just being myself. That won't lead me astray because I have something to back it up with, because that's who I am.

Leen: Yeah. Once you get that confidence in yourself, it doesn't matter what people say about the way you act because you'll be like, "It doesn't . . ." You have thick skin. It's one less thing to burn you out.

Harjit: Yeah. I feel like it's important to be respectful. I'm saying that's a completely different thing. We'll all be respectful, but I think we should be who we are and not pretend to be something else.

Leen: Building off of that, being two years stuck in a classroom, I feel like there's kind of an aspect of social interactions that we've lost. We've become so antisocial.

Harjit: We only socialize with each other.

Leen: Yeah. But I get out into the real world, and I'm like, "I don't know. Where do I put my hand? How do I do this? I've never had this problem before."

Harjit: I love that you say that.

Bushra: How do I interact with non-medical students?

Margaux: So true.

Leen: And that kind of scares me. Next year, when we're getting back into the real world, it's like you're going to walk in and you'll be like, "Hi, I'm a med student," and you're just being super awkward.

Margaux: No, I totally validate that, Leen. I think it's a legitimate fear. And on top of it, our attendings are going to be grading us for our boards.

Leen: "Why are you acting so weird?"

Margaux: Which is adding another layer of stress. So not only are we worried about our patients, we're worried if we're performing well.

Bushra: Yeah, we're going to be graded next year, and it's going to be a completely new environment, but also, I think we shouldn't lose the aspect of we're still students, and we're still learning, and all those things factor into learning.

And part of me is like, "I shouldn't be penalized for not knowing something before I learned it." You know what I mean? Because you're just thrust into an environment that maybe you've never even had the opportunity to shadow or whatever it is. Maybe I'm an optimist, but I just feel like if you just put your best foot forward, if you are caring about what you're doing . . .

And I think, like you said, Margaux, yeah, the burnout is going to be completely different. Like you said, we're all going to go in there wide-eyed and bushy-tailed. But I feel like that's kind of a breath of fresh air for the people that have been working there day in and day out, and then you have someone that's excited to be there and learn new things. I feel like that energy kind of transfers into the setting.

I don't know. I'm really excited for next year. And maybe I won't be so excited at some points, but that's okay. That's not going to take away from my experience as a whole.

Margaux: Our excitement may help other people rekindle some of the passion and empathy that they may have lost through burnout. I think if we approach it more, and medicine is becoming more like this, as a team and it's not just one person's burden to carry the weight of all these feelings and workload and emotions, then maybe slowly we can start to lessen the degree of burnout.

But like you said, there's a stigma that is prevalent in the medical profession where we have to be these strong people who don't show emotion and work 36 hours a day. You don't sleep and you don't eat, but you're still supposed to perform and be compassionate. And that stigma really eats at people because at the end of the day, they feel like they can't say, "I want out," or, "I feel bad about this."

Harjit: And also, it's the whole prestige around this title. I always remember that my job is important, but the person who makes the food in the cafeteria, their job is important too. But that whole prestige around you're a doctor and having to tell your family, "This is not what I want to do." I understand why people reach the point where they can't turn back. It makes total sense. And these are real issues and they actually happen.

I think we always talk about being a medical student, we have to do this, this, and that, but the truth is we're also learning. And on that journey, having an open mind of all possibilities is important.

Obviously, we've worked so hard, and so far, we're here because we want to do this. And we recognize the importance of understanding burnout, understanding taking out our time for things, but there are people who never got that opportunity.

Bushra: So I've noticed that wellness has been something that's been kind of thrown around, and how we should be able to put ourselves first and making sure that we're mentally healthy. That's the most important thing. I think that sentiment is also within the hospital, and residents, and stuff like that. I think they also have that.

But I think something that's lacking is that while they do say that wellness is important, they don't really know how to implement it within your heavy work schedule, just residency in general, and actually med students, to be honest. I think that's something that we can work on.

While we can say, "Yeah, there is a problem," when there's no feasible solution. It doesn't really get rid of the problem. And I think that's where we need to . . .

Harjit: Put our efforts?

Bushra: Yeah.

Harjit: I also agree with Bushra. I do want to say, I think because burnout is starting to be recognized, people are like, "We're getting into a better wellness program every year." I think that there's, obviously, this need, like, "We need to do this." But like Bushra said, that translation is sometimes difficult.

I think one way we can work on that is have these conversations. And that's what we do with this podcast. Have these conversations, knowing it's okay to talk about these things, like, "Hey, I need a breather. Let's not talk about school," or, "Let's go have lunch," or, "I really need to celebrate someone's birthday." I'm so into celebrating birthdays. But these are the reasons why.

Margaux: Yeah. Burnout is real. I think that's the message we wanted to share ultimately from this podcast. I think we are kind of at a very exciting time, like Bushra talked, where they're talking more about wellness in residency. And right now it seems to be added on top of your workload, but I think we all, as rising physicians, have the ability to change with our voice the structure of residency and the structure of how we incorporate wellness into our practices.

I think that our voices are powerful. And so by having more conversations like this and exposing burnout and the barriers and causes of burnout, it's going to be very important.

So we hope that we have empowered you guys to go out and talk about burnout and start to tackle ways that we can prevent it.

Harjit: And also remembering our passions.

Margaux: Yes, exactly. Thank you, Harjit. Don't forget your passion.

Harjit: Don't forget why you got to wherever you are in the first place.

Margaux: Yes. If you keep that in your heart and your mind, it will guide you through. You will feel burned out in medical school. It is okay to feel burned out. Make sure you talk about it. Make sure you get support in whatever way that looks like for you. But you will prevail.

Harjit: Yay.

Margaux: Thank you for listening. This was "Bundle of Hers." Make sure you check us out on Instagram, @bundleofhers, and tune in next time on iTunes.

Harjit: Margaux, you're so good at the ending, unlike me.