Avoiding Stress and Burnout in Cancer Care

February 1, 2007

Over the past 8 years, I have led discussions and had private conversations about stress and burnout with oncologists of all stripes. Several common themes have emerged with regard to what it is that stresses and burns out oncologists and what helps them the most.

Over the past 8 years, I have led discussions and had private conversations about stress and burnout with oncologists of all stripes. Several common themes have emerged with regard to what it is that stresses and burns out oncologists and what helps them the most. At the top of the burnout list are time issues: not enough time with patients, time with family, or time for relaxation. Oncologists are overcommitted and overscheduled, inundated with paperwork, phone calls, and anxiety over never seeming to know enough.

Physical, mental, and psychological weariness are enormous. Sleep is interrupted by calls, worries, children, and family issues. The afternoon waiting room is filled with apprehensive patients newly diagnosed, or waiting for news of restaging, all of them nice people, many of them friends. Telling one person their cancer has progressed despite all the hard work they and their family have done hits you hard. Telling several in succession can decimate you. You may begin to protect yourself by withdrawing, becoming cynical, jaded. Sartre's existential nausea may creep in. You begin to wonder if you have accomplished anything.

What follows are some of the best words of advice I have heard, all from fellow oncologists:

(1) Realistically evaluate your practice and decide if you would be happier earning less money but having more time and help. As it is said, few people go to the grave thinking, "I wish I had worked more hours," or "I wish I had accumulated more money." Stop taking new patients until you catch up. Hire people to help you—another partner, a nurse practitioner, someone savvy to talk with insurance companies and help with paperwork. Pay them well, so they stay with you.

(2) Hang out with other oncologists and take pride in your profession. Teach it to others. Take on a preceptor in medical school or residency. You will see just how valuable your knowledge is. It is easy to get jaded and think others have so much more going on than you.

(3) Say NO. Take time off. Arrange for adequate coverage and reciprocate. Take the cue from the mandatory residents' 80-hour work week—there is a reason why so many people put so much work into making that a reality.

(4) Read a website about sleep hygiene. Make a pact with yourself and your family to get better sleep.

(5) Exercise. Find something that gives you joy, and makes you feel young and healthy. Talk about your activities with others.

(6) Find a specialty within your practice. Be the "go-to" guy or gal for ethics, policy, sarcomas. It is gratifying to have expertise in a certain area. Attend the meetings, read the books and articles. It is a way of developing a special interest within your daily work.

(7) Schedule break time into your schedule. Schedule a lunch break and a short break in the morning and afternoon. Schedule half an hour for emergencies. No one ever played a soccer game without breaks.

(8) Schedule your family's activities first, then schedule work-related activities around them, rather than the opposite. By doing this, you send yourself and everyone else a message about priorities. This doesn't mean you don't value your profession or your patients.

(9) Share your sadness. There is nothing in the world happy about the 30-year-old diagnosed with metastatic cancer; nothing funny about her four children wondering what is going on, nothing funny about that 30-year-old breadwinner becoming disabled and losing her self-esteem along with her job and ability to care for her kids. Understand that sadness and grieving are part of your work.

(10) Find ways to help your 30-year-old. Nothing is worse than feeling helpless. As her doctor, you never are. Ask her how you can help her and feel satisfied that you have done all you could. Then talk with others caring for her, tell them how you feel, listen to their reactions. We are all adrift together in this sea of humanity. Read those articles you may breeze by thinking they are a luxury, the ones where someone writes in first person about how he deals with dying patients.

(11) Learn the best way to tell someone bad news, so you will not have the added burden of feeling inadequate in your communication.

(12) Read and study theology, philosophy, and metaphysics, to help identify the things that make you most uncomfortable. Separate things you can't influence from those you can. Remember that many things are beyond your control. Change your inner dialogue from one of self-criticism to one of thankfulness and wonder.

(13) Share your laughter. Celebrate the small victories you achieve every day: Getting the pain down from a 10 to a 3. Helping a patient truly understand her side effects. Seeing a patient transform from frightened to confident. You know that one—he cowers quietly during his first visit, but by his fourth and fifth, has discovered that your office is a safe place where people really care and will help him.

—Laurie Lyckholm, MD