"You have to take care of those basic needs, because if not, you're not going to have the space to react differently when you're getting triggered," says Diana Londoño, MD.
In this installment of “Begin Your Journey,” urologist Diana Londoño, MD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about recognizing and reacting to triggers that lead to burnout. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.
MacDiarmid: Let's come back to triggers. I find [that] on weekends I can give, I could help someone, I could be a coach. But ask my partners on a Wednesday morning while I'm under stress, I wouldn't be the best coach, for example. Let's talk more about the triggers, whether it's your perception that you feel the patient is being ungrateful or quite frankly, not very kind to you, or it's an issue with a partner down the hall. Do you have a game plan for how you prepare for triggers? How do you bail out when you can just feel yourself getting upset, frustrated, irritated, annoyed?
Londoño: You definitely have to prepare, because if you just show up and it just sort of slaps you in the face, you're just going to react with anger or frustration. This recently happened to me. It was a few days before my vacation, and my cup was really running thin; it was my birthday. Your compassion starts getting really thin. And when you haven't taken time to replenish yourself, and you're getting tired, and you're not taking care of those basic needs, and you need that vacation, you need that time to just step away for a little bit. And so when you are at that [point where your cup] is very empty and there's no room for compassion, and then the triggers occur, and then you don't have that space from that trigger to your reaction where maybe you want to really want to be a little more kind or compassionate. And that's where taking care of basic needs, or any practice where you are steering away from fight or flight... it gives you a lot of space to realize, OK, this person is annoying, me, frustrating me, make me angry, but I'm going to slow it down, slow down the movie, and maybe I can give some compassion and realize they're also probably getting triggered, and react in a different way. You have a choice of how to react. You have to take care of those basic needs, because if not, you're not going to have the space to react differently when you're getting triggered. And then later, when you step away a little bit, then you can have a little time to say, why am I getting triggered? What's going on here? What's unresolved that I need to resolve? What is it trying to teach me, what lesson? You can do that work later. But I think in the moment, if you're always on your last straw, because you haven't taken care of your basic needs, then there isn't going to be space for you to step back and act differently than being angry or rude. We have to really come prepared so our tank is full and not depleted every day at work.
MacDiarmid: I’ve learned a lot about pre framing and framing. I always liked psychology when I was training back in Halifax, Nova Scotia, and it really does allow you to be ready for the, let's say, what you perceive as the ungrateful patient or your perception that the nurses aren't doing the quality of work that you hope for, and you're getting frustrated. You can almost condition yourself to walk in the room and say, be grateful, or walk in the room and say, be compassionate, and it does prepare you well. I think preparation helps. Also, I have found that time is a stressor for me. There's not a lot of reserve when we're just rushing so much. Any thoughts on that?
Londoño: Yes, and that may be very different for different people. Some people may not feel that discomfort when they're seeing 50 patients a day; they feel fine. For me, that would give me IBS; I really cannot do that. I know my boundaries, and I know where my time is getting too thin, where I really cannot be a good physician when I'm so strapped for time or I'm just trying to rush and get people through. Those are personal things that then you have to realize by yourself and make changes and have boundaries to say, "This is how I want things to be." There are, of course, some jobs where you may not have a say. And if that's a core value that's important to you, then you may have to go look elsewhere. Sometimes, the system may not change where you are at. So you may have to pause, think about, what are your values, what's important to you? Can you work in that environment? And if you cannot, then you have to make some decisions because otherwise that breeds resentment, anger, frustration that you're going keep in because you know at your core that this is not working for you, this is not right. But you keep pushing through it, because we're kind of taught that in medicine. That really will make you ill and drive you to burnout because that's not compatible with your values.
This transcript was edited for clarity.