Opinion | Can We Please Stop Calling It Burnout?

I begin the drive home feeling oddly depleted. My overnight concluded with turning over 20-odd psychiatric patients, COVID and non-COVID admit holds, and workups to the next doctor for the third bleak January morning in a row. I’m also relieved: these were my first shifts after surgery for a broken wrist delayed by a COVID infection. Despite 3 weeks at home, the soreness in my hand and prolonged fatigue remind me that my recovery was slower than expected; I need to reassure myself that this isn’t burnout.

“The B-word” is on my mind because of an email reminder to complete a Mini Z provider burnout survey. While this is a scientifically validated instrument used to project provider retention, it’s the subject line I find insensitive: “Don’t forget to fill out the burnout survey.” I find the word burnout in our communication with each other to be dehumanizing and akin to stating that a patient has “expired.” Moreover, I find it unnatural to describe complex, individual experiences such as engagement, burnout (again, not my word), or pain and make them relatable to others using ordinal scales or graded variations of “always, sometimes, or never.”

Instead, my experience returning to work with a condition I call “Post-COVID Syndrome, Type B,” is best described as a narrative with an introduction, a body, and a conclusion.

You quickly get back into the pace of work, provided you remember the passwords to the EHR, radiology viewer, email, call room, and the bathroom. A stoic mindset facilitates intrinsic motivation to remain in the moment and make the most of the cards you are dealt. But I am thrown off by not recognizing staff. Someone asks me if I am new. The frustration and dissatisfaction from patients and families who are waiting are understandable. An elderly woman from a nursing home tells me, “You looked tired, dear,” and the moment of role reversal gives me pause. Exiting her room, a patient on a stretcher laments the time spent waiting for results. At discharge he tells me, “You know, you people really need to figure this out already — it’s been over 2 years.” Those exact words are returned in an automated email containing my individualized National Research Corporation picker comments at the end of the month, with a link to a video outlining how to boost patient satisfaction.

As I see it, the problem needing to be addressed is more complex than a simple measure of direct cause and effect. Our healthcare system is analogous to a tower of Jenga blocks constantly evolving when the players (in this case, forces outside our control) create efficiencies by moving pieces not 100% essential for stability and placing them on the top. The size of the tower increases; however, the structure becomes more vulnerable. In an emergency, disorder increases as pieces are placed slightly off-center, increasing the stress on the system. In the actual game, the players accept that a point of maximum efficiency exists that, when exceeded, will cause the tower to fall. That’s just how the game is played.

When asked to recall the rules of the game, we think of the instructions from Milton Bradley, not the overarching laws of the physical universe. According to Newton’s First Law of Thermodynamics, when the tower falls, entropy is lost, but energy is neither created nor destroyed. With that in mind, it is illogical to say that the blocks of wood “burn out” for abiding by the laws of the physical universe and gravity.

Pulling into the driveway, it begins to snow. I close down this line of thinking and start the ritual of transitioning to daylight hours. A bowl of plain Cheerios with whole milk and blueberries. A shower. I set the alarm on my phone and sleep for a few hours before getting the kids off the bus. By 7:45 p.m., I am back on the couch and being weighed down by a blanket and melatonin. The blustering snow outside continues, and I feel myself sink into the sofa and the depths of sleep.

The months that follow are marked by more of the same. The U.S. passes one million COVID deaths. The Surgeon General explicitly addresses burnout. We are on the lookout for monkeypox. There is a national shortage of IV contrast. Although the snow is gone, a 300-nanometer particle overshadows everything. And then one day, I heard Craig Finn’s song “Messing With the Settings” on the ride home. The verse, “Sundown, it feels like I’m riding a train I’m not on …” catches my attention, particularly about what it feels like for me to be a Jenga block: “… an all-at-once sensation of speeding and sinking.”

The lyrics become the diagnostic criteria for the condition I referred to earlier: Post-COVID Syndrome, Type B — a metaphysical ailment resulting from immersion in the milieu of COVID for the past 30 months — and form the basis for a screening test comprised of two fill-in-the-blank questions and a space for reflection.

Question 1: At sundown, do you feel like you’re riding a train you’re not on?

Me: Yes, on occasion.

Question 2: Have you ever experienced an all-at-once sensation of speeding and sinking?

Me: Sometimes. Right now, definitely.

Self-evaluation: Please reflect upon your responses.

Answer: I understand that the Mini-Z is not the venue for an amorphous response detailing the systemic failings of an overextended and inequitable healthcare system authored by a bleary-eyed provider at 4 a.m. whose non-dominant hand is in a Velcro splint.

Post-COVID Syndrome, Type B does not attack any objective measure of physiologic function, and patients are susceptible irrespective of COVID antibody levels or documentation of a positive test result. It’s a metaphysical ailment resulting from the ability of an inanimate particle to fuel depersonalization, making us myopic about the nature of cause and effect.

What resonates with me about the song, “Messing With the Settings,” is that the verse I found meaningful came from a woman named Rachel, who was also doing “her best with the deal she’d been dealt.” The fact that those words could find their way into my thought process and help me is an example of how even small changes in basic systems, like Jenga towers, or complex systems, such as healthcare networks, can result in unpredictable changes in the future state.

The sleight of hand — my magic trick, if you will — is that completing this survey diagnoses and treats this condition. It returns me to an exercise I learned from The Things They Carry Project, a free online writing project offering assistance to front-line healthcare workers. Taking time to put the words on paper so I can see them creates an opportunity to realign my values and perspective. As I write, I no longer see myself as a piece of the Jenga tower, and the perception of my experiences becomes analogous to the view through a kaleidoscope. As the barrel turns, the glass pieces roll and tumble through space per the laws of the physical universe. With the refractive error caused by Post-COVID Syndrome, Type B corrected, a perception of a physical world continually shaped and reshaped by reflections, of reflections, of reflections … is again seen clearly.

Michael Schmitz, DO, MS, is an emergency department physician in Maine and the medical director for the York County Emergency Management Agency.

“Messing With the Settings” by Craig Finn, copyright Songtrust Avenue, and used with permission.