Doctors of all stripes are at risk for stress and burnout because of busy medical practices, increasing demands from insurers, and not enough time for each patient visit. Oncologists are additionally stressed by the nature of their practice—dealing with the emotional and psychological trauma that comes with losing a patient to cancer.1

Experts interviewed for this article were in agreement about approaches for dealing with stress and burnout. They said that a key priority when entering clinical practice is learning how to make personal time for restoration and rejuvenation.

“All residents and fellows are starting with a deficit from a long and grueling training. They have had the desire to take care of themselves drilled out of them. Training to be a doctor overrides one’s basic self-care needs, and medical trainees suffer from constant sleep deprivation. Finishing medical training is like coming out of a cult in terms of self-deprivation,” said Ahnna Lake, MD, from Stowe, Vermont, who counsels individual physicians and speaks to professional organizations on work–life issues, stress, burnout and depletion, and health recovery.

“The first step is to reconnect with your right to take care of yourself,” Dr. Lake stated. Ideally, it would be great to take a break before starting clinical practice to hit the reset button. Although taking vacations might seem to be a good way to mitigate stress, Dr. Lake said that it is often more stressful to go on a holiday—you need to work extra hard to prepare to go away and then again when you get back to catch up. She advises finding a way to restore oneself day to day and week to week to avoid burnout.

Each person’s choices will be different, but activities that lead to self-restoration would include those that counter the functions performed at work. For oncologists, it is important to engage in life-affirming activities that might include physical exercise, lunch with friends who are not doctors, taking a walk, meditating, or attending cultural events. “You are the only person who can assess how well you are restoring yourself. At regular intervals, you should assess your energy, general health, work satisfaction, relationships, and inner joie de vivre,” she said.

Lack of energy to make changes is a sign that burnout has tipped over into clinical depression, and intervention is needed. “If you are depressed and depleted, treatment for depression can give you a leg up,” she explained.

According to Peter S. Moskowitz, MD, a certified career and life coach working exclusively with physicians, and professor of radiology at Stanford University School of Medicine and executive director of the Center for Professional and Personal Renewal in Palo Alto, California, work–life balance is the key ingredient to avoiding stress and burnout.

First define your sense of purpose, he advised, and that means doing so in the deepest way. “Why were you put on this earth?” he said. Then stick to activities that fulfill that sense of purpose, and don’t be sidetracked by secondary activities no matter how worthwhile they may seem.

Dr. Moskowitz outlined 6 important domains that should be balanced: physical, emotional, spiritual, relationships, community, and career. “Address how you spend your time and energy in each of these domains. It is important not to let your career overwhelm the other domains. Set boundaries about how much you are willing to take on. Learn to say no to requests not well aligned with your personal values and sense of purpose,” he advised.

Laurie Lyckholm, MD, an oncologist at Virginia Commonwealth University in Richmond, said: “Being an oncologist is incredibly stressful. You give patients everything you have, and you are often rewarded with beautiful relationships, but burnout is a constant threat or ‘sword of Damocles.’” Dr. Lyckholm has written several articles on stress and burnout in oncology.1,2

Signs of burnout can include substance abuse, marital conflict, overeating and weight gain, increased frequency of clinical errors, temper outbursts, relationship problems, and depression and/or anxiety.1

Dr. Lyckholm’s list of strategies for avoiding stress and burnout includes the following: Take short breaks throughout the workday, take time away from work, participate in regular physical activity, follow good sleep hygiene, seek balance both personally and professionally, incorporate time management strategies into your practice, engage in meditation, share grief and successes with colleagues, and learn to grieve appropriately when patients die (Table 1).

Table 1. Stress Management for Oncologists
Take short breaks throughout the workday.
Take time away from work.
Participate in regular physical activity.
Follow good sleep hygiene.
Seek balance both personally and professionally.
Incorporate time management strategies into your practice.
Engage in meditation.
Share grief and successes with colleagues.
Learn to grieve appropriately when patients die.

Adapted from reference 1.

Recognizing that the practice of oncology is fraught with stress, burnout, and grief, a group of researchers at the University of Rochester in Rochester, New York, found that a pilot program incorporating humanities curricula into oncology training holds promise for reducing stress.3 The Narratives in Oncology course uses a narrative-based humanities approach focused on the patient–physician relationship. During this course, medical trainees discuss narratives by physicians and patients related to cancer. So far, it appears that incorporating a course like this one into medical training can rekindle physicians’ empathy while reducing stress.

Hopefully, increasing recognition of the stresses associated with oncology practice will lead to the development of additional approaches and modifications of medical training that can alleviate this problem.

References 

  1. Lyckholm L. Dealing with stress, burnout, and grief in the practice of oncology. Lancet Oncol. 2001;2(12):750-755.

  2. Lyckholm L. Avoiding stress and burnout in cancer care. Words of wisdom from fellow oncologists. Oncology. 2007;21(2):269. 

  3. Khorana A, Shayne M, Korones DN. Can literature enhance oncology training? A pilot humanities curriculum. J Clin Oncol. 2011;29(4):468-471. 


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