Clinical psychologist Dr Matt Slavin on the early symptoms of burnout that GPs should keep an eye out for, and how to tackle them
‘I was running on fumes but not even aware of it,’ David* shared in our final session, reflecting on his experience of burnout. ‘I was just putting one foot in front of the other. The scary thing is that I didn’t even see it coming.’
David’s experience is, regrettably, not uncommon. As a clinical psychologist, I am seeing a growing number of GPs struggling with burnout, often failing to recognise the early warning signs until it’s nearly too late. The demanding nature of the profession frequently compels GPs to push through fatigue and stress, inadvertently masking the onset of burnout.
What is burnout?
Coined in the 1970s by American psychologist Herbert Freudenberger, burnout describes the impact of chronic and severe stress. It represents the long-term result of sympathetic-nervous-system activation. For me, the term conjures vivid imagery of a flame extinguished, all fuel depleted.
Burnout, as defined in the ICD-11, is an ‘occupational phenomenon’ resulting from chronic workplace stress that hasn’t been successfully managed. It is characterised by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and a reduced professional efficacy.
The demands on GPs
Stress, uncertainty, and demands are rife in general practice. I often hear, ‘there’s never enough time in the working day.’ ‘Protected time’ is rarely shielded, and tasks beyond surgeries make 13-hour days more common than not. The constant pressure, high patient volumes, and practice management create a relentless strain. By the time many GPs seek my help, they are often already deeply entrenched in burnout.
Therefore, it is essential for GPs to notice the subtle and often overlooked signs of early burnout in themselves and their colleagues. Being able to do this at the onset of the problem might mean that intervention can help them from wearing out completely.
What are the signs of burnout?
Many doctors experiencing burnout will experience an erosion of their empathy towards patients. Diminished compassion means GPs may find themselves feeling detached or less invested in their care. Instead of engaging meaningfully, they might rely on routine reactions, scripted responses or showing a disinterest in patients’ concerns. It is also not uncommon to experience an increased cynicism towards patients’ conditions or in your belief that you can make a meaningful change.
If you find yourself frequently becoming unusually frustrated or irritable with colleagues over minor issues, it could be a sign of burnout. This can also coincide with a breakdown in communication; difficulty in collaborating effectively or increased conflicts with team members can indicate underlying stress. In addition, withdrawal or a reluctance to engage in team meetings or social interactions within the workplace may signal emotional exhaustion.
GPs affected by burnout might experience a sense of disruption in time perception and work attitudes. Clock-watching and consistently feeling frustrated by time spent at work can reflect deeper issues. Another significant indicator of burnout is an increased work avoidance – moving from a high level of engagement and perfectionism to procrastination or avoidance of tasks. You might also start fantasising about premature retirement or career changes as a result.
The emotional impact of burnout cannot be understated. Those affected may experience persistent exhaustion, feeling constantly drained – even after a good sleep or time off work. ‘Brain fog’, ‘cloudy thinking’ or making more mistakes than usual can be a result of impaired concentration. Furthermore, if you find yourself having unexplained mood swings, then there might also be a risk of burnout.
Aside from cognitive symptoms, burnout can manifest itself in physical symptoms too. These can include: headaches, appetite changes, digestive issues, nausea, and low libido. Sleep disturbances are frequent too, whether it is a matter of falling asleep or staying asleep.
Burnout can also cause changes in your professional motivation and career goals. You might notice a significant decline in enthusiasm for your role, or a loss of interest in professional development opportunities. Something else that can also happen to those suffering is goal displacement: your focus may shift from patient care/professional growth to merely just getting through the day.
Addressing burnout early: the B.A.L.A.N.C.E method
Recognising the early signs of burnout is crucial for prevention and effective intervention. The approach I often use with GPs who come to me is one I have cultivated myself, to help reset the nervous system, manage stress, and restore balance:
Begin with awareness
Recognise and understand the signs of burnout. This involves being mindful of your physical, emotional, and mental state. Regular self-reflection and practices to increase emotional literacy help to identify subtle changes in your thoughts, mood, and energy levels. By becoming more attuned to these internal cues, you can catch early warning signs and take proactive steps to address them.
Assess the situation
Evaluate your current state, needs, and values. Take a step back to review your workload, work-life balance, and personal values. Understanding what is causing your stress and how it aligns with your values can provide clarity on what needs to change.
Learn the strategies
Implement evidence-based stress management techniques tailored to your needs. This could include breathwork, mindfulness practices, compassion-focused exercises, sensory regulation or body-based techniques. Finding what works best for you and incorporating these strategies into your daily routine is key to managing stress effectively.
Address root causes
Identify and address the underlying causes of burnout. This includes exploring and transforming negative beliefs, adverse experiences, and traumas that may contribute to your stress. Working with a Clinical Psychologist can provide specialised guidance to uncover and address these root causes. Techniques such as EMDR (Eye Movement Desensitization and Reprocessing) can be particularly effective in resolving deep-seated issues. By addressing these root causes, you can create lasting changes and prevent burnout from recurring.
New habits
Integrate healthy habits into your routine at home and at work. Developing a routine that promotes physical and mental health can create a strong foundation for resilience against stress.
Committed action (accountability)
Set up support and accountability to maintain new practices. This might include working with a therapist, or having a colleague or friend to check in with regularly. Accountability helps ensure you stay on track and continue implementing the changes you need.
Enjoy the results
Experience the positive changes in your well-being and performance as you move from burnout to balance.
Renewed perspectives and professional growth
Burnout doesn’t have to be an inevitable consequence of a demanding profession. By recognising the early signs and taking proactive steps, you can maintain your well-being and continue to provide exceptional care to your patients.
If you recognise these early signs of burnout in yourself or a colleague, seeking support and taking proactive steps towards balance is crucial. Prioritising self-care and mental health can make a significant difference.
*Please note: ‘David’ is a pseudonym used to protect confidentiality.
Dr Matt Slavin is a clinical psychologist specialising in burnout prevention and recovery for individuals and teams.
