Date: September 11th, 2020

This is an SGEM Xtra episode. I was invited by the College of Physicians and Surgeons of Ontario (CPSO) to give a talk at their council meeting on burnout. It was an opportunity to share my journey and give an important message about kindness.

I have discussed burnout and wellness a number of times on the SGEM:

* SGEM#289: I Want a Dog to Relieve My Stress in the Emergency Department

* SGEM Xtra: CAEP Wellness Week 2019

* SGEM Xtra: On the Edge of Burnout

* SGEM Xtra: Don’t Give Up – The Power of Kindness

* SGEM#178: Mindfulness – It’s not Better to Burnout than it is to Rust

* SGEM Xtra: Five Tips to Avoid Emergency Medicine Burnout

Burnout vs. Moral Injury

The word burnout was coined by Herbert Freudenberger in 1974. He defined it as “a state of fatigue or frustration that resulted from professional relationships that failed to produce the expected rewards”.

A distinction between burnout and moral injury was made during the presentation. Moral injury has been defined as: “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations”. This was originally described in soldiers’ responses to their actions during war.

Journalist Diane Silver described moral injury in her State News article as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” The moral injury of physicians is being unable to provide high-quality care they want to provide to their patients.

My struggle with Burnout

My struggle with burnout included the death of my father (Dr. Ken Milne Sr.) in November of 2018, the sudden death of my “little” brother Scottie (The Moose) in February 2020 and the unexpected death our family dog Moxy (best dog every) this summer. Much of this taking place in the context of the COVID19 global pandemic.

All the slides from this CPSO presentation can be downloaded and shared from this link. The CPSO video recorded the presentation and it should be available soon. There are also a number of references for further information on burnout.

* Shanafelt et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc 2015

* Shanafelt et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction.