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Stress and burnout: The intern years

Stress-and-burnoutDr Lynelle Govender, a Community Service Medical Officer at Area Military Health Unit (Nelspruit), Mpumalanga, recounts the exhausting lifestyle of the average intern

I’ve been awake for the last 26 hours. My last meal was a can of cola and a piece of cold pizza – ten hours ago. My registrar tells me I should see the patients in casualty, follow up the blood results, take the “head-injury” to CT scan and meet him in theatre for the next case.

My fellow intern is currently standing outside smoking a cigarette, like his life depends on it (excuse the paradox). We’ve all been there. Where the smell of blood can’t be shaken and the beep of a persistent monitor is the soundtrack to your life as an intern. Somewhere between sleep deprivation and being overworked (or worse, abandoned by your seniors), you start losing hope.

You are exhausted, broken and angry. Both the patients and you are suffering the consequences... and you still don’t realise that you’re experiencing burnout.

How do I stress thee? Let me count the ways:

  • Fatigue – As an intern, you know fatigue best. It’s that potent combination of sleep deprivation, poor eating habits, and an immune system that has taken a battering. No young person should be as tired as you are. Tired right down to the disturbing new creak in your knees.
  • Expectations – Your patients expect you to keep miracle cures in your back pocket. Your boss expects you to be perfect. And you, following a lifetime of achievement, have only the highest expectations of yourself. The pressure is high and the room for error seemingly non-existent.
  • Lack of supervision – Internship is already stressful without the added burden of an absent registrar, who feels the urge to sleep while you manage patients alone.
  • Personal issues – Behind every slave intern, there exists a life, relationships, finances – a whole world. In the hospital, we function as the most lowly of gears in the unit, and it is often forgotten that perhaps we have more on our plate than just pleasing the consultant.
  • Compassion fatigue – In medical school they taught us compassion fatigue in a vague way. Getting tired of being nice to patients. It didn’t sound so bad. In reality, compassion fatigue is more like a vicious cold anger. Anger at the sheer numbers of patients and frustrated at them for being irresponsible with their health.
    In reality, compassion fatigue is more like a vicious cold anger. Anger at the sheer numbers of patients and frustrated at them for being irresponsible with their health

    The bone-deep exhaustion of internship can drain all your passion for medicine and your best efforts at empathy dwindle away with it. Furthermore, an unco-operative patient is usually unceremoniously thrust upon the intern to deal with, while the senior doctors do their affectionate disappearing act.
  • Poor working conditions – If this were a glamorous TV drama, we would be wearing pristine blue scrubs while working in a pristine hospital. However, in reality, the hospitals are in some level of decay, your clothes are spattered with blood and the call rooms have more bugs than you’d care to mention. With so many things to deal with, it’s no wonder that burnout is rife amongst the intern community.
In reality, compassion fatigue is more like a vicious cold anger. Anger at the sheer numbers of patients and frustrated at them for being irresponsible with their health

So what’s the secret to surviving internship without burning out?

  • Good grazing – On a call and throughout your busy day, keep healthy snacks on hand and drink water often. Dehydration will only worsen fatigue. Sadly, caffeine and nicotine are not a balanced meal.
  • Know your rights – be aware of the legislation that is there to protect you:
    • Read your work contract very carefully. Make sure you are not working more overtime than you signed for. Do not allow yourself to be abused. Remember you can alert the HPCSA to any problems you may be experiencing.
    • An intern should have supervised learning. The key word is “supervised”. If you are unsure, ask.
    • Your hospital has an intern curator. Use his/her help when you find yourself struggling.
  • Mayday – Seek support from your peers, friends and family. When the intern-ship is sinking, there is no shame in sending out an SOS.
  • Unwind – Spare time is a rare treasure in internship. Fill these hours with the things you enjoy. Shift your focus and you will find that your mood will shift as well. These momentary distractions may seem superficial but will serve as a reminder that you are more than just an intern.
  • B is for Benzos – Avoid the trap. As medics, we’re surrounded by a variety of happy pills. Don’t make the mistake of confusing a pharmaceutical band-aid with real help.
  • Peer-perspective – Look around at your peers... the strong ones, the smart ones, the ones that seem to ooze confidence when they speak to consultants. Believe me, they have all had days of breakdown, tears and madness. They just know how to fake it a little better.
  • Keeping up the kindness – In the battle against compassion fatigue, your best weapon is yourself. Look after yourself. Take a minute between difficult patients to take a deep breath; it’s sometimes all it takes to remind yourself that your frustrations are misdirected if poured onto an unsuspecting patient.

    Don’t attempt to justify poor treatment of patients. Accept that you were at fault with a pinch of humility; it can do wonders to curb the endemic of arrogance in our profession.
  • Many hands make light work – When tackling a difficult or intoxicated patient, help is imperative. Trying to gain IV access alone will not score you points with the consultant. It will most likely only get you a needlestick injury.
  • Dodging the decay – It’s easy to feel victimised when working a tough job in a dilapidated building. Remember that the hospital is simply the environment. Your actions and attitude are more important than the setting. That said, a sleeping bag and bug repellent can be lifesavers during a rough call.
  • Reality-check – Finally, accept the reality. You are an intern; it will be an exhausting two years. But more than that, you are human, and it’s ok for you to make mistakes and ask for help now and then.

The SAMJ has published an interesting article on the working conditions of interns: Erasmus, N, ‘Slaves of the state – medical internship and community service in South Africa’, Vol 102: No 8 (August 2012)

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