If your conscious mind is asking, “Is this what burnout feels like?” your little voice already has the answer.

One of the things physicians ask me on our coaching discovery call is whether or not I think they are burned out.

They want a second opinion from a fellow doctor. That’s a natural instinct, and yet, my opinion is completely irrelevant in the arc of their life as a physician.

What matters is how you feel.

Burnout is something you feel. Burnout is something your rational mind is always trying to talk you out of.

The voice of your “rational” mind is laid down by the programming of your residency years. It says things like:

• Stay the course, don’t rock the boat.
• You’re gonna make it.
• Hang in there; you just have to work a little harder.

This voice does the arguing, the defending, the debating, and convincing.

On the other shoulder, sits your “little voice.” This is the one that tells the truth.

Everyone carries this little voice as their own inner second opinion.

So when a prospective coaching client asks me if I think they are burned out, I tell them to listen to that little voice. What is it saying right now?

This little voice survey is something I have done with hundreds of physicians at this point. There is a distinct four-part pattern to their responses.

Your little voice survey: four phrases

Level one

“I still love my patients, I still like being a doctor, I just really don’t like this job.”

This is the voice of stress. You are working too hard, and your job is not a good match with your Ideal Job.

Despite the strain, you are still dedicated to and connected with your Lightworker calling.

Your emotions and spirit are strong.

Physically, your current reality is taxing.

You are still feeling okay about your ability to help your patients and make a difference.

Let me be reassuring and sound the alarm at the same time. This is a warning shot across your bow.

You are not significantly burned out now and making changes towards a more ideal job/practice will make a quick and significant difference. If you don’t fine-tune your job now, this could progress to burnout and any of the little voice statements below.

Level two

“I’m not sure how much longer I can keep going like this.”

This is the voice of the first symptom of burnout – physical and emotional exhaustion. This is the most common burnout symptom in doctors.

It is also the voice of the downward spiral. You are drained enough that your physiology is in survival mode. Just getting through the shift, week, month is the prime directive.

If we were to measure your quality of care and patient satisfaction and compare it to baseline, you are compromised.

This little voice phrase should be a huge red flag to make some changes.

Your job/practice will not change itself. It is time for active measures to get back on a path with more purpose.

Unfortunately, most find a way to ignore this little voice and end up either chronically burned out or in a physical or emotional crisis – the brick wall.

Level three

“What’s the use? I am really not making a difference.”

This is the third symptom of burnout. Christina Maslach called it “lack of efficacy.” It is a symptom of spiritual futility.

You chose medical school to become a helper and a healer and to make a difference in the lives of your patients and their families. You have lost that connection with the purpose in this choice. It is a spirit-level wounding.

If this is your little voice, you are also hearing the, “I’m not sure how much longer …” saying too.

With this level of exhaustion, separated from the purpose of your choice to be a Lightworker, it becomes very difficult to carry on.

Beware of drugs, alcohol, depression, and thoughts of hurting yourself. Get help if you notice any of these.

With dedication and support, you can recover from this with some significant self-reflection and new actions at work. And even this level of burnout can become a chronic condition for some doctors.

Level four

“I should have never become a doctor/gone to medical school in the first place.”

This is an even deeper separation from spirit. You are so far removed from making a difference that you doubt your choice to become a Lightworker in the first place.

This is spiritual and emotional heartbreak. It is a fracturing of a life you hoped to live when you made your original choice to become a physician.

You must beware of drugs, alcohol, depression, and thoughts of hurting yourself. Get help if you notice any of these.

You can still make changes that will restore your faith in that original choice and your ability to make a difference as a doctor. And even this level of distress and despair can become a chronic condition in some physicians.

This conversation between you and your little voice is always the one I want to facilitate.

Welcome it in, turn up the volume, and give it some space to tell the truth – then listen carefully.

Listen, take heart, and take new action:

Things can always get better … always. And that change will only happen when you take new actions.

Take a break. Ask for help/support. Tell a good friend or a coach how you really feel. This does not have to be the end of your medical career.

You can still be a good doctor and return to enjoying your patients and your practice. Your little voice is trying to wake you up to let you know it’s time for a change.

Let me close today with two sayings that both sting and have most people nodding their head:

If you always do what you have always done, you will always get what you’ve always got.

You don’t get what you want in life; you get what you tolerate.

Two questions

What is your little voice saying these days?

When is now the time to stop tolerating your current reality?

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.