I don’t know when the word burnout came into my vocabulary, but I feel that we use it constantly in our health care world today. I always thought I was immune to this concept of burnout. My self-talk was that I was strong and nothing would ever happen to me. As a psychiatrist and a yoga practitioner, I thought I was better equipped to “handle my feelings” and be in touch when I was not doing well. I definitely was wrong.

Our health care system is fraught with challenges. These challenges somehow felt manageable until they did not. We are commonly practicing in overcrowded emergency departments, without safe and private spaces to interview patients or provide care. Hallway medicine is becoming an acceptable cornerstone in our health care system, and the feeling is often that there is nothing we can do as health care providers.

It is truly amazing how the symptoms of burnout sneak up behind you and then quickly start to engulf your whole being. I always thought that exercise, good social connection, yoga, and meditative practices were my armor, and I was immune until I was engulfed. The symptoms were extremely subtle at first; they were almost unnoticeable. However, as my burnout progressed and I continued to ignore how I was feeling, it progressed to questioning why I was in medicine, whether I was a good physician, and whether my daily encounters were making a difference. I remember a cold, dark winter morning walking through the doors of my institution, and I had a clear flashback of my medical school days. The days that, no matter how exhausted I was, I was fueled by this passion and excitement for medicine. It was then that it clicked for me—a moment where I realized I had to change my trajectory; otherwise, I would be swallowed whole and lose the person I set out to become in medicine.

I have often attended talks on physician burnout where we hear about the “wellness checkboxes” that can help prevent it, but in fairness, I do not think that’s the key. I think the key for me was in reconfiguring my work and essentially working less and establishing some important boundaries about my work for myself. Now, here is where this conversation becomes a tricky one because, as physicians, it has been ingrained in us that the patient, and by virtue, duty, comes first. In that messaging, there is a subtle implication that you, as the provider, come second. I fundamentally feel that this thinking is fraught. I agree our training needs to make us resilient physicians, and at the same time, there is a fine balance of looking after our own needs. Setting boundaries for our work and call schedule is part of that, and yes, this means ultimately not being remunerated as much, but it is a choice one has to make.

There is something to be said about knowing oneself first before we can extend to try and help others.

Devina Maya Wadhwa is a psychiatrist.