There was a time when I thought burnout was easy to recognize, that it came with flashing red lights and emotional breakdowns. I imagined it as the dramatic kind of collapse you see in movies: a physician walking out mid-shift, tears in their eyes, leaving their stethoscope behind.

In those days, I didn’t really think about burnout. I believed burnout happened to other people, the ones who hadn’t mastered time management or learned how to compartmentalize their tasks. I was organized, disciplined, and genuinely loved my work. How could I possibly be burnt out?

But exhaustion doesn’t always arrive as a storm. Sometimes it shows up as a whisper, a dull fatigue you learn to live with. It crept into my days disguised as irritability, forgetfulness, and that quiet sense of disconnection that’s so easy to brush off as “just being tired.”

The truth is, burnout rarely begins with collapse. It begins with subtle indifference. And in medicine, indifference is often mistaken for resilience.

The myth of “I’m fine”

“I’m fine.” Two of the most dangerous words in our profession.

We use them to deflect concern, to hide exhaustion, to maintain composure. “I’m fine” is the armor we wear when our empathy has thinned but our charts are still complete, when we’re running on fumes but showing up anyway.

We say it when we find ourselves avoiding certain patients because we no longer have the emotional bandwidth to care as deeply as we once did. We say it when we’ve gone weeks without truly laughing, or when scrolling through our phones at midnight feels easier than sleep.

This isn’t laziness or apathy. It’s survival. It’s what happens when physicians push themselves beyond human limits and normalize depletion as part of the job.

The World Health Organization defines burnout as “a syndrome resulting from chronic workplace stress that has not been successfully managed,” marked by exhaustion, cynicism, and reduced professional efficacy. That’s a tidy definition, but one that misses the heart of the problem.

Because burnout isn’t merely a workplace issue. It’s a relationship crisis.

Burnout through the lens of the Anatomy of Alignment

In my Anatomy of Alignment framework, I describe life as a three-legged stool supported by three essential relationships:

• Relationship with self: How you see yourself (your values, boundaries, and capacity for self-compassion) and whether you can pause long enough to listen to your inner signals before they become screams.
• Relationship with significant other(s): This might be your partner, a trusted friend, or a confidant who truly knows you. The person who reminds you that you are more than your title, more than the letters after your name.
• Relationship with work and society: This includes your connection to your calling, your sense of contribution, and the meaning behind your work. When this leg weakens, purpose is replaced by performance (and fulfillment by fatigue).

The stool stands only when all three legs are sturdy, reinforced by crossbars of faith, rest, and stress management.

When one leg falters (often the relationship with self) the entire structure wobbles. We compensate by leaning harder on the others. Physicians, for example, often overinvest in the “work” leg, pouring everything into patients, charts, and responsibilities, while quietly neglecting their personal and emotional needs.

Eventually, that imbalance becomes unsustainable. Compassion fatigue sneaks in. You’re still standing, but barely.

And because our “work” leg isn’t just a job but a calling (even an identity) the cracks feel personal. When our performance falters, so does our sense of worth. We patch those cracks with caffeine, late-night charting, and the classic reassurance: “It’s just a busy season.”

But the uncomfortable truth is this: In medicine, every season is busy.

When empathy erodes, patients feel it (even when we don’t)

It’s not just physicians who suffer when emotional fatigue sets in. Patients feel it too.

Research consistently links physician well-being with patient outcomes. A 2018 JAMA Internal Medicine study found that burned-out physicians were twice as likely to be involved in patient safety incidents. Other studies have shown that patients cared for by engaged, empathetic doctors experience shorter hospital stays, higher satisfaction, and better adherence to treatment plans.

When we’re depleted, we can still deliver competent care, but something vital is lost. Compassion becomes mechanical. Our tone flattens. Eye contact shortens. We miss subtle cues: the hesitation before a question, the tremor in a voice, the “by the way…” comment that often reveals a hidden fear or diagnosis.

We think we’re holding it together. But patients can sense when we’re emotionally absent. And that’s what makes burnout dangerous: It often goes unnoticed (by us). The longer we normalize depletion, the more invisible it becomes.

Perceived risk vs. actual risk

There’s another dimension to burnout that rarely gets discussed: the difference between actual medical risk and perceived medical risk.

When a physician is emotionally fatigued, both increase.

A patient may not be able to identify what feels wrong, but they can sense the disconnect. A doctor’s distracted demeanor, shorter visits, or lack of empathy can make even competent care seem unsafe.

And here’s the hard truth: Most malpractice suits don’t arise from clinical mistakes; they stem from broken trust.

Patients rarely sue doctors they feel connected to. They sue doctors who make them think dismissed, unseen, or unheard. That’s why burnout isn’t just a personal wellness issue. It’s a risk management issue, one with profound ethical and financial consequences for health care systems everywhere.

Medicine: the profession that teaches self-disconnection

It’s an irony few outside medicine truly understand: A field built on empathy systematically trains its practitioners to disconnect from their own emotions.

We learn early to ignore hunger, fatigue, grief, even joy, anything that could interfere with “professionalism.” We’re told to be stoic, efficient, and perfect. But those very traits, while useful in crisis, become corrosive when adopted as a lifestyle.

Physicians are at least twice as likely to die by suicide as the general population. That statistic should stop us in our tracks. This isn’t about weakness. It’s not a lack of resilience. It’s a culture that mistakes emotional suppression for strength.

We’re taught to care deeply, but not too deeply. To empathize, but not internalize. To connect, but never crumble. It’s an impossible formula, and it’s taking lives.

The moment it hit me

I’ll never forget the patient who quietly held up a mirror to my own fatigue.

She was scheduled for a routine visit, nothing urgent, nothing complex. Yet as I reached for her chart, I felt that familiar sigh escape me. I walked into the room determined to stay composed, efficient, and professional. We went through the motions: history, examination, plan. No errors, no missteps. Just another patient, another day.

Then, as she stood to leave, she said softly, “Thank you for listening. You’re the first doctor who made me feel seen.”

I smiled, but inside, I froze. Because I knew (deep down) I hadn’t truly been there. My mind was already elsewhere, halfway through my task list, bracing for the next appointment. That was my wake-up call. Not because I had failed clinically, but because I had drifted so far from the heart of my profession that I couldn’t feel the difference between being present and merely performing presence.

The subtle signs we miss

Burnout rarely announces itself. More often, it slips quietly into daily routines.

• You stop returning calls from friends.
• You begin to dread certain clinic days.
• You feel irritation toward patients who remind you of your own vulnerabilities.
• You find yourself laughing less.
• You feel nothing after good news (or bad).

You call it exhaustion, promising yourself that rest will come later. But it never arrives later, because the system never stops demanding. So you stand perfectly still on that uneven stool, pretending you can balance forever.

You can’t. Eventually, the wobble wins.

Why this matters beyond the doctor’s office

When physicians lose empathy, the damage extends far beyond individual interactions. Teams fracture. Communication erodes. Medical errors multiply. And the trust between patients and providers (the foundation of care) begins to crumble.

But this erosion isn’t only about fatigue. It’s about moral injury, the deep ache that comes from knowing what good care looks like but being unable to deliver it within a broken system. It’s the guilt of rushing through appointments because of administrative overload. The shame of knowing patients deserve better than the ten minutes you can give them, the helplessness of realizing that compassion has been replaced by compliance.

That isn’t burnout. That’s betrayal: of the ideals that once drew us to medicine and of the humanity the system too often forgets.

The relationship prescription

So, what can we do?

We begin where we often tell our patients to: with awareness. You might not be in complete burnout. You might just be inching toward it. But awareness allows intervention.

Start by strengthening your stool:

• Reconnect with yourself. Revisit your “why.” Allow yourself to rest, to feel, to want.
• Nurture your relationships with friends, family, and colleagues. Emotional isolation breeds depletion.
• Re-examine your relationship with work. Ask whether you’re serving it, or it’s consuming you.
• Reinforce your support (faith, community, therapy, creative expression). Whatever reminds you that your productivity doesn’t define your worth.

You can’t pour from an empty cup, and many of us have been trying to fill others from an empty mug for years.

Humor, humanity, and healing

Viktor Frankl once wrote: “Between stimulus and response, there is a space. In that space is our power to choose our response.”

That space (that moment of pause) is where healing begins. The best medicine isn’t always found in a prescription pad. It’s in laughter with colleagues, in silence between patients, in permission to be human.

If your empathy feels lost, don’t panic. It’s still there, just buried under endless messages, unfinished CME credits, and the exhaustion of caring too much for too long. You can find it again, with humility, support, and the courage to slow down. Healing doesn’t require grand gestures. Sometimes, it begins with something as small as admitting you’re not OK, and believing that’s a perfectly acceptable place to start.

From surviving to aligning

The path forward isn’t about chasing balance or adding more to-do lists of self-care rituals. It’s about alignment.

When your relationships with yourself, others, and society are in harmony, the work regains meaning. You rediscover purpose in the familiar rhythm of medicine. The same patients, the same system, but a renewed sense of connection to why you began.

We must stop glorifying burnout as proof of dedication. It’s not. It’s evidence of disconnection: from self, from values, from humanity. When physicians heal, so do patients. When doctors align, the system shifts.

That is where hope lives: in alignment, not endurance.

Final thoughts: from awareness to action

The next time you hear yourself say, “I’m fine,” pause. Check your pulse, not the physical one, but the emotional one. Ask yourself: Am I aligned? Am I connected? Am I whole?

Because the cost of ignoring burnout isn’t just personal suffering, it’s diminished empathy, broken relationships, and a loss of the soul of medicine itself.

We may not fix the system overnight, but we can start with honesty, and by offering each other the compassion we so freely give to patients. Medicine will always be demanding. But healing doesn’t require perfection, only presence. And sometimes, the most courageous thing a physician can say is, “I’m not OK, but I’m working on it.”

That isn’t a weakness. That’s wisdom.

Tomi Mitchell is a board-certified family physician and certified health and wellness coach with extensive experience in clinical practice and holistic well-being. She is also an acclaimed international keynote speaker and a passionate advocate for mental health and physician well-being. She leverages over a decade of private practice experience to drive meaningful change.

Dr. Mitchell is the founder of Holistic Wellness Strategies, where she empowers individuals through comprehensive, evidence-based approaches to well-being. Her career is dedicated to transforming lives by addressing personal challenges and enhancing relationships with practical, holistic strategies.

Her commitment to mental health and burnout prevention is evident through her role as the host of The Mental Health & Wellness Show podcast. Through her podcast, Dr. Mitchell explores topics related to mental fitness and stress reduction, helping audiences achieve sustainable productivity while avoiding burnout.

Dr. Mitchell is also an author. Her book, The Soul-Sucking, Energy-Draining Life of a Physician: How to Live a Life of Service Without Losing Yourself, addresses the unique challenges faced by health care professionals and provides actionable solutions for maintaining personal well-being in demanding careers.

Dr. Mitchell’s expertise and advocacy have been recognized in her role as an executive contributor to USA Today, Thrive Global magazine, KevinMD, OK! Magazine, and Brainz Magazine, as well as across various television and radio platforms, where she continues to champion holistic wellness and mental health on a global scale.

Connect with her on Facebook, Instagram, and LinkedIn, and book a discovery call to explore how she can support your wellness journey. For those interested in purchasing her book, please click here for the payment link. Check out her YouTube channel for more insights and valuable content on mental health and well-being.