All right, well, so let's introduce Dr. Scantonbury. Alan, if you... So Dr. Dawn Scantonbury is a cardiologist and senior associate lecturer at Queen Elizabeth Hospital, University of the West Indies. And I'll let her tell a little bit about her wellness region here and then take us through her talk. Burnout and solutions to deal with them. Thanks, thanks all for having me. This is a Tai Chi class and I'll talk a little bit more about that as well. So we're gonna talk about causes and solutions of burnout. So we've all seen these images, the burnt out matchstick, healthcare workers all burnt out. And I particularly like this one with the battery image where the battery is on empty. So my journey with burnout starts the end of 2022. Part of this, this is when we were a work group, not a committee as yet. And one of the things that we had done was to trial this online mental health therapy app. And so we had this free trial for a few months and, but part of it, they give you, you give them your credit card and you just have to remember to cancel it before the period of time is up. And I joined the app, I did a subscription and forgot about it and didn't do anything for it. And then unfortunately I also forgot to cancel. So my credit card got charged. So I'm like, okay, I could as well take advantage of it. And I did, you know, part of signing up was to get a therapist. You answer all these questions or what are your preferences and values, et cetera. You get a therapist and you do some sessions with a therapist. And I remember during one session thinking to myself, I am wasting my time. And I'm just telling this woman what she wants to hear. And I am not doing this anymore, but so like cancel the rest of the sessions with her because of course, by the end of the month, I forgot to cancel the subscription again. So my credit card got charged a second time. So I had a few more weeks left. So I decided to do some group sessions. And one of the sessions was on burnout. And they took you through these different phases or stages of burnout. So there's this 12 stage burnout construct. And then there was a five stage construct. And because I'm busy and I kind of have a little bit of ADHD, there was no way I was going to go through that. But this five stage thing kind of resonated with me that on honeymoon phase, et cetera. And it was much easier to navigate. And I had an aha moment. And at that point, I went over my life. And I thought, you know, all of these people are talking about burnout. And I'm like, I'm fine. There's nothing wrong with me, but I am the definition of burnout. And, you know, sometimes introspection or retrospection or whatever is necessary. So I kind of took a step back and walked myself backwards throughout my career since fellowship and thought, you know, I really need to make a change. Otherwise I will be completely burned out. So I'm going to take you through that retrospect for scope that I did. So my honeymoon phase, I finished fellowship 2015, went back to Barbados. As I said, I'm the, I was the only interventional cardiologist in our public health system at the time. So I kind of, I actually started the PCI program in our hospital straight out of fellowship. So public job, it's, we are, even though we're not quite an underdeveloped country, we kind of are in the public health system and very, very underfunded. But I got the program up and running, yippee. I, you know, it's general cardiology I'm doing as well. My ECHO list was actually under control. And, you know, I was doing all of this. I joined the university as adjunct faculty. I started volunteering as a medical director in cardiac rehab. I was doing all of this. And, you know, I was feeling on top of the world and more than married, as you can see, I had this cape going around, you know, on my back and I was killing it, I thought. So then, you know, as the years go by, you know, and the problem when you only have a few cardiologists, everybody, as I thought, wanted a piece of me. Cause I was giving talks. I, you know, was, made myself very available. So, you know, the hospital administration, you know, had these special projects with, that they wanted to get started. I had my own pet projects for mortality reduction in my cardio infarction in our country. Cause our, and my mortality is pretty high and I was gung ho about trying to get that down. And then I had all my previous commitments. I got my first employee who was another source of stress. And as I said, you know, this is the onset of stress. But I, you know, I thought I was handling it, but, you know, it was no longer, you know, I am super woman. Then a few years later, I, you know, I was also very involved in medical education and continuing medical education. And our foundation decided that we were going to put on this symposium. So it was a two day CME event that I had planned. And that was, it took a lot, you know, dealing with sponsorship, et cetera. And then there were all these other responsibilities and the public system was extremely inefficient at this point. You know, I think initially, you know, the shine was off of my PCI program. So initially they were giving me whatever I wanted, but then by 2018, 2019, you know, when I ordered stuff, things would take forever to come. So at some point we had to pause and stop doing procedures because of lack of supplies. And then, you know, because there are so few of us and so much work, you know, the echoes were piling up. I couldn't get to read all of them. And on a daily basis, I felt like I was actually going to work to do a bad job. And then on top of that, you know, my brother was living with me and then he bought a house and moved out. And that was my, he was my off vent. When I got home, I used to complain to him all the time. And, you know, we would chat and, you know, drink a glass of wine and just, you know, talk about all sorts of things, but he moved out. So he wasn't there anymore. So, and then because I was so busy, I wasn't going to my family gatherings as often. So I had less social support, more work, more responsibilities. And, you know, I was feeling extremely stressed out at that point. And, you know, I heard myself on, it was some radio program, someone was interviewing me and I was talking about being stressed out. And that was the first time I had actually heard myself talk about being stressed out because before, you know, there were all these stressors, but I felt like I was handling it. So that is number three, that chronic stress stage, you're actually starting to feel stressed out. And then going into COVID, before COVID actually started, I think I had reached the burnout stage, but of course I didn't call it burnout at that point. I was thinking to myself, this PCI program isn't going anywhere. We're doing very few cases. You know, we can't get primary PCI off the ground because I'm not able to get my nurses trained up because we're not doing enough cases to get them trained up. My, you know, volunteer role in the Heart and Stroke Foundation was broke. And, you know, I'm like, what role did I have to play that? I felt like I wasn't accomplishing anything at work. Of course, my secretary I thought was a nightmare and I needed to fire her, but I didn't know how to get rid of her. And everything I felt was an effort. And, you know, maybe no one, I was at the one point to say no one cared, but I think at some point in time, I did think that because I felt like I was alone in my bubble dealing with the world. Then in 2020, you know, we all know what happened. Thankfully, at home in Barbados, we had very, very little COVID. So we did this whole lockdown thing, very aggressive lockdown, but we had very, very little COVID in the country. And the whole point of the lockdown was to try to keep COVID out. But the great thing about it was that even though I was working every day and they, you know, they canceled all our vacations and days off, et cetera. And there was the uncertainty as to what was going on with the world. There was less traffic, which is a big source of stress, mind you. And because, you know, we didn't have as much, you know, stuff going on in the country, admissions and cardiac admissions dropped. And I think part of it was that people were fearful of coming to hospital. So less MIs coming into hospital. So I had more time to exercise. I picked up Tai Chi, and I kind of went the other direction as far as the burnout curve. But then, you know, as we started to open back up and our COVID numbers increased and our workload increased and exploded. And then into 2021, I got, I myself got COVID, and I had this prolonged recovery period after that. But then it was back to the grain with fewer resources because all the money went to COVID and they weren't giving me any money in my PCI program. So I went back on the other direction with that burnout curve. So, you know, one thing that I learned from this retroscope that I've been doing, or retrospection, is that burnout is not unidirectional. So you start off with the honeymoon phase and everything is fine and dandy, and you're gritting your teeth, and, you know, it's not quite as bad, you know, you're getting a little bit of stress and you're really stressed out, but you could go the other direction. And you wanna arrest this cycle before you get to the point of chronic and severe burnout, where, you know, it could be marked by all these symptoms that Dr. Duffy was talking about, physical symptoms of a headache and illness, actually, and depression, and it can really quite be disabling. So, you know, this little diagram I have is, you know, if you find yourself with these symptoms and this, you know, set up in your life where you're out of control, you know, you're no longer in control of what is going on with you, you know, there is that possibility to actually take it in the other direction. So, you know, going back to this mental health trial, this app, you know, in these group sessions, and sitting and listening to people go around the circle and listening to what they were planning to do to decrease burnout, obviously, you know, I couldn't just sit in the back row. I had to actually come up with a plan myself. And my three-step plan was to turn my lifestyle and my life around, was to remove the chaff, live life, get help, and I'll go through each of these. So, number one, you gotta identify what were your stressors. So some of them, I could, you know, I could quit my job. I'd made a commitment to go back home and help my country, et cetera. So, you know, my plan at that point was to kind of take the bull by the horns and figure out, you know, what is causing my issues in this public job? How can I deal with this? How can I make things better? And unfortunately, one of the things that I actually did was ultimately, I'm now head of my department. So that's another set of stressors, but at least I have a little bit more control over some of the issues within my department. You have to ask yourself, can this go? Do I have to do this? Do, you know, not everything that someone asks you to do, you have to do, you know, learn to say no. Will it add value to your life? Will it get you where you want to be in life? And is this really and truly where you want to be? And I have to say that, yes, I want to be at home. I want to be doing this. It's just, I'm probably going about it the wrong way. So I needed to set a few boundaries. And I'm saying all of this and I'm thinking myself as I'm preparing this talk, I'm being very hypocritical because I know what to do and I know I'm not doing it, but at least I feel a little bit more in control because I know that I should be doing it, if you understand what I'm saying. The next thing is to kind of live life. So even if on the professional side, you don't have full control, at least you can do things to make life have more meaning. So, you know, at least have a full night's rest and pray, meditate, do Tai Chi, do yoga. This is a Tai Chi class that I had taken during a conference that I actually planned this year, a big Algarve Caribbean conference. And I kind of introduced some of my colleagues to the Tai Chi. And I do Tai Chi every Saturday morning. It's 6.30 in the morning, spend an hour and a half and kind of groan myself and calm myself. Exercise is an important part of living life. You know, even if things aren't going well at work, you can at least burn some calories. And then of course, we all have vacation, take the vacation. Again, I don't do all of this, but at least I try to take more of my vacation days each year than I usually do. And then if this is not sufficient, you have a support system. You have family, you have your mentors, your friends. Do not ignore them. Don't ignore your family. Ignore your family for your work. Don't ignore your friends for your work. Make friends, dates, go out, shoot some pool or whatever it is you want to do with your friends, but you need that outlet to let off some steam. And if you're doing this mental introspection and you realize, hey, I'm a little bit further on this burnout curve, maybe you need some professional help. So you can do that online stuff that I did that was very helpful in opening up my eyes to what was going on, or you can do in-person stuff or whatever, but there are a lot of resources out there to help. So I'm just putting this back up again to remind you that this is a cycle. It's not unidirectional. You can go in the other direction. And the goal is to arrest this cycle before it gets to this stage of severe burnout, where sometimes it leads to more mental illness and can be irreversible as well. So try to look into your lives and stop it up here. Maybe even get back to that honeymoon phase that we were at. Although the honeymoon phase, it sounds good, but it's actually part of burnout because taking on too much is a sure recipe for the stages of burnout. That's an awesome talk. Thanks, Dawn. I'll ask Sena, who's the youngest here, I guess, in career years. Tell us about your experience and is there anything that caused you to burnout that you turned it into a positive aspect and helped build yourself? Absolutely. One of the benefits of being at maybe my career stage is increased awareness. And so I feel like kind of looking back and reflecting on my journey, I feel like I burned out really early. I felt like I was riding that burnout curve really in a sweet spot. And then I fell off that curve real quick and really early. To me, it happened when I was in interventional fellowship and had a new baby and was looking for jobs. And I just realized I had so much on my plate and I just was not in a position where I was going to be able to keep all things going with any amount of success. And for me, realization of that moment was really important. I think I realized it really quickly. I think COVID helped a lot because that happened around then too. And life took a pause and I had a moment to just kind of reflect on how I was feeling. And I realized that I was doing the things I love and being surrounded by the people I love. I had a new baby and she was giving me joy. I had a wonderful job lined up. I was an interventional cardiology fellow. This is what I wanted my whole life, but I wasn't happy. So why was I surrounded by things that gave me joy and I loved doing, but I was not happy. And I realized that I was probably burnt out. And I started by first building a community. And so reaching out to people, asking for help, finding people who are at the same stage of life as me. And then I started setting boundaries. And as hard as it was, I started saying no. And I started walking away from obligations that I just couldn't put on my plate at that point in time. As I expanded my community and the people I surrounded myself with, I expressed my concerns. I've done so much to get to this point in my life. Am I actually putting all of that on hold or is it gone? Have all of my successes just, are they all gonna be gone if I say no to all of these obligations? And the incredible support I received around me by other interventional cardiologists who also happened to be women, who also happened to be new mothers, really helped me move on and move forward. And what ends up happening is every couple of years, or maybe every 12 months to 18 months, I have to do a self-check. I check on where I'm standing at right now, if I'm still happy, or if I need to do something to make myself happier, what do I need to do? And my most recent check revealed that I don't have a hobby that I love. And so that's when I took on hiking and I realized I love hiking. I love disconnecting from the world. I love listening to the sound of rushing water. I love listening to nature and I love being there. And when I come out of that situation, hot and sweaty and just really exhausted, I feel recharged and ready to take on the day. So that's how burnt out happened for me. It happened really early and I was so surprised, but I think it taught me an incredibly valuable lesson. And the lesson that I would kind of pass on to others would be to just do a self-check. And if you can't check yourself, find others around you to check yourself with. Ask people around you if you're doing okay, because people want you to succeed. They want you to do well.

burnout

stress management

mental health

Tai Chi

COVID-19 pandemic

support networks