Spiritual Direction: Intervention for Burnout

By Dr. Tim George

I am a believer in stories. Stories are important to me –– especially physician stories.

Recently, a story from a physician came to my inbox. The title of this article, Why Do We Burn Out New Physicians?,  written for Plough magazine, caught my eye. For me, as a newly retired physician and one trying to understand both burnout and retirement, the article was a must-read. There is much to ponder over in this article. I invite you to read it as well.

Dr. Nussbaum’s story begins with him sitting in a pew, attending daily Mass with few in attendance. In that church are mostly the poor and marginalized, there for their Eucharistic nourishment. The homilist that day seemed to direct his message squarely at the physician:

“You find one, you see.” He pointed a finger right where I was sitting. “Burnout. I hear people talking about this.” He jabbed his finger forward like lightning. “The Gospels, they tell you what to do about burnout. You feel burnout? You find a poor person. Give them $20. You no longer feel burnout. If somehow, you still feel burnout, give $20 to another poor person. You no longer feel burnout. If somehow, you still feel burnout, you give another poor person $100. Then you feel good. Amen.”

He goes on to tell of his journey at a time when his life was maxed out trying to be present to his wife and children during his years of training. He references the internist William Osler’s collection of writings, Aequanimitas, given to medical school graduates in past years, where physicians are called to a practice of medicine that takes priority over other duties in life. Dr. Nussbaum ends his story by writing about how the nuns in days past (before health care became a business) “worked tirelessly, well outside of any day-tight compartments, their lives fragranced by the smells of incense and coffee” (my italics). This was a time when the nuns had fine-tuned their work to include the love of God and the love of neighbor in the care of their patients. The piece concludes with the statement, “We don’t need Osler’s noble calling, but some humble vocation in a just system where clinicians can give their lives away to patients. We’re missing the nuns who live burnout sermons instead of preaching them.”

So, I went on a bit of a journey to discover how and where the burnout sermon fits into my life.

It seems Osler had a sense of the physician as a sort of superhuman. This was a man (physicians were always men at that time) whom Osler asked to assume the quality of “imperturbability” (implying coolness or assurance even under severe provocation) as well as “equanimity” (balancing head and heart) while practicing the art of medicine to “stand above the common herd.”

Perhaps it is when we realize that we physicians are no longer called to stand above the common herd but to stand with the common herd that we experience burnout. It’s when we discover that we cannot continue to live our life as our “false self” but must discover our “true self” and live it out. This discovery involves healing and caring for the entirety of who we are; our physical, psychological, and spiritual parts.

When I ponder in prayer these thoughts, I must ask myself two questions: When and why did I burn out from medicine and what are the graces I’ve received through the process? The answer to the first question tells me that my burnout occurred as my marriage of 20 years was falling apart. Unbeknownst to me and well before I was aware of how much trouble my marriage was in, I was looking for a way out of my practice that would provide me the peace I could not find at home or work. It was more than a burnout from medicine, it was a burnout from life that I was experiencing. Following the divorce, I knew I had to make a change in my life. After the relocation of my practice of medicine and my second marriage to a woman very aware of the place of God in her life, I was drawn to my heart’s deepest desire. I turned to address my relationship with God.

How I addressed this is the important part of my story. Because I found value in the witnesses of Spiritual Directors, I was called to spiritual direction myself. There is something holy, intimate, and self-revealing in the monthly hour I spend with my Spiritual Director. This time allows for the vulnerability, and therefore, the awareness I need to grow in my relationship with God, and because of that, I am making progress on my path of self-discovery. The identification of my false self as a physician has given way to the realization that my true self, that of being a child of God, has set me free to put my priorities in order. I can now embrace the fact that I was called to love God first, followed by my spouse, family, and work. I can live with the “common herd.” And I know I cannot love, authentically love, God or my neighbor without loving myself.

This is the beautiful part of my story. My awareness that I can live my life from the place of true self has brought me to a place of joy, peace, and gratitude. It’s been hard work, this transformative experience. But because of it, I have been able to recommit to my spouse and family, have a deeper prayer life, and, until my retirement, to my practice of medicine in a manner I envision the nuns doing, with a life “fragranced by the smells of incense and coffee”.

As I reprioritized my life and continue to grow in self-knowledge, I have “burned in” to a life where I am selling my riches and following Jesus (Mat 19:21). I trust that not only did my patients see Jesus in me but now all who I meet will find Him on display whenever we encounter one another.

Giving of oneself as a physician requires balancing the whole of our lives.  Our priority is to find a way to make our patients and all parts of our lives a holy story and for this story to reflect the burnout sermon. We must choose not to leave our workday walking out sad like the rich man in Matthew’s Gospel, but rather sell our possessions as physicians and follow Jesus. It is our riches that tie us to this world. It is in the awareness of dissatisfaction with a life of riches that leads to burnout. We ought to recognize that we, children of God, gifted with the title “physician,” are to live the burnout sermon in all aspects of our lives.

Is there a way to prevent burnout before it smacks us in the face with no option but to “option out”? How do we physicians find ways to live the burnout sermon and live it before it’s too late? I believe I’ve found a good part of the answer to these questions in spiritual direction. But for spiritual direction, I’m unsure what my life would be like now. How I wish I had discovered this earlier… before burnout. Perhaps physicians, much like me, need an intervention. Perhaps the “new physician,” which includes all physicians these days, can find help in living out the burnout sermon and prevent burnout in our practices by seeking the help of a good Spiritual Director. We can bring to spiritual direction our broken stories and see if we can sort through ways to put the pieces of the story back together. The Spiritual Director can help us appreciate how active God is in our lives. Through spiritual direction, we may be able to submit to the fact that our false self as a physician must yield to our true self as a child of God.  Only then can we treat our patients with the wholeness and holiness of the story where we live lives filled with the fragrance our practices provide … with smells of incense and coffee.

Finding a well-formed Catholic Christian Spiritual Director is not always easy. Those who practice in a larger metropolitan area will find a retreat house a good resource. Quite possibly the parish you belong to will have a listing for your area. Seek any religious congregation in your area and ask if they have anyone doing spiritual direction in their house. Call your diocese, they usually have a list of formed Spiritual Directors. Even those living in rural areas can find a Spiritual Director because the opportunities for online direction sessions have increased since the pandemic.

It may take some work and you may even find you need a second or third choice of spiritual directors to make a “good fit,” but I do not doubt you will find abundant graces, enough to live the burnout sermon every day and remain “burned in” to the fullness of God’s gift of life.

Dr. George is a member of the Catholic Medical Association and a certified spiritual director. He can be reached at tkgeorge53sd@gmail.com .

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