Today we met up with Dr. Joe to discuss mental health and burn out in the veterinary world. Dr. Joe recently has undergone complete burn out and went down the road of professional help. As part of his recovery process, he has created the Facebook group Vet Positivity which has been incredibly receptive so far.
Dr. Joe’s Background:
Dr. Joe started off as a vet nurse, and then pursued vet school. Upon graduation he immediately pursued an emergency and critical care internship, and followed that with a research job with some locuming on the side, and is now currently a full time locum.
Dr. Joe’s Experience with Burn Out:
Dr. Joe, like most of us, felt that he would never be affected by mental health issues or burn out because he was “tougher than that.” However, in the past few months Dr. Joe has experienced full blown burn out and depression, and describes it as “compete, utter, hit the bottom, bounce off the bottom and hit it again burnout.” He was suffering from migraines to the point that his doctor was worried about aneurysms, as well as clinical depression.
Dr. Joe also admits that depression and burn out affect way more than your own personal bubble, and it was when he realized he was hurting those he loved most, and when those comprising his support network told him “you’re freaking depressed, you need to do something about it, get on-top of your life,” he finally sought help. It takes harsh and strong words to break through sometimes, because there is a huge component of denial, shame and stigma when it comes to mental health issues.
Dr. Joe discussed that improving your mental health is a long, continuous process. It involves ups and downs, improvements and set-backs, and you need to be committed to the long process.
What was the process to get to the point where you went for help?:
Dr. Joe ended up hitting rock bottom before he sought help. His denial and lack of intervention prior led to those he loves being damaged as a bystander to his burnout. Dr. Joe desperately wants to share with you to not wait to hit rock bottom, and to get help earlier!
Dr. Joe shares that there is a huge stigma with mental health, and most people avoid seeking professional help because they feel it is only for you if you are a “complete nutter.” He shares that for months and months he was in denial, saying he was doing something about it but not actually doing anything. Eventually things in his personal life completely “blew-up” and desperation led him to seek help. Dr. Joe really wants to catch people before they hit the level he hit, and before they create damage in their professional and personal lives. It is much better to seek help early and avoid the complete rock bottom.
Dr. Joe went to his family doctor first, because if you get a mental health note by your doctor and get a referral you can get 10 sessions with a mental health professional covered by Medicare (Australia’s public health-care plan). In part of this process his doctor had him fill out a questionnaire called the Kessler Psychological Distress Scale and the higher you score the more likely you are suffering from mental health issues. These questions are good to read and assess, and are somewhat uncomfortable to face honestly.
Dr. Joe then went to his appointment, and shares that it was very weird, but useful because the psychiatrist was able to “make you watch a film of your own life…they ask you questions and the way they phrase it it makes you look back on what you were doing.” This helped Joe realize that his actions were not representative of ‘him.’ Often, with depression, your actions aren’t true representations, and you just aren’t yourself.
What Tips Have You learned?
1. SEE THE POSITIVE:
Dr. Joe shares that his doctor told him that we are predisposed to see the negative side of things, for evolutionary survival response. For this reason we have to train our brain to focus on the positive. This was why Dr. Joe created the Vet Positivity Facebook Group!
2. HELPING OTHERS:
Part of the healing process for yourself is to help others, and both Vet Positivity and KICK ASS VETS have this as their driving motive. Helping others to prevent going through what you went through, and learning from your mistakes, and improving their lives, is one of the most cathartic things you can do. (Moribidity and Mortality rounds is a way to do this for clinical cases!)
3. “STOP THAT THOUGHT”:
When you are looping and thinking negative thoughts, say out-loud “stop that thought.” By doing this you actively stop your negative thoughts, and you help break the cycle.
4. IF YOU AREN’T SLEEPING, GET OUT OF BED: Get out of bed as soon as you wake up, and if you are lying in bed and can’t sleep, get up and get out of bed.
When you are lying in bed at night and not sleeping, you are just left with your own thoughts and these often can spiral to a negative place. By removing this situation where your brain is free to run rampant, which leads to building your stresses into monsters that are much bigger than they truly are, you prevent these monsters from taking over. So, if it’s 2am and you can't sleep, get up and go read a book, do cross-stitch, do something relaxing but something that is activating your brain slightly so you cannot spiral on negative thoughts. Be sure however to avoid social media, internet, or any screens at these times!
5. SLEEPING AIDS/APPS:
There are many sleep aids and apps that you can listen to that get you to focus on something else. Often they get you to perform breathing patterns, or focus on various parts of your body. These help engage your brain in a calm manner, but enough to block out negative thoughts.
6. MINDFULNESS MEDITATION:
Dr. Joe was skeptical, but now he does it every single morning. Meditation can be challenging, and Dr. Joe shares that he realized that mediation is not what he thought. “I think most people think that meditation is sitting crossed legs, you close your eyes and wait for yourself to levitate off the ground,” but Dr. Joe describes that the apps he uses are making your mind work but you aren’t thinking. Examples include breathing patterns, and then concentrating on sounds like the cars, or the birds. This focuses your brain on something and helps you stop thinking. “The trick is that once you start doing that you have to then realize when thoughts come into your mind, and then be able to snap out of those thoughts, and concentrate back onto the sounds or breathing.” This helps you train yourself to detach your brain from the negative thoughts.
7. TAKE TIME OFF: “You need to take time to detach yourself from whatever is causing the anger.” Taking a break is imperative to reset your brain, and allow you the ability to look at your situation clearly.
Dr. Joe and KICK ASS VETS discuss that we were both fortunate enough to go to school in countries that provided massive subsidies to our tuition, so we were able to pay off our loans very quickly, and can financially afford to take time off when needed. For those that are struggling financially as well, and cannot take time off, and the only option to pay down loans is to work multiple jobs, this may not be possible. We don’t know what the answer is to this, however getting paid appropriately is part of this, and addressing your financial health is imperative. There is a Facebook group called “Debt-Free Vets” that is full of information on managing high debt-loads. Check out our other blogs on Evaluating Your Worth,Performance Reviews,Interviews, etc. to try to get a raise to help you work smarter, and not harder!
8. EXERCISE: As easy as it is to say, it can be just as difficult to do. Set aside 30min minimum each day to go for a walk if nothing else. When you exercise you feel better, and can better cope with stress.
9. EATING HEALTHY: At work there is junk food everywhere. KICK ASS VETS shares that if you have a work-place that provides food, you can discuss with your boss about instead of providing cookies and candy, to instead have apples or other fruit. Or, you can try to band together with your fellow colleagues to not have candy around. Another alternative is to ensure you have LOTS of healthy snacks with you, so you can grab something healthy instead of junk.
10. GOOD SLEEP HYGIENE:
Sleep is so very important. When you haven’t slept all demons grow into bigger and bigger creatures than they really are. Having a routine before bed that allows you to calm down, and doesn’t include social media or ‘screen time,’ is very important.
11. TALK ABOUT IT:
“Talking about it disassociates you from the problem”- Dr. Joe shares that by talking about problems and situations, it can be very helpful because you can finally then see the situation from another’s point of view. Also, opening up helps you not only release some of that stress, but then opens lines of communication to get help, and to recognize the amount of support you have. So, whether you talk to friends, or professionals, talking about it is important!
Stress can be Good, and is Necessary:
Stress is an important part of any job, and any productive life. No stress at all in life is unhelpful, and hinders growth. “You need those stressful cases to push you to learn something new” shares Dr. Joe. When you get those weird cases that don’t follow the rules, the stress of that case makes you push, and makes you learn. That level of stress is good, and we all need a bit to make us accomplish our goals, and to make those goals worth while. However, when does stress go from good, to bad?
What is Burn Out?:
The WHO calls occupational burnout a syndrome resulting from chronic work-related stress, with symptoms characterized by “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy.”
5 Stages of Burn Out:
This great bit of information was gathered from Calmer, a group that focuses on mental health in professional settings.
1. HONEYMOON STAGE: When you first start a new job or venture and you are excited, energetic, creative, productive, you want to prove yourself, you’re committed to the job, and you are feeling positive and good. It can be very hard work, and ‘stressful’, but in a good way!
2. ONSET OF STRESS: This is when some days start to be come difficult, and you start to notice a decline. Your optimism starts to wane, and you start to emotionally feel the drain. You may experience physical signs of headaches, GI issues, hypertension, inability to sleep, etc. You may also start to notice some behaviour changes like your threshold to irritation drops, your productivity drops, you become forgetful and you tire more easily. You start to stop focusing on personal health (exercise, diet) and start to socially isolate yourself.
Another important sign is that you might start questioning yourself, or avoid making decisions, that you would previously have not had a problem with. Dr. Joe shares that “I find myself asking a lot more to someone else, “what do you think of this? And normally I wouldn’t second guess myself in the slightest with some of these things… it creeps up before you know it but you don’t recognize it.” He also shares that this concept leads to further lack of confidence, further questioning, and you spiral.
THIS is the stage where we need to intervene and make significant changes, this early on! After this stage we start to go into denial and it’s much harder to seek help!
3. CHRONIC STRESS: This is the stage when the bad days outweigh the good days. At this point you stop having hobbies, you become cynical, you start to miss work or are late, your physical signs increase in frequency and intensity, you are apathetic in your personal and professional life, you withdraw form society, your sex drive drops, and you might start to feel panicked or out of control, and you might start self medicating with alcohol or drugs. Denial kicks in at this point as well, so you may find it much harder to accurately assess yourself or your actions.
4. BURNOUT: This stage is when most will need professional help to recover. You start to want to ‘run away from the world’, you might feel empty inside, pessimism takes over your life as does work, and you obsess about work at all times of day. You have self-doubt, your physical signs heighten even further, and you feel you cannot perform you work properly either by questioning yourself, or not having the energy, or not having the sympathy/empathy for your patients.
5. HABITUAL BURNOUT: This is the final stage where depression, unrelenting sadness, and complete physical and mental fatigue take over. You might not be able to get out of bed, cannot fathom the idea of going into work, and you are getting sick all the time, headaches, belly-aches, you name it. Some will experience suicidal thoughts at this stage as well. This is a very scary place to be, and addressing your issues before you hit this stage is important!
Dr. Joe shares that he feels the stages are good as an indicator, but when you are in the thick of the process it can be difficult. The concept of the stages can feel very abstract, and you need to rely on your family and friends to help guide you, reading their body language, seeing their reactions, and outwardly asking them for help and guidance. Dr. Joe also shares that when you start to internalize, and not ask for help and take all the pressure on yourself, that is most dangerous. He has 2 friends that were nurses that have sadly taken their own lives, and they were, as so commonly is the case, individuals that no-one knew they were feeling unwell, feeling depressed, feeling sad. Checking in with eachother, and being OK to open up when you are feeling unwell, is incredibly important. Part of Dr. Joe sharing his story with us is to try to remove that social stigma against struggling with mental health, because so often that stigma, and that shame, leads individuals to hide their problems, hide their feelings, and then instead of getting help they take their lives.
Risk Factors for Burn-Out:
As veterinarians and veterinary nurses/techs, we are predisposed to burn-out, because by personality and by profession, we all already hit a lot of the risk factors.
1. STRONGLY IDENTIFY WITH YOUR PROFESSION:
Having such a strong identity with your profession, and not seeing yourself as an individual outside of that is a huge risk factor. Dr. Joe challenges me with “if you meet someone knew and they say ‘tell me about yourself,’ what would you say?” … my response is that I would start with “I’m a vet,” and he points out that I didn’t even start with my name. This strong identity of being a veterinarian means that when things in our profession don’t work, or are incredibly hard or demanding, or even downright abusive, we take it personally instead of separating it as part of the job.
2. HIGH WORK LOAD: This includes working lots of overtime, and given the recruitment crisis and constant understaffing that most clinics are facing, this drastically increases our risks.
3. SUPERHERO SYNDROME: Trying to be everything to everyone, taking on all that responsibility yourself. See the blog on Superhero Syndrome for more.
4. BEING IN THE HEALTH PROFESSION: Just working in the health industry, by nature, predisposes you to burn out. It is a difficult, emotionally taxing, and challenging job with minimal recognition or thanks.
5. FEELING A LACK OF CONTROL: Especially as an associate you have no control over schedule, sometimes the medicine performed, work environment, clients’ financial situation, etc.
Dr. Joe shares that “a lot of people go into locuming, including myself, because they want to gain more control over their lives. And it’s true, you do, your scheudle, your pay, and to be honest even the medicine you practice… which is great. But you can lose control very easily as a locum as well. You don't know when your next job is coming even though there is enough work to go around 10x, so you book yourself out solid… and before you know it… gah.”
Dr. Joe also shares that one of the catalysts to his burnout and depression was COVID because overnight he lost ALL of his shifts as the clinics’ knee-jerk reaction was to drop all locums, and then as the clinics realized they needed vets the locum work came back, but he took any shift he was offered ‘just in case’ and ended up working WAY too much. COVID has definitely increased the stress of locum life, as the uncertainty has sky-rocketed.
Causes of Burnout:
1. LACK OF CONTROL: So many vets have no control over their schedule (which sometimes changes week to week, and sometimes isn’t published until a week or two before the shift), work-load, assignments, level of medicine performed (either from pressures from the boss, or financial restraints by clients), etc.
2. LACK OF RESOURCES: Time, energy, money, staff, equipment, you name it! The vet industry is constantly trying to ‘fix’ patients with limited resources, and for individuals that are highly motivated to provide amazing care, and truly love their patients, this is distressing.
3. DYSFUNCTIONAL WORKPLACE ENVIRONMENT: So many clinics are poorly managed. Vets are doctors, not businessmen, and this leads to companies and clinics being chronically dysfunctionally managed. There is a massive amount of staff turnover in the veterinary industry, and this is due to these poor managers, and staff trying to escape one bad environment, and just ending up jumping into another one.
4. EXTREMES OF ACTIVITY: A clinic that is constantly off the walls busy, or a clinic that is continually very very quiet, are both causes of burnout. The mind needs variety.
5. LACK OF SUPPORT: Feeling supported by your boss, and feeling safe and valued in your workplace is incredibly important. Unfortunately, in the veterinary industry, all too often vets feel undervalued, unsupported, and unsafe from managers/bosses, clients, and even sometimes colleagues.
6. WORK-LIFE BALANCE: With the recruitment crisis that the veterinary field is experiencing, so many clinics are understaffed, and this leads to hours and hours of overtime (sometimes unpaid), staying late, extra shifts, and the emotional toll makes it hard to drop work when we get home. This leads to a massive imbalance between work and life.
By the very nature of the inherent aspects of the profession, the very common work-place dynamics, we are already half-way up the burn-out mountain before we even start day one. On top of this you add the types of people that become vets/nurses, and it’s no surprise so many of us face burn out.
Dr. Joe shares that in his worst period he felt very alone, “there’s no-one for me to talk to, I don’t want to burden my partner with this… I’m alone with my problems.” Dr. Joe really wants everyone to know that there are so many people out there to help, and wants to help people have the courage to ask for help. Even though he thought he was alone, he realized, once he took the step to ask for help, he had so much support. One of the goals and motives Dr. Joe had for Vet Positivity was to create a safe space for vets to ask for help. Part of this initiative was to start up the Mentoring Program, where vets/nurses/students can sign up and ask for help both in the professional capacity, but also and more importantly, in the mental health capacity. Dr. Joe also strives to help remove the stigma, and he shares “that’s what I had to struggle to get my head around. I wanted to be the tough guy that was reliable that wouldn’t cripple under pressure, and I was the first one to crash.” KICK ASS VETS shares their struggle with burn-out but also loving their job. Just because you love your job, doesn’t mean that you can’t experience burn-out.
Dr. Joe also shares the large feelings of stress of having to be seen as the strong vet to the nurses, to colleagues, to clients, and to bosses. KICK ASS VETS shares that yes, this is part of the job. Putting on a brave, strong, confident face, for your team, for clients, to keep calm while you might be losing it on the inside, is part of the job. This part of the job however leads to this habit of not showing your insecurities, and not sharing your stress, and this sets us up again for burnout.
Dr. Joe wants people to hopefully recognize the early signs, and address the early signs, and specifically shares “if you see an animal come in, and you don’t care if it lives or not, or if it’s easier for you if it dies, is the day you should take time off.” This is an all too common feeling for those in the vet industry, when a difficult case comes in and a small part of your being wants the owner to euthanize because ‘it would be easier.’ This feeling doesn’t make you evil, and you aren’t the first to feel it, but it is a huge sign that you might be feeling the early (or late) signs of burn-out.
Dr. Joe and KICK ASS VETS both want everyone listening, everyone reading to know that there is support! If you are struggling, if you are feeling overwhelmed, burned out, depressed, suicidal, whatever it is you are feeling, YOU ARE NOT ALONE! Please, please, please, reach out. We are here!