In some ways being a pelvic health physio is very similar to being a counsellor – we have the same exposure to emotional trauma and provide emotional support. This article on burnout popped out at me the other day. Unlike counsellors we don’t get training and resources to tell you what to do, and it’s not spoken about.
When my Dad was dying I found myself completely overwhelmed by the needs of others. I love my job, I love the profession, but I was surviving one clinic to the next. I was head-down dug-in, just getting through each interaction and trying to stay alive, keep my Dad alive and support my family practically and emotionally. I was multitasking at an exponential rate; running clinic, running my business, running his medical situation. Working through emotional exhaustion I took everything personally, beating myself up for not ‘giving’ enough to support a patient and therefore taking their lack of progress, their hurt, their need for me to emotionally prop them up personally. And at the same time I was battling major compassion fatigue – I really didn’t care about anyone anymore, and beat myself up more for that. That isn’t me. Come on, find some energy to care. Even the thought of someone needing something from me created a knotted ball of tension in my chest. Something had to give. I’d hit burnout.
A couple of months off helped with the immense grief. But things didn’t change. I went back to work and worked through my grief, but the gnawing tension and stress of clinical interactions was still there. Simple interactions were exhausting. Somewhere in January I accepted that grief and burnout take time, and that recovery isn’t going to look like it did before.
I’m sharing because I think it’s important there are more voices talking about burnout in physio. Frontline social workers have a short shelf life of a few years, it’s similar in other challenging professions. Why would physio be any different? I had so much help from our international pelvic health family when I needed to stop – so many people told me their stories and what helped them, but I would never have known otherwise. And as the world is in an uncertain state I can see more emotional exhaustion and burnout headed our way after this intense period. I thought I’d add my thoughts on what’d helped me:
Accept what you can’t change, change what you can (if you need to).
Accepting that you’re not ok is the first step. It sounds like a well trodden cliché, but its truth.
If I asked you who you were, what would you say? My whole identity is based on “Physio”. Stopping clinical work felt utterly terrifying because it was stepping into the unknown. I knew I needed to but I had to be told by several friends, and then supported by family that it’d be ok. I now keep a very small clinical caseload that I can cope with. I can be fully present for each patient and then recover emotionally throughout the week. I spend the large proportion of my week being creative developing resources and courses for Physios. And I get time to be active, which is restorative. I also see myself as more than a Physio now. It’s an important part, but it’s just one part.
“Boundaried generosity” is a phrase I like. ‘It’s like the advice about oxygen masks on an airplane – you have to put on your own before you can help anyone else.’
Set your physical, emotional and mental boundaries. I create before I consume – I don’t do email or social media before 1pm, I stop checking my email at 5pm. I space out patients with plenty of breaks and make sure I move between sessions. I’m still working on not taking on patients’ emotional burden. Doing something completely different during the day helps.
With all our knowledge and training it’s easy to go into an appointment from a starting point of power. You can feel you’re the one with the expertise and the expectation is that you’re there to tell this person how you’re going to get them better, then to “do” things to them to achieve that end. But that’s a falsehood. Time and again studies have shown the Best, Fastest, most Efficacious Therapy happens when the control is in the hands of the patient, their self-efficacy is boosted and we play a coaching role.
So reframe your sessions. Go in curious with all the knowledge and experience you carry, allowing the patient to lead. Ask permission to share ideas. That’s what they are – your ideas, not necessarily truths. They have their own biases in your experience. Coach people to set goals for what they want to achieve. Giving the power back to the patient can feel scary, but it frees you from the burden of expectation. It’s about them achieving what they want to, not you making lasting magic happen in one 30 minute period of their week.
You can’t heal the world
It’s a noble goal. Accepting that there are some people who you will not help, regardless of your modality, how much effort both you and the patient put in, how much you work on that therapeutic relationship. It can feel awful, it isn’t a failing. Feel secure in yourself that you did your best for them and it’s ok they didn’t improve under your care. You’re not good for everyone and you can’t know everything. That’s ok.
“ Burnout is related to unclear, disappointing outcomes. It’s hard to sustain work where the results aren’t concrete’
This is especially true in chronic pelvic pain which has such unclear and small outcomes at time, yet forms 90% of my caseload. I didn’t have any inhouse mentoring at the time, it would have been useful for someone to be watching my back clinically. Find a mentor. And if you can’t, I now offer clinical mentoring virtually.
And finally… fill your cup, give form your saucer!
That’ll be in the next blog. There’s no questioning it’s going to be a difficult few months. I hope it goes as well as it can for you. It’s going to be a marathon, not a sprint, so pace yourself. And at the end when everything starts to get back to normal it might be worth taking some time to pause, reframe and set your boundaries.
Sending you much love at this time.
Happy Bladder’s going Digital. You asked, I listened. The online Happy Bladder course will be available for all my local & international colleagues within a month. Watch this space.
We’re going to get our head around neuroimmunocentric treatments for the pelvis. Why should we be thinking about central sensitisation in prolapse? How can we treat autonomic windup in chronic prostatitis? Digital AND live offerings will be coming your way – sign up to the newsletter to find out more.