1. Thriving on the Front Lines of Healthcare using the Spiritual Discipline of Decision-Making Battle Fatigue or

2. Getting Started Equip you to help: – Self - preventative or restorative – Colleagues – Family – Friends – Patients Can’t cover everything in one hour – Give some basics and different aspects – Focus on the “treatment tool” as this reveals the causes

3. Goal To learn about Burnout Definition Signs & Symptoms Causes Treatment Tool Summary

4. BURNOUT: DEFINITION BURNOUT: DEFINITION What is Burnout?

5. What is Burnout? Secular Different than being tired Herbert Freudenberger, PhD 1974: – debilitating psychological condition brought about by unrelieved work stress Not DSM, but in ICD-10 – "State of vital exhaustion" (Z73.0) under "Problems related to life-management difficulty” – Not considered a "disorder”.

6. Definition Chronic reaction to chronic stress Negative reactions between environment and personal characteristics “the extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results.” Emotional exhaustion and a reduced sense of personal accomplishment

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15. Maslach Burnout Inventory (MBI) Maslach Burnout Inventory (MBI) Symptoms & Warning Signs

16. Warning Signs and Symptoms EmotionalPhysiologicalCognitiveBehavioralRelationalSpiritual

17. Emotional Symptoms Emotions – Numb – only extreme emotions register – Rarely positive feelings – Difficulty managing emotions: wear on sleeve

18. Emotional Symptoms Emotions - Lots of negative feelings Depression Apathy Overwhelmed Shame Guilt Failure Remorse Lonely Hopeless Helpless Hardened Callous Selfish Excessive Concern Anxiety Worry Fearful Angry Bitter Resentful Judgmental Paranoia

19. Physiological Symptoms Energy Limited activity, outings Strength Sleep – increase/decrease, rarely feel rested Appetite GERD, diarrhea, headaches, HTN, back/neck pain, TMJ, palpitations Exacerbation of other illnesses Infx due to compromised immune system Start to need meds (GI, pain, sleep, OTC) Caffeine, Alcohol, Tobacco, Drugs

20. Cognitive Symptoms Concentration Focus Distractible Short-term Recall Intellectual Dulling Organization Multitasking

21. Distorted Perspective – Urgency in most things – Intensity in most things – Me-centered lenses although doing a lot for others – Me against the world – Not able to see normal or easy situations clearly Cognitive Symptoms

22. Behavioral Symptoms Compulsive about minor details Micromanage Procrastinate Blow off important details, Need to do things Self-sabotage Cry Accident-prone, clumsy Suicidal thoughts, actions Don’t take vacations or minimal vacation Not much recreational activity Neglecting your needs

23. Relational Symptoms Loss of compassion Relationships are draining Viewed as tasks/hindrances in the day Isolation Disconnected Argue/conflicts Passive or Aggressive

24. Spiritual Symptoms Disconnected from God Disconnected from Self and Others Activity – Stagnation, or going thru the motions Purpose – Lack of Direction Passion – Lack of enthusiasm Wisdom – seeing life through fleshly lenses Fruit of the Spirit missing Rationalizing and excuses/blaming Guilt/Shame and hiding

25. Common Statements I don’t enjoy my work like I used to. Everybody always needs something from me. I’m so far behind. I feel overwhelmed. I don’t even care anymore. Am I making a difference? Patients and physicians, we are all just numbers. Just let me practice medicine. I don’t get enough time with the patient. Why is God doing this to me?

26. BURNOUT: CAUSES BURNOUT: CAUSES Why Do We Burnout?

27. Occupational Causes of Burnout High Stress High Pressure - Mistakes can be deadly/costly Long Hours – Isolation, less other activities Decreasing autonomy/control Need to always be on for crisis, patients, and staff Much ‘wasted time’ on bureaucracy Increasing busywork Less Recognition for high batting average Less Tangible($) and Intangible Rewards

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29. Battle Fatigue = Chronic Stress High alertness for extended time Secular – Healthcare system – we will fail, our patients will die – Patients – Schedules – Coworkers and colleagues – Our own issues – Family – Yard and house projects Spiritual – Satan and our Flesh (pride)

31. Setups for Burnout We tend to think that just because we can sprint one day, we can sprint the next forty years. Med school – Residency – Professional Practice Not aware of boundaries – ours and others We have been conditioned to blow past boundaries in med school, and residency Ask very invasive questions Touch people’s genitals Lack of self-monitoring/self-assessment; Busy assessing others Boiling a frog

32. Personal Causes of Burnout Needs Self/Identity – doctor, not child of God Ability - we are good at it Relationships – patients, colleagues Consistency – practice activities Adoration/Unconditional Love – patients (often really conditional though) Safety/Security – financial, status Meaning – save lives, help people SARCASMSARCASMSARCASMSARCASM

33. Personal Causes of Burnout

36. Biblical Perspective Then I considered all that my hands had done and the toil I had expended in doing it, and behold, all was vanity and a striving after wind, and there was nothing to be gained under the sun. (2:11) So I hated life, because what is done under the sun was grievous to me, for all is vanity and a striving after wind. (2:17) For all his days are full of sorrow, and his work is a vexation. Even in the night his heart does not rest. This also is vanity. (2:23) Then I saw that all toil and all skill in work come from a man's envy of his neighbor. This also is vanity and a striving after wind. (4:4) He who loves money will not be satisfied with money, nor he who loves wealth with his income; this also is vanity. (5:10)

37. What is Burnout? Spiritual Misplaced Worship = Addiction – Worship = perceiving God accurately then responding accordingly – Worshipping something else Addicted – Work becomes a coping skill to – Fulfill Needs – relieve some of our stressors, but not working anymore We start to put our eggs in the wrong basket, not God’s basket. My kingdom come, my will be done. Insidious because not intentional

38. Bible Work Concepts Bible – God works in Genesis, Jesus in Revelation Man made in God’s image – Worker – God-given Ability Sin – makes work more challenging Work Ideal Goals: – Glorify Him in our work activities – Be an awesome worker, then a platform to evangelize – Salt and Light

39. Bible Work Concepts Proverbs – diligence, joy Ecclesiastes – Work – God = Vexation Noah – 100 years wasn’t burned out Jesus – “It is finished” Carpenter Evangelist, Healer, Teacher Many parables – talents/pounds Middle of Night – Peter, James, John to pray To whom much is given, much is expected Luke 12:48

40. Why Do We Burnout? Spiritual Spiritual Complacency Aren’t diligent with our decisions Not taking time for reflection and growth Why/Motivation: Subtly My kingdom come, my will be done Powered: Flesh vs. Spirit Bottom Line Why We Burnout?

41. The Catch-22 Be a great steward and get the most out of our skills; to shine brightly, constantly… Good and faithful servant! But not Burn Out. But our job is intoxicating as it meets so many needs. Where is balance?

42. Bible Work Concepts Obedience Vs. Relationship

43. Romans 12 : 1-2 I therefore urge you, brothers, in view of God's mercies, to offer your bodies as living sacrifices that are holy and pleasing to God, for this is the reasonable way for you to worship. Do not be conformed to this world, but continually be transformed by the renewing of your minds so that you may be able to determine what God's will is- what is proper, pleasing, and perfect.

44. Proverbs 4:23 Keep thy heart with all diligence; For out of it flows the wellspring of life. As a man thinks in his heart, so is he. Proverbs 23:7

45. Casting down imaginations, and every high thing that exalteth itself against the knowledge of God, and taking every thought captive to the obedience of Christ 2 Corinthians 10:5

46. 1 Peter 1:13-15 Therefore, prepare your minds for action, keep a clear head, and set your hope completely on the grace to be given you when Jesus Christ is revealed. As obedient children, do not be conformed to the passions of your former ignorance, but as he who called you is holy, you also be holy in all your conduct.

47. “ The end of the matter; all has been heard. Fear God and keep his commandments, for this is the whole duty of man.” We fear man and keep our own commandments All about decision-making Ecclesiastes 12:13

48. "The good physician knows the disease the patient has. The great physician knows the patient who has the disease.” Sir William Osler Father of Modern Medicine Self-Assessment and Reflection

49. Reflect – take time Assess - Decisions Determine our Motivations Need a Strategy for Heart Examination Autopsy What To Do

50. Spiritual Discipline Exercise for the brain, mind, spirit Helps you squeeze the Bible Learn who you really are Decision - Making Basics

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52. SPEARS All the elements Right sequence Requires thought Requires intention Requires practice Copyright 2012 - Lighthouse Network 52 Stimuli Perception Emotion Assessment Response Summary Thought

53. Stimuli Stimuli is anything that acts on or mobilizes your coping mechanisms All stimuli is neutral God is sovereign Copyright 2012 - Lighthouse Network 53 Stimuli Perception Emotion Assessment Response Summary Thought

54. Test How many squares are there? Hint: What is the most important question?

55. Perception Exercise Things are not always as they seem: the correct answer is 84! Assumptions Jumping to conclusions Knee-jerk reactions

57. Perception Perception is what really drives the decision- making process Subconscious We are usually unaware of perception because it occurs so fast in the decision-making process Copyright 2012 - Lighthouse Network 57 Perception Emotion Assessment Response Summary Thought Stimuli

58. Devil Dogs Bell Meat No Drool Drool

59. Perception Satan gets to us as early as possible, when we are most gullible Our brains our easily influenced as kids (neuroplasticity) Maturity is seeing life clearly Copyright 2012 - Lighthouse Network 59 Perception Emotion Assessment Response Summary Thought Stimuli

60. Filters Greatest Perceived Threat GPT Greatest Perceived Need GPN Life Depends On LDO Confidence C Motivation M

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62. God has lots of emotions! Anger – Mat 23, Mark 3, John 2, 2 Kings 24 Jealousy – Exodus 20, Deut 6 Sad/Wept – Luke 19, John 11, Heb 5 Troubled – John 12 Forsaken – Matt 27 Abandoned – Matt 27 Tempted – Matt 4 Worried – Luke 22 Copyright 2012 - Lighthouse Network 62

63. Emotion Warning system Not a decision-making system Distort reality Volume Buttons Solomon(1 Kings 11) Copyright 2012 - Lighthouse Network 63 Perception Emotion Assessment Response Summary Thought Stimuli

64. Assessment Who is stronger: a tiger or a man? Emotional and intellectual volume – We fail when we let our emotions rule our intellect Copyright 2012 - Lighthouse Network 64 Perception Emotion Assessment Response Summary Thought Stimuli

65. Assessment Court Opportunity vs. Adversity We must Look to God first (Light) Confession Weigh pros and cons using the filters (GPT, GPN, LDO, C, M) – SMB Damage/growth – Motivators Copyright 2012 - Lighthouse Network 65 Perception Emotion Assessment Response Summary Thought Stimuli

66. Response We need a relationship with God We need to put on the Armor of God Is this helping me or others become more Christ-like? WWJD? Mark 12:30 Copyright 2012 - Lighthouse Network 66 Perception Emotion Assessment Response Summary Thought Stimuli

67. Summary Thought After review of each element Celebrate our successes, and learn from our failures Are my responses working Heart Change Self-reflection and assessment is paramount Autopsy Copyright 2012 - Lighthouse Network Stimuli Perception Emotion Assessment Response Summary Thought 67

68. Summary Thought This is a chance to review each element Celebrate our successes, and learn from our failures Are my responses working Heart Change Self-reflection and assessment is paramount Copyright 2012 - Lighthouse Network 68 Perception Emotion Assessment Response Summary Thought Stimuli PAIN Old Beliefs New Beliefs Stimuli Perception Emotion Assessment Response Summary Thought Driving Force for Dysfunction

69. Old Self vs New Self, Old Man vs New Man, Flesh vs. Spirit Process Behavioral Change Examination of Heart Heart Change leads to Real Transformation Motivators for Change Deconstruction/Reconstruc tion

70. Community Physical Health Discern Real Crisis Take breaks – Jesus did Delegate more Build meaningful relationships Realistic expectations Debrief/Vent regularly – accountability partner Learn to relax – people, hobbies, Hot Tub Self reflection and awareness Have fun when others are dying Other Tips

71. Summary Healthcare Professionals Great calling but setup for addiction/burnout We can still shine brightly and continuously We do not have to burn out Need a strategy for efficient reflection and autopsy to check your HEART regularly SPEARS to renew your mind Stepping Stones for daily devotions that are heart checks and practical

72. Lighthouse Network Helpline Finds addiction and MH treatment options. Expertise about all elements of the system Free to client Saves the clinician incredible amounts of time We find great options for struggling people 877-562-2565 x:101 Copyright 2012 - Lighthouse Network72

73. Lighthouse NETWORK Resources Within Reach: Disciplines for Real Life Change – 10+ Hours of DVD – 140 Page Workbook Edging Forward: Godly Decision Making Parenting: Early Childhood and Teens (DVD) Can Psych Meds Help Christians? (DVD) Addiction: Sin vs. Disease DVD kbenzio@lighthousenetwork.org www.LighthouseNetwork.org Stepping Stones Daily Devotional - Free

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