It is not easy to be a healer. Doctors and other providers experience a number of challenges in the healing role. How do you rate on the Headington Institute Burnout Scale?

Mythologists describe the “Wounded Healer” as an archetype, and many would argue that most people trained in Western medicine currently are or have previously been in this role. Many physicians, in particular, have personalities that set them up for suffering a great deal because of their approach to their work. As Spickard et al, note:

“Certain personality traits may enhance the risk of burnout by influencing the individual’s response to stressors in the workplace. Compulsiveness is a character trait found in many physicians and, although it may be adaptive behavior for the demands of medical education, it can also have an enormous detrimental impact on their professional, personal, and family lives. The compulsive triad of doubt, guilt feelings, and an exaggerated sense of responsibility has been well described. Physicians with compulsiveness have chronic feelings of not doing enough, difficulty setting limits, hypertrophied guilt feelings that interfere with the healthy pursuit of pleasure, and the confusion of selfishness with healthy self-interest. A dissociation (diminishing awareness of one’s physical and emotional needs) leads to a self-destructive pattern of overwork. A psychology of postponement takes root in which physicians habitually delay attending to their significant relationships and other sources of renewal until all the work is done or the next professional hurdle is achieved.” (JAMA 2002;288:1447-50)

slide presentation on burnout by Dr. Hakam Yaman defines burnout and explores how it arises and how it might be addressed. The Canada Medical Association has created the Center for Physician Health and Well-Being, acknowledging that this is an important issue. A 2007 Occupation Health Article, and 2004 JAMA article review study findings related to burnout and how it might be better-addressed.

Burnout doesn’t just affect physicians themselves. It has been found to negatively affect prescribing practices (SSM 1980;14A:495-9) and patient compliance (Health Psych 1993;12:93-102). It also decreases overall quality of care (Med Care 1994;32:745-54).

What are some strategies to avoid or deal with burnout? The American College of Physicians lists several. Some great tips are also available in the student section of a past issue of the British Medical Journal. An article by Zeckausen in Family Practice Management has some excellent tips and resources as well.

Specific suggestions found in many of these resources include:

  • Be certain that you have control over your work environment
  • Spend time with people you love; a supportive partner is key
  • Cultivate religious, spiritual, creative pursuits
  • Be aware of your self-care needs, including for healthy diet, exercise, social contact and a sense of meaning and purpose
  • Set limits and boundaries
  • Begin a mindfulness/meditation practice
  • Manage stress. Mind Tools has some useful tips
  • Have good mentors and confidantes
  • Cultivate your sense of humor. Check out The Doctor’s Page for a treasure trove of healthcare jokes and anecdotes
  • Ask for help. Do you have your own healthcare providers to take care of you?
  • Avoid common thought distortions that healthcare providers often fall into, as outlined in the box below, as created by Felice Miller in West Medical Journal 2001;174:49-50:

Common thought distortions and how to challenge them

1. Magnification or minimization. One aspect of the situation is over- or underemphasized: “I didn’t check with the patient whether or not he understood why I gave that medication. That was a wasted visit.” “Too much was going on to discuss that dizziness today.” Take stock of what you did well.

2. Polarization. Using black and white thinking: “My colleagues are going to think I am incompetent.” “I made a mistake; I am a terrible doctor.” Are there shades of gray? Can you rephrase the thought to be less extreme?

3. Personalization. Taking the situation personally and ignoring the total picture: “It’s my fault.” What would you say to a colleague in the same position?

4. Stress-producing language. Using words such as ‘should’, ‘have to’, ‘must’, and ‘need’. Instead, try ‘would like’ or ‘want’. Instead of “I should never make a mistake,” say “I would like to improve my skills in that area.”

5. Pessimistic thinking. Thinking of the situation as permanent, pervasive, and personal: “I’m never going to have the respect of my colleagues” or “I’m not suited to this profession”. Instead, acknowledge that a situation can be temporary, specific, and related to factors other than oneself.

6. Catastrophizing. Is this unfortunate incident a catastrophe? Note thoughts such as “I’m going to be sued” or “I killed the patient.” If the bad outcome happened, what would/would not be the actual consequences, and could you handle them?


“Engrossed late and soon in professional cares…you may so lay waste that you may find, too late, with hearts given way, that there is no place in your habit-stricken souls for those gentler influences which make life worth living.”
– William Osler

“As I learned through hard experience, the practice of medicine is a black hole that can absorb every moment you will give. It’s easy to become so devoted to your patients that you neglect the people who matter most to you.”
– Matthew D. Foster, MD in Medical Economics 10/23/95

“..The archetype of the wounded healer reveals to us that it is only by being willing to face, consciously experience and go through our wound do we receive its blessing. To go through our wound is to embrace, assent, and say “yes” to the mysteriously painful new place in ourselves where the wound is leading us. Going through our wound, we can allow ourselves to be re-created by the wound. Our wound is not a static entity, but rather a continually unfolding dynamic process that manifests, reveals and incarnates itself through us, which is to say that our wound is teaching us something about ourselves. Going through our wound means realizing we will never again be the same when we get to the other side of this initiatory process. Going through our wound is a genuine death experience, as our old self “dies” in the process, while a new, more expansive and empowered part of ourselves is potentially born…”

“…Going through and embracing our wound as a part of ourselves is radically different than circumnavigating and going around (avoiding), or getting stuck in and endlessly, obsessively recreating (being taken over by) our wound. The event of our wounding is simultaneously catalyzing a deeper (potential) healing process which requires our active engagement, thus “wedding” us to a deeper level of our being…”

“…The wounded healer only becomes able to heal and help others (which is to simultaneously be healing and helping him/herself again and again in the form of seeming “others”), when instead of being resentful, bitter and feeling victimized by their wound, he or she recognizes their wound as a numinous event, an archetypal moment that seeks to make them participants in a divine, eternal happening.”
– Paul Levy, The Network of Spiritual Progressives