“What’s my motivation?”
It’s a simple questions at the heart of examining our own behavior. So much so, that it’s cliché to imagine a fussy actor hassling their director for an answer.
Building on Maslach’s work1, 2 (mentioned previously) Gail Gazelle, Jane M. Liebschutz, and Helen Riess discuss coaching. Professional coaching is widely used in other sectors, and is finding its way into the medical profession.
Specifically in regards to burnout, the coaching that Gazelle, et al. discuss revolves around
an internal locus of control. In other words, does the health care provider believe she or he is in control of the events in their life, or do they feel that external factors control them?
Clearly, things happen to us we have no control over, but this emphasis on control, and its academic cousins, Self-Determination Theory and Positive Psychology, are a means to talk about motivation. Talking with a healthcare provider about what they do have control over
emphasizes the centrality of internal autonomy in maintaining motivation and satisfaction.
When a healthcare provider reconnects with their professional and personal motivations (much like having a deep sense of calling to the healthcare field), it makes work satisfaction easier to obtain by
aligning personal values with professional duties.
Another aspect of coaching which Gazelle, et al. discuss is the idea that coaching is different from professional mental health help. Mental health professionals primarily deal with a more traditional model of pathology and treatment. Coaches seek to make their clients aware of their own abilities, reach the goals they determine for themselves, and treat clients as
the expert on their own life:
Coaching presupposes sufficient inner resources and the necessary expertise to tackle life challenges, and provides the guidance to harness these internal mechanisms.3, 4, 5 A core coaching construct is amplifying a client’s internal locus of control, defined as the belief that one’s actions have as much or more impact on life outcomes than external forces or individuals.6 Studies in a variety of professions note an inverse correlation between internal locus of control and burnout.7, 8 In addition, coaching increases self-efficacy and self-determination, vital counterbalances to burnout,9, 10 and critical for physicians rapidly losing workplace control.
On a social level, coaching
carries less stigma than professional counseling does. While the authors admit there is some overlap, the professional coach
should have a low threshold for recommending psychological and/or psychiatric evaluation since coaching
is not appropriate with active psychiatric illness (such as major depression, psychosis, or obsessive compulsive disorder), and not effective in the setting of active substance abuse.
The ideas which Gazelle, et al. work with aren’t only valid for seasoned professionals. The authors demonstrate the need for these ideas to be implemented in medical education.
Medical training emphasizes perfectionism, denial of personal vulnerability, and delayed gratification.11, 12, 13 Traits such as compulsiveness, guilt, and self-denial may facilitate success in medical education and training; however, in a long-term career, these same traits can fuel feelings of inadequacy. Set in a professional culture that stigmatizes weakness and self-care,14 these factors contribute to burnout, when external pressures overwhelm internal sense of control.
The habits that future doctors develop to survive and thrive in med school and residency are the same habits that feed into burnout.
Gazelle, et al. describe several examples of coaching dialogues. The format is very simple: a conversation about how the healthcare provider feels at their job, and a frank discussion of any incidents where the physician, etc., feels any symptoms of burnout.
The conversations between a healthcare provider and a coach are iterative: they go over the same events or thought processes several times, which
helps expose and challenge negative emotional patterns, including self-defeating inner dialogue. Identifying these negative patterns and countering them with a physician-directed assessment of their own strengths helps
identify, bolster, and apply strengths in challenging situations is another technique, important in a medical culture known to malign personal weakness.
The goal of coaching is to help the healthcare provider stop reacting to events as if they had no control over their actions, but instead help the provider act with
purposeful response. Gazelle, et al. demonstrate that this alignment of their motivation and calling to become a healthcare provider and their actions results in engagement, which Maslach describes as
characterized by energy, involvement, and efficacy — the direct opposites of the three burnout dimensions,15 which are emotional exhaustion, cynicism, and depersonalization.
Our Narrative Understanding of Meaning
We have a natural inclination to draw conclusions from what happens to us. When we tell stories about what happens to us professionally, our thinking is automatically directed towards our own selves as the character in a kind of Aesop’s Fable, and we usually can’t help coming up with a “moral of the story”. Gazelle, et al. mention some of these:
- “The demands on my time are too much; I’m exhausted and not accomplishing anything.”
- “I should be smarter and more efficient. I don’t have what it takes.”
- “People think I’m a great physician, but they don’t see the real me.”
I don’t consider myself a burnout coach in the sense that Gazelle, et al. describe, but I find several encouraging things about their work:
Telling our stories is an important part of connecting us with our work and our reasons for that work. It’s important to tell one another the stories of when our work doesn’t go well. That’s the most direct route to challenging our negative assumptions about ourselves and realizing that we have the power to change our reaction to a situation, if nothing else. It’s important to tell the stories of our successes, too. They challenge our negative assumptions about ourselves and help connect us with our calling and purpose.
Another encouraging element of their work is the inclusion of financial data. They cite studies which demonstrate that it’s financially worthwhile to confront our interpretations of our own stories:
Widely employed in the business world, studies reveal financial return of 2.2 – 5.7 times on investment [in coaching].16, 17 In addition, coaching can strengthen diverse professional skills, including decisiveness, time management, productivity, communication, leadership, and teamwork.18, 19
It’s also encouraging that this work is a growing trend, and that healthcare providers, administrators, and medical researchers are all interested in where work of this nature is going.
The article reviewed: Gazelle, Gail, Jane M. Liebschutz, and Helen Riess. “Physician Burnout: Coaching a Way Out.” Journal of General Internal Medicine 30, no. 4 (2015): 508–13. https://doi.org/10.1007/s11606-014-3144-y.
3 Stober, Dianne R., and Anthony (Anthony M.) Grant. Evidence Based Coaching Handbook: Putting Best Practices to Work for Your Clients. John Wiley & Sons, 2006. ↑
4 Whitmore, John. Coaching for Performance: GROWing Human Potential and Purpose: The Principles and Practice of Coaching and Leadership. Nicholas Brealey, 2009. ↑
5 Kimsey-House, Henry, Karen. Kimsey-House, and Phil. Sandahl. Co-Active Coaching: Changing Business, Transforming Lives. Nicholas Brealey, 2011. ↑
7 McIntyre, T C. “The Relationship between Locus of Control and Teacher Burnout.” The British Journal of Educational Psychology 54 (Part 2) (June 1984): 235–38. https://doi.org/10.1111/j.2044-8279.1984.tb02585.x. ↑
8 Schmitz, N, W Neumann, and R Oppermann. “Stress, Burnout and Locus of Control in German Nurses.” International Journal of Nursing Studies 37, no. 2 (April 1, 2000): 95–99. https://doi.org/10.1016/S0020-7489(99)00069-3. ↑
10 Glass, D. C., and J. D. McKnight. “Perceived Control, Depressive Symptomatology, and Professional Burnout: A Review of the Evidence.” Psychology & Health. 11, no. 1 (January 1996): 23–48. https://doi.org/10.1080/08870449608401975. ↑
11 Miller, N. M., and R. K. McGowen. “The Painful Truth: Physicians Are Not Invincible.” Southern Medical Journal 93, no. 10 (October 2000): 966–73. ↑
12 Spickard, Anderson, Steven G. Gabbe, and John F. Christensen. “Mid-Career Burnout in Generalist and Specialist Physicians.” JAMA 288, no. 12 (September 25, 2002): 1447–50. ↑
13 Wallace, Jean E., Jane B. Lemaire, and William A. Ghali. “Physician Wellness: A Missing Quality Indicator.” The Lancet 374, no. 9702 (November 14, 2009): 1714–21. https://doi.org/10.1016/S0140-6736(09)61424-0. ↑
14 Novack, Dennis H., Anthony L. Suchman, William Clark, Ronald M. Epstein, Eva Najberg, and Craig Kaplan. “Calibrating the Physician.” JAMA 278, no. 6 (August 13, 1997): 502. https://doi.org/10.1001/jama.1997.03550060078040. ↑
16 McGovern, Joy, Michael Lindemann, Monica Vergara, Stacey Murphy, Linda Barker, and Rodney Warrenfeltz. “Maximizing the Impact of Executive Coaching: Behavioral Change, Organizational Outcomes, and Return on Investment.” A Journal for People and Organizations in Transition 6, no. 1 (2001): 1–9. ↑
18 Kauffman, Carol, and Diane Coutu. “The Realities of Executive Coaching,” Harvard Business Review Research Report (2009): 1-32. ↑
19 Theeboom, Tim, Bianca Beersma, and Annelies E.M. van Vianen. “Does Coaching Work? A Meta-Analysis on the Effects of Coaching on Individual Level Outcomes in an Organizational Context.” The Journal of Positive Psychology 9, no. 1 (2014): 1–18. https://doi.org/10.1080/17439760.2013.837499. ↑