By Dr Nyasha Grace Gogoma

Introduction

In the fast-paced, high stakes world of medicine, healthcare workers often face a myriad of challenges that can take a toll on their mental and emotional well-being. From long working hours to complex decisions and poor patient outcomes, the pressures of the job can feel immensely overwhelming, leaving many practitioners feeling “burnt out.” But what is burnout anyway, and how can connectedness combat it?

What is Burnout?

Burnout is defined by the WHO as a syndrome “resulting from chronic workplace stress that has not been successfully managed,” and comprises three defining characteristics: emotional exhaustion, depersonalisation, and decreased professional efficacy.¹ Emotional exhaustion refers to a sense of energy depletion; depersonalisation denotes mental distancing from and negative or cynical feelings towards one’s job, while decreased professional efficacy refers to feelings of low personal accomplishment and/or incompetence.^1,2 In other words, work that was once worthwhile and significant becomes unpleasant, unfulfilling, and meaningless.^3,4

The Odds are not in our Favour

Unfortunately, burnout is extremely prevalent in healthcare workers worldwide, and South Africa is no exception. Literature suggests that in addition to the abovementioned factors, most Sub-Saharan health professionals face the additional challenges of staff shortages, scarce resources, and high caseload.¹ It is unsurprising then that a recent systematic review of burnout among healthcare providers in Sub-Saharan Africa reported burnout rates in rural South African doctors of up to 81%.²

Demographically, the emotional exhaustion component tends to occur more in females, while cynicism is more commonly seen in males. In addition, burnout is more frequently seen in those just beginning their careers and in people demonstrating an external locus of control.⁴ Negative consequences of this condition include sub-optimal patient care, increased risk of road traffic accidents even after controlling for fatigue, absenteeism, increased skilled staff turnover, and greater patient dissatisfaction.³ The light at the end of the tunnel, however, is that many studies have found social support was protective against developing burnout.²

The Light at the End of the Tunnel

The power of positive social connection, one of the six tenets of Lifestyle Medicine, cannot be overstated, yet it is arguably one of the most under-prescribed. The Havard Study of Adult Development, a 75-year cohort study conducted between 1939 and 2014 concluded that the number one predictor of happiness and longevity was having social connections.⁵ Furthermore, social connection is known to buffer stress through vagal stimulation and oxytocin release, thereby dampening the effects of the sympathetic nervous system. On the other hand, low social interaction has a greater impact on mortality than obesity and lack of exercise and is equivalent to smoking 15 cigarettes daily or alcoholism.^6,7

A Word on the Workplace

The need for total organizational reform in preventing burnout is undeniable. In most cases, the root cause of chronic stress in healthcare workers is the workplace structure and culture itself.⁸ To promote well-being and mitigate burnout, the workplace environment ought to be one that views employee wellness as foundational.^8,9 Such an environment is characterised by respect of work-life boundaries, collaborative management, professional growth opportunities, and opportunity for workers to engage in personally meaningful work at least 20% of the time.^8,9

The Connection Prescription

We will now focus on the individual efforts that medical professionals can take to prevent, treat, or manage burnout in themselves, at the core of which is social connection. Social connection occurs when we feel that we are part of something greater than ourselves, when we feel close to another person or group, and when we feel we belong, are welcome and understood.⁷

1. Gratitude

Gratitude is the ability to recognize the goodness in life and ascribe it, at least to some extent, to others, and has been linked to enhanced emotional well-being and decreased feelings of stress, anxiety, and depression.¹⁰ Gratitude also fosters pro-sociality and pushes us to seek social support.¹⁰ Social expression of gratitude may be more beneficial than personal gratitude reflections alone.¹⁰

Prescription:    1) Once a month, write a gratitude letter to someone and personally deliver it to them and/or read it aloud

2) Daily after each work shift, choose a co-worker with whom to share three good things that happened that day

2. Kindness

Kindness has also been shown to create meaningful social connections and is linked with prosocial behaviours such as volunteering and generosity.⁶ After helping someone or even seeing someone being helped, we often feel a particular type of happiness called elevation or “Kama Muta.”⁶ This sensation, partly mediated through the opioid system, is described as warmth in the chest, and is linked to a feeling of optimism and connectedness with others.⁶ There is evidence that volunteers have decreased levels of inflammatory markers such as C-reactive protein. Along with its anti-inflammatory effects, volunteering as a form of positive social connection is also linked with increased vagal (parasympathetic) tone and immune competence, which may help to explain why connected people tend to live longer.⁶

Prescription:    1) Once a month, spend time volunteering at an orphanage, aged care facility, disadvantaged school, or other institution of your choice

2) Once a week, anticipate opportunities for generosity by identifying people around you in need and preparing resources within your means to give to them

3. Micro-moments of Connection and Positivity Resonance

Micro-moments of connection are short, genuine social interactions, and can occur anywhere, anytime, and with anyone.⁵ These momentary exchanges are all the more impactful when they are marked by positivity resonance. Positivity resonance is a brief experience that happens when two or more individuals share a particularly high-quality social interaction. Such connections are defined by three features: shared positive affect, mutual concern, and biological and behavioural synchrony.¹¹

An example of positivity resonance would be sharing the thrilling news of your baby’s recent birth and being met with shared squeals of joy, genuine interest in your baby pictures, and a well-timed congratulatory hug or handshake. Real-time sensory connection is thought to be a pre-requisite for positivity resonance, meaning that such interactions typically occur with face-to-face interactions where physical touch and direct eye contact are possible.¹¹ Moments of positivity resonance cultivate lasting social resources that foster better overall health and well-being.¹¹

Prescription:    1) Be fully present in and savour random moments when loved ones, colleagues, or even strangers share positive experiences with you and be open to sharing your own positive experiences with them

4. Community Membership

Finally, the need to belong to a group and develop collaborative relationships is a human instinct that likely developed to confer our ancestors with a survival advantage through shared resources and safety in numbers.¹² According to Maslow, “feeling part of a group larger than oneself such as a work community, religious affiliation, community centre, volunteer organization, team, interest group, or club is an essential component in the self-actualization process,” and contributes to peak performance and well-being.⁷

Prescription:    1) Once a week, attend a local religious gathering, community club, or other interest group in person and take part in group activities

Conclusion

In conclusion, positive social connection is a powerful tool in our quest to live happy and healthy lives, and when practically applied, is useful in combating burnout in healthcare professionals.

References

1. Moses AC, Dreyer AR, Robertson L. Factors associated with burnout among healthcare providers in a rural context, South Africa. Afr J Prm Health Care Fam Med. 2024;16(1), a4163. https://doi.org/10.4102/phcfm.v16i1.4163
2. Dubale BW, Friedman LE, Chemali Z, et al. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-019-7566-7
3. Sovold LE, Naslund JA, Kousoulis AA, et al. Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority. Frontiers in Public Health. 2021;9(1):1-12. https://doi.org/10.3389/fpubh.2021.679397
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5. Clayton JS, Bonnet J. Foundations of Lifestyle Medicine Board Review Manual. 4th ed. American College of Lifestyle Medicine; 2023:336.
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9. Lianov L. A Powerful Antidote to Physician Burnout: Intensive Healthy Lifestyle and Positive Psychology Approaches. American Journal of Lifestyle Medicine. 2021;15(5):563-566. https://doi.org/10.1177/15598276211006626
10. Burke J, O’Donovan R. Gratitude as a protective factor against burnout in healthcare professionals: a systematic review. British Journal of Healthcare Management. 2023. https://doi.org/10.12968/bjhc.2021.0163
11. Major BC, Le Nguyen KD, Lundberg KB, Fredrickson BL. Well-being Correlates of Perceived Positivity Resonance: Evidence from Trait and Episode-Level Assessments. Personality and Social Psychology Bulletin. 2018;44(12):1631-1647. https://doi.org/10.1177/0146167218771324
12. Southwick SM, Southwick FS. The Loss of Social Connectedness as a Major Contributor to Physician Burnout: Applying Organizational and Teamwork Principles for Prevention and Recovery. JAMA Psychiatry. 2020;77(5):449–450. https://doi.org/10.1001/jamapsychiatry.2019.4800