Choice: My Lighthouse in a Wave of Disillusionment By Tracy Asamoah, MD on 10/18/18 - 2:30 PM

I stared, hypnotized by the cursor, it’s pulsating blink, blink, blink strengthening my resolve. I had been working as a staff psychiatrist for 4 years and had become increasingly frustrated and disillusioned by what I and my colleagues were being asked to do. Sitting in front of my computer, hoping to squeeze in another patient note before the next family came into my office, I reaffirmed my limits.

“You either cooperate or get off the boat,” our newest administrator threatened during our last staff meeting. Anger, anxiety, sadness. They all battled for prime real estate in my emotional landscape. Our clinic helped underserved residents in our community who frequently came to us in crisis and despair. Their stories and lives were fragile and complicated. I often left work at the end of the day feeling depleted.

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When I initially accepted this position, the clinic seemed visionary. I was inspired by its mission to offer the highest quality care to marginalized communities in an integrated healthcare setting. I felt empowered as one of the first child psychiatrists with the organization. In all my glittery idealism, I envisioned designing programs to provide families with care and resources in a safe and supportive setting.

Four years later, sitting in a cold, barren conference room listening to our new leadership, I felt defeated. Standing in starched, black and gray suits, individuals tasked with evaluating our work by how our practices impacted the bottom line, dictated edicts of how we would have to do more, in less time, for more people or “get off the boat.” Feelings of resentment, ineffectiveness and detachment from my work had taken root as I sat in my office each day. Sitting in the conference room, I visualized walking a plank in the middle of the Pacific Ocean, a gleaning silver saber jabbing impatiently in my back while I pondered my choice.

A choice. I still had this. With the beginning stages of burnout emerging, I felt a brief flash of optimism when I spotted this buoy of hope in the distance. I clung to this as I began considering my options for an uncertain future. Choice was my greatest asset in regaining control of my future and sense of well-being.

Research has revealed that one of the most significant triggers of burnout is the stripping away of personal control. In the workplace, loss of control grows from a loss of choice or sense of being an active agent in one’s professional life. For me, it started when, one after another, ideas that I thought would improve patient care and bolster employee morale were dismissed in favor of practices that increased revenue and patient census in the clinic. This was followed by greater external control on who I saw, when I saw them, how often and for how long. The pressure of these external forces threatened to extinguish the passion and fulfillment I derived from my work. Many physicians struggle with burnout from similar factors.

I chose to leave. Exhausted from treading water in a sea of uncertainty, I recognized that my lifeboat was the power of choice. Empowered by the knowledge that I had options, I chose to run away from increasing constriction and to run towards self-determination.

At first, I felt like this:

Self-doubt, anxiety, fear, excitement, and relief jockeyed for position in my mind. I realized that as with all choices, positive and negative outcomes were both possible.

What if my husband couldn’t work? What if I never figured out what I wanted to do? However, I soon discovered one important emotion absent from the torrent filling my head, regret. While I had chosen an uncertain future, I was assured about my path towards self-preservation. I was empowered through my choice and being an active agent in my future.

The seed of any worthwhile or important choice begins with a nudge rising from within that suggests, or more forcefully urges us toward change. It involves understanding your options and the benefits and drawbacks associated with those options. Finally, it involves accepting the outcome of your choice. As in the case of addressing burnout, these choices can have a drastic impact on emotional, psychological and physical well-being. While not all choices are as dramatic as quitting a job, every choice carries with it the weight of what we will gain and what we will lose. However, our choices give us power and that power allows us to be the navigators of our own lives.

File under: The Art of Psychotherapy, A Day in the Life of a Therapist