Urologist shares her personal experiences with burnout

In this installment of “Begin Your Journey,” urologist Diana Londoño, MD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about her career path. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.

Transcription:

MacDiarmid: How did you know that you had burnout?

Londoño: It manifested very differently [each time]. The first time, it came because of chronic worry about patients. I was in a job where I was solo practice; I didn't have any backup. I worked probably 8 months straight, including weekends, rounding and seeing patients, and I never had time to stop that chronic little worry in the back of my head about patients or what to do or having to round. If you start out with fear, worry, or stress, all of these, however you want to label them, they're activating our sympathetic system, our fight or flight, and then causing all the cascade of changes in our body leading to the burnout, and the symptoms that come with that. For me, the first time I was burned out I felt foggy and unsure and a little bit paranoid, like, what should I do? [One day,] I couldn't decide if I should put a Foley catheter in a patient that was a little bit complex. It's such a simple thing as a urologist. And when I realized I couldn't decide such a simple thing, it really was scary, because we make so many decisions every day for so many little things and big things. So when I started to feel foggy, I said, something's wrong. I went to the doctor and said, "It must be my thyroid, it must be sugar, something's definitely off. Please check blood levels to figure out what the issue is." There were no physical issues, just chronic stress, worry, anxiety. And the doctor said, "Here's your Zoloft and here are some graphs about the sympathetic system and dopamine and the parasympathetic system." I was a little bit in shock. It was definitely time to get a therapist, and be on Zoloft. I came off that, and I thought, things are fine. I didn't even call it burnout because I didn't know what it was. I just thought, I feel foggy.

The second time was more from chronic fear. For me, it was COVID-19. I know people managed it very differently, but for me, it was a lot of fear. So your sympathetic system is in overdrive; you have this chronic underlying stress, fear, worry. My whole body now was bathed in cortisol. I couldn't sleep. I was waking up multiple times, I was grinding my teeth. I developed asthma. I mean, I literally had pulmonary function tests that showed asthma at 42 years old. I had reflux, I was on Protonix. I started to get joint pain, and my rheumatoid factor was up. You're developing autoimmune diseases; you're fighting your own body with chronic stress. When I changed things, all that went away. I don't have any of those symptoms. I sleep like a baby, I'm not on Protonix, I don't have asthma, I can run without problems. I don't have joint pain. So it literally manifested as physical illness. The amazing thing is our bodies are so wise. We have wisdom in our bodies, with red flags that tell you, "Hey, pay attention." Listen to your body; these are the signals telling you something is out of balance. And I can say that having gone through burnout, something is out of balance in your system, in your body. The body always wants to maintain that balance, that homeostasis. That's what it wants to do. But we do things to it, either by what we consume in our mind, in our food, our lack of exercise or relationships, where things get out of balance. So then it's telling us, "Please pay attention, so you get back to that regular state." So again, it manifested very differently, and I didn't have the awareness. It had to be pointed out. My husband said, "You're becoming pretty negative," and I said, "Of course not." But of course I was. I had negative thoughts, I was cynical, which is what happens in burnout. You're cynical, you're angry, you're apathetic, you're depersonalizing patients. That's how you become. So it was really an eye-opening statement, but it was one that needed to be said, so I could then take action and do something different.

This transcript was edited for clarity.