Dear Bill | I'm Not Feeling It

Posted by Bill Esteb on Aug 29th 2020

Dear Bill,

I've been at this for just over 20 years and between the insurance companies and patients who want instant results in one visit I'm feeling a bit burned out. Do you have any suggestions?




This is a common tale. It's often the result of the world not lining up with our expectations. Or more commonly, when we make significant emotional investment in something that isn't adequately rewarding us.

Constantly giving, giving, giving without a commensurate return can be disheartening and discouraging. Worse, it's unsustainable.

One solution is to give up and merely phone it in. This is a common defense mechanism that ultimately leads to a detached cynicism and eventually full-fledged burnout. The hope is that something or someone will put us out of our misery. Or, circumstances (having to pay the bills) will give us the motivation to do what is necessary to persevere. Like any health condition, in this case emotional health, it's easier to stay out of burnout then it is to escape burnout.

A healthier approach would be to become present to the expectations you have set for yourself and do some recalibration.

Burnout as a Symptom of Needing a Vacation

Instead of addressing the cause, like patients, it's tempting to merely treat the symptoms of burnout. That usually involves a sandy beach and some brightly colored drinks with umbrellas. It's the greatest myth about professional burnout.

"Oh honey, you just need a vacation."

It has been awhile since you've gotten away from the practice. And based on your state of mind, the notion of lounging on a tropical beach for a week or so sounds appealing. And while you're not keen about the loss of momentum your practice will experience, a holiday may be just what the doctor ordered.

And while most chiropractors don't take nearly enough vacations to rest, relax and recreate, the motive here is flawed. You're attempting to treat an emotional problem with a physical intervention. About a week or two after your return, the familiar feelings of fatigue and emotional detachment have returned.

Burnout as a Symptom of Poor Boundaries

Every chiropractor I've met who acknowledges being a little crispy around the edges reveals some issue with personal or professional boundaries. The more common trespasses include:

Projection – Assuming patients value their health to the degree you do.

Parenting – Treating patients like children who must be constantly monitored.

Reputation – Believing that what patients do or don't do is a reflection of you.

Persuasion – Thinking you can convince patients to embrace your vision of health.

Recalibration means accepting your limitations and relinquishing your habit of attempting to control things that are outside your domain. Particularly your habit of being responsible for what patients do or don't do.

Burnout as a Symptom of Inappropriate Expectations

Another cause of burnout is failing to achieve one's goals.

Perhaps your practice isn't yielding the income you expected. Maybe you thought you'd have your student debt retired by now. Or that some statistical goal you've set seems elusive. Or your spouse has become resentful that the practice isn't producing a professional income.

Like the punishment of Sisyphus who was forced to roll a large boulder up a hill, only to have it roll back down just short of the top, practice success seems elusive.

It's hard to see the joy in practice if it constantly feels laborious and futile.

Recalibration means setting more realistic expectations and enjoying the journey. Because there's no place to get to. Imagining that "I'll be happy when…" or "I'll be secure when…" or "I'll be a success when…" is the perfect strategy for postponing the needed emotional reward that is needed to fuel your service to others. Take some time to review your thank you cards, website reviews, "Atta boys" and the countless ways patients have expressed their gratitude over the years.

Burnout as a Symptom of Taking On Inappropriate Responsibility

Finally, another common cause of burnout is the emotional stress produced by making a promise you're not sure you can keep. Namely, accepting a patient on the basis that you will relieve whatever symptom that has prompted them to seek your care.

Using adjustments to treat a patient's symptom is all too common in chiropractic. And even if you make the distinction that your intention is to restore function, not treat their symptom, it's largely lost on patients.

While you may not be conscious of the stress that taking on the resolution of a patient's symptom produces, it shows up in the constant awareness of each patient's symptomatic improvement and trying to estimate their commitment to your care plan. Exhausting. Worse, your vigilance is rewarded by these same patients dropping out of care without even a thank you or goodbye!

Recalibration means constantly reminding patients that their chiropractic care isn't treating their symptoms. It usually ends up producing that effect, but not in the way pain medication hijacks their body so they can't feel the symptoms.

"You're in the right place. We've helped many people who experience migraines. But we don't treat migraines. Let me explain." Or, "You have every reason to be hopeful because helping people with migraines is practically routine around here. But we don't treat migraines. Let me explain."

Expect most patients to nod at your assertion but ignore it. Plan on reminding them on every visit. Plan on emblazing it on the walls or your practice. When patient appreciate and embrace this important distinction, you'll experience two healthy outcomes:

1. You create patients as partners. No longer are you expected to singlehandedly resolve their symptoms as they have been taught my consulting medical practitioners.

2. You experience a newfound sense of ease. No longer do you walk on eggshells and constantly check to see if they're still on board.

Hope that helps.

Thanks for the question!

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