Burnout and the�PGA Professional

Meg Leddy MMSc, PA-C

Duke Wellness Ambassador

Thank You

What are my Credentials?

• Bachelor Degree in Nutrition and Sports Medicine
• Certified Athletic Trainer
• Yale University School of Medicine Physician Associate Program
• Physician Assistant in orthopedics, general surgery, cardiothoracic surgery, and surgical oncology
• Duke Wellness Ambassador
• Suffered severe burnout
• Married to a Class A PGA professional for over 21 years

Similarities between Medicine and Golf

• Increased time on a computer screen (Tee times software, Ghin, Golf shop management software, Point of sale, Tournament operations, Emails, Web meetings)
• Unreasonable expectations from customers
• Staffing shortages
• Decreased experience level in staff
• Long hours
• Called upon do perform duties not in your job description
• You are the one the customer has access to (complaint center)
• You may be getting judged by your least paid employee

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Why am I here?

BECAUSE EVERY HUMAN CAN GET BURNED OUT

What people think burnout is

• Too many hours on the job
• Short staffing
• Not enough sleep
• Not enough exercise
• Not enough vacation
• Not enough time with family/friends/loved ones

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My Definition of Burnout

A dysregulated nervous system due to the constant, chronic onslaught of environmental and mental factors that are considered “normal”.

What we have accepted as normal

Chronic Fatigue and Stress

Poor Sleep

Work is a paycheck. Happiness happens outside of work.

This “normal” life keeps our nervous system on high alert

• Work
• Family (kids, aging parents, pets)
• Finances
• Health issues
• Traffic
• Social Media
• News/Politics

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Fight or Flight

Rest and Relax

What happens when you are stressed all the time?

Yerkes-Dodson Stress Curve

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Old Playground Equipment

Chronic stress affects our physiology

Acute elevations in cortisol levels are beneficial to promoting survival of the fittest as part of the fight-or-flight response. However, chronic exposure to stress results in reversal of the beneficial effects, with long-term cortisol exposure becoming maladaptive, which can lead to a broad range of problems including the metabolic syndrome, obesity, cancer, mental health disorders, cardiovascular disease and increased susceptibility to infections.

Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27. PMID: 31249398.

Burnout is Insidious

Brain Science behind burnout

Image from: https://kids.nationalgeographic.com/science/article/your-amazing-brain

Brain Non-Evolution

I am just a big dumb animal

- Phil Leddy

We all are functioning with an outdated operating system.

Artist Emma Leddy

Neuroplasticity

The highway for seeing the negative

The path for seeing the positive

You can Flip it with intentional practice

The highway for seeing the positive

The path for seeing the negative

What the burned out eyes are able to see is limited:

Eye-tracking of attention of burned out and depressed participants was the same: �more focus on dysphoric stimuli / �less focus on positive stimuli

J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality Duke University Health System

Fatigue and Stress

The Prefrontal Cortex (PFC

Mayo Clin Proc. 2021 March ; 96(3): 763–769. doi:10.1016/j.mayocp.2020.12.027

Functions of the prefrontal cortex (PFC)

• Governs higher order reasoning
• Social cognition
• Complex decision making
• Attention regulation
• Planning and organization
• Guiding appropriate social behaviors
• Maintaining integrity

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• Regulates emotional circuits
• Affects mood and anxiety
• Metacognition – thinking about thinking
• Insight into oneself and others
• Moral consciousness
• Emotional intelligence
• Empathy

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Mayo Clin Proc. 2021 March ; 96(3): 763–769. doi:10.1016/j.mayocp.2020.12.027

Relevance to Work

Examples of PFC dysfunction

• Forgetful, concrete thinking
• Difficulty concentrating, disorganized
• Impaired decision making
• Reduced insight, judgement, moral conscience
• Decreased empathy and compassion
• Decreased optimism and persistence
• Decreased self-regulation, inhibitory control

Examples of consequences

Potential for errors

Harder to manage complex tasks

Sub-optimal customer service

Decreased commitment to professionalism

Impaired communications with peers

Cynicism and decreased engagement

Increased likelihood of unprofessional behaviors

Mayo Clin Proc. 2021 March ; 96(3): 763–769. doi:10.1016/j.mayocp.2020.12.027.

Burnout is insidious

Mayo Clin Proc. 2021 March ; 96(3): 763–769. doi:10.1016/j.mayocp.2020.12.027.

“Brain research has demonstrated that uncontrollable stress, but not controllable stress, impairs the functioning of the prefrontal cortex”

Type of Stress matters

Thus, if one feels confident that one can handle a challenging situation or that there are sufficient supports to maintain one’s safety, the PFC can inhibit the stress response and maintain a more optimal neurochemical environment.

Simplified

Pictures from Dreamstime.com

Uncontrolled Stress

Controlled stress

Pic of comedian

Moving our Baseline

Wellbeing

Stressed Baseline

(completely dysregulated)

Moving our Baseline

Wellbeing

Improved Baseline (dysregulated by stress but regulated at baseline)

Thriving

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Wellbeing

Stress

Healthy Baseline

(regulated all the time)

So how do you shift your baseline to become more regulated?

• Time off
• Breathing
• Green Space
• Core Values
• Building Relationships

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“We can see symptoms of breakdown when we begin to lose our ability to concentrate,” clinical assistant professor of psychiatry Mark Rego said. “We have the tip of the tongue phenomenon, we lose things easily — these are both from working memory breaking down — and our emotions escape their confines into harsh speech. Eventually the system will break down and we will need to rest to focus at all.”

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The Cornell study found that after a month of reduced stress, these effects disappeared. In healthy individuals, the plasticity of the prefrontal cortex allowed for such cognitive impairments from stress to be reversed. However, this cycle could threaten long-term mental health.

“How people fall apart”: Yale faculty discuss the impact of burnout on the brain - Yale Daily News

We all need a month off

First things First

• Plan time off TONIGHT
• I am going to suggest UNSCHEDULED time off
• Stay – but you are not allowed to do anything for the time you would normally be at work – no household anything – kids etc
• Go – somewhere close – but again no plans once you get there
• GET BORED
• TURN OFF THE PHONE
• Let work know there will be NO CONTACT

Screen Apnea

• temporary cessation of breath or shallow breathing while working (or playing!) in front of screens
• about 80% of the people observed and tested had email apnea

https://lindastone.net/2014/11/24/are-you-breathing-do-you-have-email-apnea/

https://www.adweek.com/brand-marketing/infographic-what-is-everyone-doing-on-their-second-screens/

Screen Apnea

• Cumulative breath holding contributes to stress-related diseases
• Implicated in
• Immune function
• Learning, memory and cognition
• Sleeping
• Weight
• Feeling pain
• Inflammation

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• With email apnea, or compromised breathing, we tend to go into a “fight or flight”
• When the sympathetic nervous system is activated, it causes the liver to dump glucose and cholesterol and the heart rate increases. We crave sugar and carbohydrates

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Breathing

Breathing

• Chest/intercostal breathing
• Fight or flight
• Sympathetic
• Increased heart rate
• Increased respiratory rate
• Decreased blood flow to gut

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Breathing

• Belly/diaphragm breathing
• Rest and relax
• Parasympathetic
• Decreased heart rate
• Decreased blood pressure
• Increased blood flow to gut

4-7-8 Breathing

Image from: https://www.catherinespann.com/post/breathing-for-relaxation-the-4-7-8-breathing-exercise

Get into Green Space

Green Space

• Lowers the stress hormone cortisol
• Lowers heart rate
• Lowers blood pressure
• Increased parasympathetic (rest/relax)
• Decreased sympathetic (fight/flight)

Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Environ Health Prev Med. 2010 Jan;15(1):18-26. doi: 10.1007/s12199-009-0086-9. PMID: 19568835; PMCID: PMC2793346.

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Core Values

Image by Canva Pro Photos

Addressing Depression, Burnout, and Suicide in Oncology Physicians Daniel C. McFarland, Fay Hlubocky, Bibiana Susaimanickam, Robin O’Hanlon, and Michelle Riba American Society of Clinical Oncology Educational Book 2019 :39, 590-598

Burnout, however, also evolves from the matching of work environment with the individual, wherein both entities experience poor outcomes if there is a mismatch, creating burnout.

Core Values

• Circle everything that resonates with what you value (not what you think you should value) – usually about 15 are circled
• Condense it down to two core values
• Use these values to guide your decisions and your life will start aligning with your values

https://daretolead.brenebrown.com/wp-content/uploads/2020/02/Values.pdf

Benefits of knowing your Core Values

• Being able to say no
• Setting boundaries (disappointed, resentful, or violated)
• Helps you lead your team (more to come)

Relationships are Key

• “Contrary to what many people think, it’s not career achievement, or exercise, or a healthy diet,” write the authors—though those things matter, too, they add. Instead, “one thing continuously demonstrates its broad and enduring importance: Good relationships.”

Commit to thinking of everyone as a leader and talk accordingly

• Trust – small, habitual gestures of care build trusting relationships over both time and distance
• Asking and LISTENING to the person
• Forgiveness – sometimes the greatest exercise of power is the choice to forgive rather than to punish
• Growth mindset
• Accountability
• From a place of wanting the best for that person – get curious and ask questions
• Stability
• Giving people permission to act like human beings – find out their core values and unique gifts

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My Definition of Burnout

A dysregulated nervous system due to the constant, chronic onslaught of environmental and mental factors that are considered “normal”.

Regulate you nervous system

• Time off
• 4-7-8 Breathing
• Get into Green Space
• Live into your Core Values
• Invest in your relationships

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Do not be defined by your job

• Mother
• Wife
• Sister
• Friend
• Skier
• Corn Hole player
• Podcaster
• Speaker
• PA
• Human being with complex scars and emotions

Who are you?

• How do you want to show up for the people you care about most?
• How do you bring your unique talents and abilities into your world?
• How do you lead, teach, mentor, empower, uplift, and serve those around you?

Thank you

Meg Leddy PA-C

margaret.leddy@duke.edu

The Second Brain�The Enteric Nervous System

• About 90 percent of the fibers in the primary visceral nerve, the vagus, carry information from the gut to the brain and not the other way around https://www.scientificamerican.com/article/gut-second-brain/
• ENS dysfunction may not only cause abnormal gastrointestinal function but also has been implicated in cognitive and mood disorders – Li JH, Duan R, Li L, Wood JD, Wang XY, Shu Y, Wang GD. [Unique characteristics of "the second brain" - The enteric nervous system]. Sheng Li Xue Bao. 2020 Jun 25;72(3):382-390. Chinese. PMID: 32572435.

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The improved diet focused on fresh and whole foods that are high in nutrients. It also limited processed refined foods, sweets, and fried food, including junk food.

Depressive symptoms, including mood and anxiety, improved enough to achieve remission criteria in more than 32% of the participants.