Practicing What I Preach (Even When I'm Still Burnt Out)
Last week, I wrote about being burnt out. About the downward pull, the emotional exhaustion, the specific, embarrassing flavor of depersonalization, where I wasn't distant from my patients but very much from my colleagues. I laid out the four moves I was making and published the blog, which, in retrospect, takes a particular kind of audacity when you are still, actively, in the middle of it.
Here's the update: I'm still in it. The break I identified is still on the horizon, not yet in my hands. And in the meantime, I am doing exactly what I told you to do, which is to enact the minimum baseline and white-knuckle my way forward.
The interesting part? I had to go give a lecture in the middle of all of this.
Last month, I was invited to speak at Vanderbilt Health's Respiratory Therapy Symposium, where I gave a talk called "Self-Care, Avoiding Burnout, and Depression to Optimize Patient Care." Which: yes. The irony is not lost on me. Picture me building slides about burnout recovery with the specific cognitive heaviness of someone who is, in fact, burned out. At some point while writing the talk, I genuinely laughed out loud at myself, alone, at my laptop.
But here's what preparing that lecture gave me, and what I want to pass along to you, because some of it surprised me.
The first thing I said was this: burnout is not a "you" problem.
I mean it every time I say it, but I needed to hear it myself, out loud, in a virtual room full of exhausted healthcare workers who threw up Zoom heart reactions when I said the words. Burnout isn't what happens when a weak or insufficient person runs out of steam. It's what happens when a caring, conscientious, capable person is placed in a particular kind of system and asked to give more than is sustainable, indefinitely. The system leverages our caring. It is, frankly, designed to. The 2025 AMA data shows that 2 in 5 physicians are still burned out, down from the pandemic peak of 63 percent. It’s movement, but it’s certainly not a finish line.
A 2025 study of nearly 1,900 ICU nurses across 12 countries found that the single strongest predictor of individual burnout was perceived burnout in colleagues. Not workload. Not staffing ratios. Not acuity. The burnout of the person standing next to you. In another study, nurses reported that their colleagues were experiencing exhaustion at a rate 20 points higher than they did. We are, in other words, absorbing each other's depletion and systematically underreporting our own.
If you've ever wondered why burnout feels contagious, it’s because it is. The research confirms it.
The thing I kept coming back to, building the talk and sitting in it afterward, was the hedgehog question.
If you're not familiar, the Personal Hedgehog Concept asks you to sit at the intersection of three things. What you're genuinely passionate about. What you're actually, demonstrably good at (not what you think you should be good at, what people actually tell you that you are). And what sustains you versus what depletes you. The most effective people, in work and in life, don't try to be excellent at everything. They find that intersection and build their lives there.
I know what mine is. The problem, when I'm burned out, is that I've drifted so far from that center that I can barely see it. Everything feels depleting because I've lost the thread back to the part that energizes me. The exercise isn't a cure for burnout, but it is a compass, and sometimes a compass is the thing you most need to get you out of a confusing place.
There were three practices I put in the talk, first, because the evidence supports them and second, because I must have subconsciously been looking for easy practices to develop while I was at my minimum baseline and working my way towards my break.
Three Good Things. At the end of every day, write down three things that went well. They can be tiny, almost embarrassingly tiny. For each one, write a few words about why it happened. Repeat for 15 days, then assess whether you’d like to continue doing it. There's RCT data behind this (Sexton and Adair, 2019), and I will tell you that on day four of a brutal stretch, when my three things were "I showed consideration for a colleague (by surprising them with a coffee they hadn’t asked for)," "I sat with a fellow going through something hard (because I remembered when I went through the same thing in training and how awful it felt)," and "I did not cry in the elevator (because I was focused on my Transition Ritual (more on that below))," it helped. The point is not the size of the three things. The point is training your attention toward what you were able to do, even if the day was hard.
Mapping Your Yes. Take your last two weeks, or your calendar, and sort every commitment into two columns: Yeses That Energize and Yeses That Drain. Then ask yourself the honest question: What am I saying “yes” to out of genuine necessity, versus out of discomfort with the alternative? The latter are the yeses that drain. Identify one depleting “yes”. Write out, specifically, what you could say the next time that request comes in. Boundaries aren't just things you have. They're muscles, and like all muscles, they atrophy without use.
The Transition Ritual. Pick a physical signal that marks the hinge between work and the rest of your life. Taking the elevator downstairs after your shift. Walking to your car. Changing your clothes. A specific playlist that belongs only to that moment. The body needs a cue, not just a thought. Pair it, if you can, with a set-down statement: "I did what I could do today. I'm leaving it here until tomorrow." It sounds almost embarrassingly simple. It works in a way that is also almost embarrassingly simple.
I am still doing all of these, imperfectly, while waiting for the break I promised myself. I am still at my minimum baseline, still resisting the gravitational pull of dramatics, still trying to release what isn't mine to control.
What I keep coming back to, what I told that virtual room of respiratory therapists and believe completely, is this: burnout is not the price of caring. It is what happens when we care without tending to ourselves.
You already know you can keep going without tending to yourself. You've proven it, probably more than once, and at significant cost. The question is whether you're willing to try the alternative.
My break is coming. Have you identified yours?