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What to do to avoid/treat burnout: Enhancing Emotional Wellbeing

Allen Lloyd

Description

OBJECTIVES At the conclusion of this CME activity, the learner should be better able to: 1. Identify how to recognize burn out. 2. Understand key lifestyle factors that avoid burnout. 3. When the cat is out of the bag—know how to treat burnout. 4. Understand the most important Christian principle that reverses burnout. 6. Demonstrate how to fulfill that need once it is recognized. 

Conference

Recorded

  • November 1, 2019
    3:00 PM
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This talk is what to do with burnout in a handsome emotional wellbeing and Prevention and Treatment Webster defines burnout as the exhaustion of physical or emotional strength usually as a result of prolonged stress or frustration. And we all know about occupational burnout and it's characterized by exhaustion lack of enthusiasm lack of motivation feelings of ineffectiveness and it usually has a dimension where you know notice that the person is exhibiting more frustration and even cynicism in regards to talking about others and when it's truly present it's also going to result in reduced efficiency and efficacy within the workplace occupations with the largest risk are social workers nurses. Teachers lawyers engineers physicians mid-level practitioners. We should put Dennis in there as well custom service representative and police officers although Dennis for whatever reason at this point Dennis used to have more of a burn out than physicians but lately it's the opposite physicians experiencing more burnout than Dennis and of course virtually all of these occupations are Human Services fields where we are providing services to humanity and high stress work environment and emotional demands of the job are also contributing factors for this so maybe one of the reasons why the original occupation was agriculture and those sorts of things where you would have weren't having to work with faulty humanity 247 or at least you know a good. Share of the time. Divide out is not defined as a distinct disorder in the d.s.m. 5 but it's interesting only included in the i.c.d. 10. Under life management difficulty and life management difficulty would kind of encompass this social psychologist Christina mass lock and Susan Jackson developed the most widely used instrument for assessing burnout namely the must lock burnt out inventory and a mini z. burnout survey is used to measure burnout and physicians by the a.m.a. and a growing body of evidence suggest that burnout is clinically nossa logically similar to the pressure in fact it's very difficult to distinguish the difference between burnout and depression. Although we've had some individuals come through our program saying I'm not here for depression I'm here for burnout but when you look at their scores. It is severe depression in a study that directly compared depressive symptoms and burned out workers and clinically depressed patients interesting late no diagnostically significant differences were found between the 2 groups burned out workers reported as many depressive symptoms as clinically depressed patients. And and now there's a new term called brownout and more recently the term brownout has been used in the business world of the scribe less serious versions of burnout and it refers to staff who are disengaged and d. motivated in their job role and of course one of the most common reasons for burnout today and disengagement and d. motivation is actually the abundant use of screens in the workplace. And if you want to prevent brownout in your employees you probably need to have a screen reduction policy of some sort or an absence of screens being utilized in the workforce and at least you'll decrease that rate of brownout some. Many z. physician survey takes a look at job satisfaction job stress energy exhaustion and control over your workload as well as time for documentation also takes a look at your surrounding work atmosphere and your values aligning with department leaders and efficiency of rest. Deficiency of the rest of the team meaning the. Remainder of the team outside of you how efficient are they if they're very inefficient it's going to tend to affect your own work performance and also your you will tend to get burned out far more easily. Also if you're using a car in your home or the electronic health record in your home that is of course related with physician burnout and of course your proficiency in actually utilizing the record there's a lot of physicians that just aren't very profession at this even yet and this of course can affect this aspect of things. And of course it's a good since the symptoms are identical of burnout and depression to go over the 9 diagnostic hallmark symptoms of depression Now these are not all the symptoms of depression is over $100.00 symptoms of depression but there is none that are diagnostic hallmark that are used by the d.s.m.. In diagnosing in the d.s.m. a by the way is not change from 3 to 4 to 5. Like it has for some fields where it's changed significantly for depression and anxiety it's virtually the same so deep sadness is one of those symptoms of course women tend to notice this more so than men because they will notice their sadness as a result of crying spells men tend not to get the crying spells they tend to get the emptiness feeling and women will see the doctor because a crying spells but no man will see a doctor because he feels empty and. And so a lot of men actually deny that they're in deep Russian but the d.s.m. States emptiness actually qualifies so if you're feeling empty the majority of the time that actually is one of those symptoms apathy is also another symptom this is when you wake up in the morning and you're not excited about the day you do get up but you get up out of a sense of duty and responsibility but not interest and that can happen once in a great while to anybody but when it happens it's particularly commonly or even a quarter of the time that's abnormal and if it is up to over half of the time that is distinctly abnormal but yet a lot of people put up with this because there are there are slaves to their debts and and they they they just feel trapped and they have to get up and of course they know they should anyways but apathy is a major part and of course that means they have as this progresses you actually get to the place where you're not able to experience pleasure as much things that used to be pleasurable for you are no longer pleasurable. And of course this has to do with brain chemistry issues as well the brain chemical that's most tightly linked to the development of apathy is what it's dopamine. And so these are issues with dopamine production or dopamine receptors very often and so this is where dopamine can play a role agitation or irritability is one of those diagnostic hallmark symptoms and this is the symptom that turns out out of the 9 that are it that is least able to be self diagnose you know I've met a number of individuals that come to our program unfortunately their spouse might be with them on the 1st visit and all ask them Are you more irritable than you used to be no say no and their spouses over there saying oh yes they are and and then the spouse will tell you know some stories of how they flown off the handle in ways that they didn't used to do that and then they'll turn around and say I guess she's right I guess I am more irritable and so sometimes you need to ask others if you're more agitated or this is of course psycho motor retardation psychiatric Bible puts these 2 together not meaning that if we you one you have the other but if you have either one you're you're suffering from that 3rd symptom 4th or sleep disturbances and of course this could be insomnia could be hypersomnia. Most people in the medical care world do not have hypersomnia. Because they're not allowed to have that but they can have insomnia and the most common. Form of insomnia is actually early morning awakening they're able to go to sleep when their head hits the pillow but they wake up too early and can't get back to sleep and at 1st they might be waking up at 4 in the morning and can't get back to sleep but as the depression gets more severe it's like 2 o'clock in the morning and they can't get back to sleep weight or appetite changes and if this can occur either way if it's weight gain or weight loss it qualifies which is more common weight gain is more common in a why is it more common because we tend to self medicate with food and what type of food do we tend to self medicate with it's the sugary foods and sugar actually transiently raises serious tone and it's one of the ways in which we're. Getting our serious tone and levels up there so not only tastes good but we actually feel less stressed and we feel a little better maybe a little more socially connected and this is why we'll never get rid of our obesity problem in this country until we get rid of the mental health issues behind it it's not just a matter of calories in calories out yes it is that but you can't necessarily control that unless we're taking care of the mental health issues behind it but you can also get into weight loss and anorexia and in every one of our programs we only accept 20 in our residential programs we have the overweight and we have the underweight. And of course we'll have the normal weight as well but interestingly on the same program than under way individuals wall gain weight and the overweight individuals all lose weight. We're of course dealing with the brain chemistry issues behind it but weight loss tends to be associated particularly if it's combined with anxiety there are some people who will hurt for them to eat and they'll get Nazia and they'll get bloating and they'll get all these g.i. symptoms and one of the reasons as an internal medicine g.i. doctor I went into this field because I would be seeing people that had been and and of course one of our areas expertise is a difficult to diagnose patient so they come to me seeing that difficult to diagnose patient and they've had their scopes done they've had their C.T.'s done they've had their biopsies a bit everything done and they're still in significant g.i. distress and after I look solver I'll say you know your problem is not your g.i. tract it's your anxiety and they'll say almost to a person doctor I know I have anxiety but I have anxiety because of this if you fix this my anxiety will go away and I'll say nose there. Your g.i. problems are caused by your anxiety by the way there's 21 different. Systems involved physically that can happen with anxiety and anxiety tends to result in a lot of physical symptoms and the g.i. track is one of those major ones and so all say you need treatment for your anxiety and sometimes these individuals pretty easy to diagnose and one guy in particular is really arguing me against this says I want to see confirmation how in the world after you looked at all this did you know it was anxiety and I said well you gave me a big clue because you said the only thing that gets you better out of anything is when you take your Lorazepam. And I said Laura is a Pam is not doing anything for your g.i. tract but it is blunting the symptoms of your anxiety but now you're needing more and more you recognize you can't go without it and so for an individual like that they actually need a residential program because they're not going to get off their Lorazepam with this type of g.i. distress and all that without actually residential program so they'll have to schedule and go to the residential program and then they'll be just thrilled at how their g.i. problems are all solved and of course other problems that with their anxiety was causing as a result of getting to those underlying issues but you can also get weight loss without anxiety if it is a sudden severe onset of depression so if whatever happens in your life it sudden severe onset you can often lose your appetite just from the depression and necessarily anxiety lack of concentration this is when you lose your focus and you're reading something that's interesting to you and you get to the bottom of the page and you realize you forgot what was at the top of the page. And you have to go back and read it again and it might be so severe that even the 3rd time you've missed it and so lack of focus and concentration is a key ingredient for major depression and burnout and then of course this is when we know it's crossed the line. When you actually have feelings of worthlessness and that of course if you have any ability to be of use to yourself or others you're certainly not worthless but these individuals will view themselves as worthless and that's a sign that we've gone beyond I mean you can't just call this burnout Now this is actually a major depression and then morbid thoughts are also a sign that it's crossed the line and morbid thoughts is not just. Thinking you'd be better off dead which a lot of people actually believe that they're not actively suicidal but they actually pray that they would their lives would would be taken at night in their sleep and the Lord would just not allow them to wake up in the morning and of course that's a morbid thought but we also need to be. You know encouraged by the fact that there were great people in the Bible that Kasia only had this and of course Elijah was one of them but also a lot of people don't realize Moses was one of them. Moses actually in the 1st year of his ministry. To the people of Israel said I can't take this law. I can't take them Why have you assign me to be over them and he says Just take my life he said and he asked God to take his life and of course he was in the service industry. Servicing all of these individuals and all of their issues and it was kind of interesting that Moses grew and developed to the point where after that the Lord said let me take these people who are from you and Moses prayed and said Please don't take me if you're going to take them because he had developed that love and compassion for this unruly group of people but morbid thoughts of course if you're actually thinking of ending your life that would be a morbid thought or if you're thinking that it would be better if someone else would just go ahead and die for you that is also a morbid thought and and then it goes beyond that preoccupation with death or symbols of death when you're thinking of death a lot we had one individual come to our program just in the last program in and she was not actively suicidal so she answered all those questions 0 when it came there when she came in but when I talk to her. She was just preoccupied with death and there was a reason why she was preoccupied with death because she could think of 10 people in the last 5 years that were below the age of 60 that had lost their life that she knew pretty well and she was getting in her mid fifty's and thinking you know am I next and so she was worried she was going to die and worried she had some illness that was going to take her out as quickly as it did some of these other people and she just couldn't quit thinking about it and then she got on to a site where talks about what happens when you die in regards to your cells and all of that and then she had her 1st panic attack and came into her husband in and said you know what can and what can I do and it was actually a result of that realizing how far it had taken her. That she enrolled in our program because of just pervasive morbid thoughts every day she could not get her mind off of it and then fatigue and by the way I should mention on her in a comprehensive program for the last 5 days of the program she never once thought about death. And she had. Recovered from that and then fatigue this is where you know apathy is when you don't have the interest but fatigue is when you don't have the energy and it can really you run out of energy too early in the day or you wake up with not enough energy now you don't need all of these symptoms if you read the fine print up there how many of these do you need if you just have 5 of those symptoms that's enough for major depression and or burnout as we mentioned and of course the more the more severe or if you have feelings of worthlessness and morbid thoughts. We always rate that as severe those are severe indicators. But if you had 2 of those symptoms that still abnormal that's called minor depression or sub syndrome or depression or that would might be called the brownout part of things and instead of the actual burnout. Physicians do experience high rates of burnouts rates of burnout have also been increasing over time women experience higher rates of burnout than male counterparts in the medical world it's actually quite a difference between 20112014 rates of physician burnout increase from 45 percent to 54 percent so a 10 percent increase over those 3 years and by the way it's increasing even more since that time 51 percent of docs reported burn out half of all doctors in 2016 had it with women reporting 55 percent compared with men 46 percent. And in general the men are working longer hours so it's not necessarily the amount of hours that women are working versus men because if you look at the difference in hours and physicians of males and females it's it's clear that overall the average female hourly work rate is higher and of course it's there by choice that it's last because of normally home responsibilities and other things that have to be done so it's not that she's working less overall than men it's just at the job working in employable state working less in that regard. I am in Mayo did a study in 2016 and it showed at 10 percent increase in 3 years number one specialty and burned out at least in 2016 anyone want to guess what it was. Emergency Medicine So the e.r. docs tend to burn out relatively quickly and normally in 10 years it's starting and by 20 years of the cynicism all of those things are well on their way and I have a physician friend of mine. Who was an e.r. doc and after 10 years was starting to notice it and when he was coming up on 20 years he actually said you know what my father is an electrician and he's making more money than I do and he's very healthy no burn out at all I'm just going to give up the practice of medicine and that's what he did and he went into his father's business. And he now actually makes more money than any other doc and he owns about 4. Trailer parks around the country large trailer parks and he flies in a his eclipse jet around checking on these trailer parks and no longer has any burnout and is is feeling great but he's not in the service industry anymore you know he's in the he's in the real estate business and really the physician service business and I think there's a solution to that besides just changing professions that we're going to get into. In 2016 you're all a g. was also high burnout rate pm and r I was surprised to see them up their family medicine radiology I was surprised to see them. There in the top 10 orthopedics also in the top 10 and of course a lot of this has to do the demands of the profession and the shortage the might be out there and internal medicine was also in the top 10 the least of all however were preventive medicine specialist they continue to show the least rates of physician burnout and job satisfaction rates tend to be the highest and there's others there but I also noticed in the the ones that were least radiation oncology for whatever reason also has a very low rate of burnout so of course there are physical symptoms there's also health symptoms you know poor health results relationship issues also resolved in regards to family and in regards to coworkers as well where the coworking relationship is affected and then of course when you're actually thinking of leaving the practice of medicine when you're only in your forty's or fifty's you know that can be a clue that this is happening and of course the ultimate worst effect is physician or dental suicide which is also on the rise. Here are some quotes from some. People of Senate in this area burned out makes it nearly impossible for individuals to provide what. Compassionate care for their patients so if you have if you're struggling with all those issues you're not getting enough sleep you're waking up with apathy you're all of those things you know you're going to a conference like this saying you know I know everyone's talking about giving compassionate care or reaching the soul but I don't seem to be able to do that it actually could be due to burnout and so we really need to solve that issue in order for you to be able to go to the next step this was Stephen a Lockman quote. From Minneapolis and then of course their workplace causes. That. That have been shown to be underlying causes combined with other things but too many bureaucratic tasks you know physicians are actually more. Involved in bureaucratic tasks than ever before you know it's one of the issues I'm not say you know is internal medicine I do a little bit of primary care but one of the aspects of primary care I hate is all these björk tracking you know bureaucratic tasks of signing a family leave document or signing this or signing that and everything has to be signed by a doctor and you're not doctoring at all you're just providing some paperwork and having to fill out why you're saying what you're saying in all sorts of issues related to that and there are more now than ever before of course spending too many hours at work wonder what are the primary reasons why lately doctors are spending too many hours at work. It's bureaucratic tasks and also something that has decreased their patient care interaction. And it's called the electronic health record by the way I think we're going to find out this was not necessarily the benefits outweigh the risks in regards to the h.r. record and of course the societies in charge of us were very much wanting this because as you can't manage somebody unless you measure them and it's hard to measure them unless you have the electronic health record to be able to do that and so they really wanted ways to be able to measure and not have to do chart on its on paper charts but it's clearly taken you out of the realm when you were in paper charts you weren't writing much down at all but you were maybe writing things that needed to be done for that patient but you were primarily dictating into a addictive phone and by the way the dictating records were actually far more accurate than the electronic health record. They were identifying things where you could remember the patient but with the templates and all of these things that are going on you have to distrust a little bit of the electronic health record and then you'll see a consol come into the hospital and all he's done is copied and pasted everything that I did and then he has his impression and plan that's very different. And. There is a lot of a lot less accuracy than there used to be in regards to the electronic health record. And so the increased computerization of practice has caused a workplace cause for burnout and then also the lower incomes despite the increased demands it's very clear today in fact I was just talking to someone who is a. Dentist in another country and he's here getting a residency at Loma Linda so that he can be a dentist in this country and. It's clear that dentistry is a far more. What what should I say far more sought after specialty than it was a few years ago because the medical incomes have gone down considerably dental incomes have not and in medical incomes used to be higher than dental incomes but in reality the amount that Obamacare in these things are reimbursing doctors for a time there was a point in time where I think doctors were overpaid. That's not the case really anymore in regards to the type of work that they're doing and also the amount of hours that they're spending in things like that. Over pay doctors is just really not the issue that it used to be and when the demands are placed on you plate particularly since we have employed doctors and ever more than ever before where you don't have really a decision where they're going to do this or net that also adds into the complexity. So a few years ago. The doctor remarries and I published a study in over $4000.00 individuals taking a look at the underlying causes of depression and of course we developed a test called the depression anxiety assessment test that actually not only takes a look to see whether you have it in to what degree but also looks at the underlying 10. Causes and and so there are genetic issues in fact in the physician world itself. There are there is more of this gene than any of the other mutated genes but this is called an under methyl later physicians tend to be under methylated as under methylated or exteriors tents interior They also tend to be highly competitive and that's why they got into medical school was because of this tense interior that drove them into studying hard into excelling and things of that nature but it turns out under methylated tend to have more of a serious a less serious tone in activity in their brain and so this is something that we actually measure we can now measure to see whether someone is an active under methyl later and you'll see a preponderance of physicians attorneys. Even some sports heroes you know the baseball pitcher who has to strike out the guy and stare him down and do what it takes to win they're often under methyl later and I should say one of the things when they come to our program we tell them are under methyl later at 1st they're gratified that wow we're finding a brain chemistry problem that we can fix here but as soon as we start to fix it they say if this gets fixed am I going to not be as competitive as I used to be not going to be able to perform on this level Actually it won't adversely affect their performance if anything will help them but we're not necessarily completely reversing anything in regards to the on the under math everything in regards the under methylation we're reversing But typically the serious tone and tripped off and issues that come with that as well as dopamine issues there's also a dopamine. A less dopamine activity in the under methylated And so there's developmental issues these are adverse childhood experiences that can also play their wall this is where attachment issues can have a role to play and we screen for those we also screen for lifestyle issues and for lifestyle issues we're primarily looking at. Out being in or actually getting enough physical exercise but there is also an advantage of getting your physical exercise outdoors in green spaces one of the things that we have found out that has occurred and you know I can. I could measurably see this because I I became president of Wiemar in 2008 and one of the things I used to like to do in regards to physical exercise course I had young boys and and sons and needed to keep them active was actually playing tennis so in 2008 when we'd go down to the Auburn tennis courts just 10 minutes away from there to play we would often have to wait for a court you never have to wait for a court today in fact they got rid of several tennis courts. And you still I've never had to wait for a tennis court what happened after 2008. The smartphone came out smartphone came out in 2007 and so people are replacing outdoor time that they used to do with screen time and that has not been a good replacement you even go to national parks today far less people visit national parks they're they're less outdoors and they used to be and I just fear for even a place like this in 30 years when all the people that weren't raised with devices die off the planet is anyone to get even a golf anymore to keep the golf course open. And they'll want to they may want to play golf on a screen somewhere but actually getting outside and green spaces being outside in nature does help our brain chemistry it actually is something that's very healthy for us and so we look for things that are lifestyle related in regards to this circadian rhythm I think we addressed that in the last hour you know some of you weren't here for the last hour but setting our body clock regularity. In in morning time in particular that morning light addiction hits are also at an all time high and there is a lot of physicians and Dennis they're addicted to their screens and this is the most rapid rising addiction in fact anyone want to guess what percent of Generation y. and z. these are people that reached adulthood around the year 2000 or people who were born after 2000 Anyone want to guess what percent of them agree that they're addicted to their smartphones. The ones who agree that they're addicted are 40 percent now do you think it's more or less than that it's significantly more than that and studies are showing about an 80 percent and of course this is where they actually can't imagine life without the device and they go through a sorts of resistance exercise we had one of those generations ears in our program and he heard about what we do with devices in our program and I was there for the 1st evening the 1st evening lecture we give is actually on devices in our program the 1st formal lecture because of what it does and regards to brain chemistry and now the evidence is overwhelming how it drives people to distraction you know you get on there to do your homework and then within and 5 minutes you're not doing your homework anymore because you've got a push notification you've got a news notification that Donald Trump said something about another woman and you've got to check that out and then a snap chat comes in. And and so there is constant driving to distraction that goes on in this is the area of our brain called the anterior cingulate gyrus in the frontal lobe and when we're driven to distraction this is the identical area that we need for managing distressing emotions So anyone that's addicted to a phone is not going to be able to manage their distressing emotions and so they have to be able to get over that and of course they have to engage in what we're saying and if they're being distracted by someone giving them a text message in the middle of a important lecture they can actually lose the most important part that would help them in this process so you know after that lecture I knew a little bit of background for him so the next day I was seeing him and I said So what did you think about this lecture. And he said you're right you're absolutely right I need to make a complete change in regards to my devices and I said So what did you think about giving up your phone he says I gave it up I gave it up last night I said but you only gave up one of your phones. How do you know I have another phone. How did you know that he said and I said you know if you're really going to if you just agreed with all of those things why not give up the other phone well someone might need to get in touch with me. You know they always have these reasons but you know that would be the inhibiting thing in fact there's a you want to get the book by Victoria Dunkley she's an l.a. psychiatry just and she says she will not diagnose any mental illness whether it be h.t. bipolar depression anxiety she won't diagnose any mental illness in any psychiatric patient until they're screened free for 6 weeks. And her 1st half of her book gives the evidence in the 2nd half of the book actually tells you how you can live your life completely screen free. It's called reset your He's She's a child adolescent psychiatrist It's called reset your child's brain. Is the name of it but it really should be called reset your brain because the same is true with adults we have 70 year olds that are addicted to their phones that come into our program this is not just a young person's issue this is a lot of people's issue in fact we had a 72 year old man that was in our program. And after that 1st lecture and his wife said he's retired me just on a screen a lot and and she was trying to get him to do other things and he thought he needed to be on the screen for looking at stocks and looking at other things like this and the very next day when he came in and he said the entire price of this program was worth it for that one lecture I am going to change completely change my relationship to screens and so anyways that addiction is on the rise but the other addictions are on the rise there's more marijuana in fact medical people are using the c.b.d. and all sorts of stuff to try to patch things together in regards to. Things and they think although this is bad for most people for me I need it and so they justify themselves in regards to their addiction which is actually causing them less ability to manage their emotions nutrition. Of course plays a vital role what we eat does get turn in the neurotransmitters it's crucially important toxic causes can be an issue and of course it could be mercury by the way we have noticed a lot more emotional issues in fish eaters the non fish eater and that has to do with the mercury content of fish and fact the studies are very clear the risks of fish outweigh the benefits now even though mega 3 is beneficial it's better to get your omega 3 from other sources because it's less toxic sources and so but another toxicity it's even more common is the one I mentioned the last hour in regards to the free copper toxicity and of course seafood can be one of the reasons there's a lot of copper in seafood but it may be some genetic issues that are helping to bring that about social complicated stress or grief of course these can be adverse adult experiences that can also be a hit like the job and things that we mention and then there might be contributing medical conditions like a hormonal issue or other issues and then another category that's on the rise our frontal lobe causes us not only due to the devices but due to the fact that most of humanity including doctors and dentists are not doing things have bitch will lead to enhance their frontal lobe ability and they are actually doing things to detract from it by the way I found it interesting Speaking of doctors and residence My son is in a 2nd to residency and for the 1st time in both of our lives you know all the time growing up I thought. My kids have not had it is hard as I had it. You know. They've they've had things pretty well handed to them on a silver platter and they haven't had to work as hard although they're good kids overall but you know we grew up in different areas and I know I didn't have it here as art as my dad had it you know growing up in the World War 2 generation in the post depression era and things like that but this year in a 2nd year of orthopedics I had to say Alan it's clear you're working harder than I've ever worked in my entire life and right now he's on 6 he's on 10 weeks 6 nights in a row of work and he goes to work at 6 pm every night and he doesn't get off until 9 am and is only. Day off is on Saturday night and there's 10 weeks and they tell them don't take vacation you can't even go to your brother's wedding which actually happen to be an issue during those 10 weeks he actually did go to his brother's wedding but rather his wedding was on Sunday and they had the time it so he just arrived for the wedding because he was in the wedding was in college tennis see and then he left right afterwards and he got one resident to cover for him from 6 pm to 11 pm till he got home and he could work from 11 pm on and. But yet his wife he just got married a year ago I was talking to her and he said he comes home every morning with a big smile on his face he just one of his work and he also loves coming home and he says I just can't believe how healthy. He is during this gruelling time and of course one of the reasons why he's healthy during the grueling time is because it is on a regular schedule he said if I were only working 4 nights a week I wouldn't stay on this schedule but he has a sleep time he sleeps that and almost that entire day and then he gets the the light therapy when he gets up and he is on a very regular schedule and he says I'm grateful for the 6 nights a week that I'm working because if it were 4 I wouldn't be doing near as well but I've got my circadian rhythm there I've got all this going on but he's also doing frontal lobe enhanced meant which often isn't done now I give him as an example because as we know and it's difficult more difficult now to find internal good internal medicine residents and those sorts of things that they keep very close to abse of their hours but when residency hours dramatically decreased actually burn out in depression and suicide rates increased. So it wasn't work related so much why did it increase as soon as their hours at work decreased it was because of what else they were doing instead of working and they were primarily doing frontal lobe suppressing activities you know they actually alcohol or drinking has gone up among residents and now that they have more time and of course entertainment movies in forms of self entertainment and things like this they're doing frontal lobe suppressing activity which they think is giving them a break but in reality it's causing more of the mental health issues so this is why in our time off we need to be intentional in regards to doing frontal lobe enhancing activities so and of course physical exercise is a important part and we're gars to work life balance aerobic exercise is is very important and this is something in my own life that is a key ingredient you know I'm I'm very intentional doing my 4 miles in the mountains every morning and it is a key part of my own mental health but if you have the ability to work with your hands as well there is some 3 dimensional aspects that are even more important I don't do near as much g.i. as I used to being at Wiemar and in the administration roles that I'm there and so I don't do as much 3 d. work with my hands as I used to and so I have to find other ways to get that besides the g.i. lab but that's one of the things that dentist are going to have you're doing work with your hands in 3 d. all day long and some of the surgeons are going to be doing more of that and of course there's a lot of surgeons that feel good about that they like their 7 30 am case and there is something that just seems to help their brain as a result of doing this difficult surgery in the morning and and that type of work is healthy. Sleep is also important. And. We talked about limiting screen time and by the way these are the 3 things that are sign that your life is in balance if you don't are not in balance if you don't have time for exercise if you don't have a time for enough sleep or if you don't have time for good devotional exercises on a daily basis your life is not a balance those 3 have to be a key ingredient for physicians and that's just a very. You know very easy indicator are you getting sleep are you getting exercise or are you doing your devotions and if not something has to change you've got to change something to be able to get that so and of course when do tradition. Burnout and depression is also and it's often inflammatory disease of the brain and interestingly one of the ways we can decrease inflammation is not only getting arachidonic acid out of the diet which means a plant based diet or acted out of gas in his and eggs it's in fish it's in meat in arachidonic acid as we all know is a pro inflammatory mediators so this is one of the things that can really help is getting a record on the capacity out. Of the diet but it's also one of the things that can help is going into daily ketosis and how do we pay people and this is where you can do plant based ketosis I told you about that ketosis diet that's unhealthy in the last hour but the ketosis diet that's healthy is when you're eating a plant based diet and you don't eat the evening meal. And after 12 hours of fasting your b.d.n.f. level goes up and it will peak at 17 hours brain derived neurotrophic factor and particularly if you have a sedentary work. Schedule you know or you're not getting a lot of exercise at work which most of us in the medical field are not that evening meal skipping that evening meal can actually be healthy for the brain it turns on the positive neural plasticity switches and then there may be some things that we need to do about workplace stress like Team efficiency and computerized assistants I know a lot of the family practice docs with all their bureaucratic tasks in the h.r. they've done a lot better by hiring scribes and they don't hardly ever touch the computer they're doing patient care and they're they're involved and they're scribes are the ones doing all that work for them and they're there improvement in their life goes up significantly and. And then watching out for distortions and thoughts in magnification the I can't stand it itis and confusing needs vs wants a lot of doctors and dentists get upset because they think their needs aren't being met but in reality it's their wants not being met and they don't have to get that out of kilter over just not getting a want met How do you know the difference between needs and wants and just ask yourself a simple question How long can I go without this before I die if it doesn't affect that it is not a need it's a want and then we can be more rational about it and then in regards to the frontal lobe the devotional life as it is key to balance healthy classical music helps there are several books that we utilize in our program that can help with the frontal lobe enhanced meant and of course this is scientific scientific studies show a strong relationship between even regular church attendance and higher life satisfaction stronger marriages and higher ratings of general health status there's a co-relation between low church attendance and depression of young among young people especially over the last 15 years church attendance is an all time low in our young people and. Notice suicide rates are half among church attenders if there was an anti-depressant that decreased the rate of suicide by even 10 percent it would be malpractise not to prescribe it but somehow it's not malpractise it tell your patients if you go to church and if you have a devotional life enhancing your frontal lobe could help you a great deal and of course it can also help the caregiver. And researchers actually perform functional m.r.i. scans on 1000 young adults while learning about biblical themes in a church or on a video this was an interesting study so and fact most people when you take a survey of most people you know I most people go to church the reason why they say it's not social things. The reason why most people stay the majority of people number one reason why most people go to church is to see what the Bible says about how they should live their wanting to know what the Bible says and so we need to recognize that in our churches we need to take advantage of that if we're not telling people how the Bible into relates with their life we're not necessarily helping their frontal lobe as much unless you're just playing some good Bach and good Beethoven there in your church service but they found spiritual feelings stimulated the nucleus accumbens this part of the brain is associate with processing reward is also stimulated by listening to music or even having sex volunteers reported feeling peaceful and warm inside and in some more in tears by the end of the scan just listening to what the Bible says about their life and helping someone to break that Bible down to them they felt a peak spiritual feeling when watching the stimulating church video senior author Noor a radiologist Jeff Anderson said religious experience is perhaps the most influential part of how people make decisions that affect all of us for good and for ill and so this is something that unfortunately our world has entered into this spiritual void and given Eastern meditation as a substitute this is no substitute I tell you Eastern meditation is going to have more of a placebo type of a fact but it's not going to have near an effect like this and we need to actually regular Biblical study meditating upon the word of gone in order to experience that and so sense of purpose is also important in preventing or avoiding burnout. Also becoming an expert in something useful developing a passion outside of your usual source of income can also be healthy and increasing your love for God and for humanity and in regards to love this love aspect of things which is also this area of nucleus accumbens that's one of the reasons why sex stimulated this area's well and regards to the love aspect of things I think sometimes we have misunderstood a little bit particularly in modern society the love of God and even the love for God often the phrase that I hear repeatedly is that God's love is on conditional I'll admit it is unfailing it is a passionate pitying love for the lost but unconditional is often defined this way there is nothing you can do to make God love you less or there is nothing you can do to make God love you more and actually that part of God's love is not true. And I will show you the evidence now in regards to the Pettingill of the parables of the law sheet the last point in the product will son bring out in distinct lines God's pitying love for those who restraining from him although they have turned away from God He does not leave them in their misery he is full of kindness and tender pity toward all who are exposed to the temptations of the full flow and this is a quote actually from Christ object lessons and he tells us to love our enemies do good to them which hate you bless them that curse you pray for them the spitefully use you and this is actually not a precious love or a romantic love or a brotherly love that he's asking us to have for these people this is the pitying adopt a lot the self sacrificing compassionate love that he's asking us to give but the more neglected aspect of God's love is not the pitying love which we hear a lot about today it's actually his precious life in this is something he desires for each one of us to experience there's a tax repeatedly in the Gospel of John that says the disciple whom what jesus love when Jesus therefore saw as mother and the disciple standing by whom he loved he saith unto his mother well and behold I son and then he said to the disciple behold I mother and from that hour that disciple took her and do his own do you think that was a blessing to John absolutely it was that a blessing that was equally made available to the other disciples No Was it just because. Of randomness that Jesus did this notice this quote he enjoyed this is John the Beloved to a pre eminent degree to the friendship of Christ and he received many tokens of the Savior as confidence and love. He experience a preeminent degree this is not the same degree as the other disciples now it was offered you know next to him was Judas both of them had significant issues. But Judas did not take advantage of his time with Christ like John did John was taking full advantage John did not naturally possess the loveliness of character that he later experience by nature he had serious defects he was not only proud he was self-assertive an ambitious for honor he was impetuous and resent Flunder injury he and his brother were called what the sons of thunder evil Templer The desire for revenge the spirit of criticism they were all with John the Saviors affection for the beloved disciple was returned with all the strength of what ardent devotion John clung to Christ as the vine clings to the stately pillar for his master's sake he braved the dangers of the judgment hall and lingered about the cross the others wouldn't do that and at the tidings that Christ had risen he hastened to the separate current zeal outstripping even Peter the depth and fervor of John's affection for his master was not the cause of Christ's love for him but they what the effect of that love John desired to become like Jesus and under the transforming influence of the love of Christ he did become meek and lowly self was hidden Jesus above all as companions John yielded him self to the power of that wondrous life. What is that called It's actually called Precious Love that God doesn't have hated precious love for those who are continually going against him he has peddling love compassionate love but it's like the child that's wayward versus the child that is totally on board with mom and dad and with the principles that Dave outlined there is that there's a precious love that develops there notice this the savior loved all the 12 but John's was the what the most receptive with more of the child confiding trust he opened his heart to Jesus thus he became more into sympathy with Christ and through him the Savior his deepest spiritual teaching was communicated to the people the Lord rouse out the soul in prayer and gives us to feel his what Precious Love This is what I desire every morning as I am praying and reading the Word of God claiming the promises asking God if I'm in compliance with the commands and drawing Arce my soul out in prayer I want to feel not as pitying love so much as this precious love we have in nearest to him and can hold sweet communion with Him We have tamed distinct views of his tenderness and compassion in our hearts are broken and melted with contemplation of the love that is given to us we feel indeed an abiding Christ in the soul or pieces like a river wave after wave of glory rolls into the heart and indeed we sup with Jesus and He with us we have a realizing sense of the love of God and we rest in His Love no language can describe it is beyond knowledge we are one with Christ our life is hid with Christ in God we have the assurance that when he who is our life shall appear then we also will appear with him in glory. So the precious love that tender love I could speak more about it but the example also isn't marriage is the love unconditional in marriage well there might be pitying love that's unconditional but not precious love if like what like Lucifer who was close to him walked away he might have a pitying love but it's not no longer any precious love when divorce occurs what does happen to that precious love christ bride is the church and each member of the Church Triumphant will be a giver and a reception to the precious love of Jesus and this is something that will keep you from burning this is something that will keep your wife in perspective it's one of the 3 aspects of crucial aspect of keeping you purposed I want to experience more of God's precious love in my life and less of God's pitying love and when I respond fully to Christ pitying love with its review and moral lessons that cut across our natural tendencies and selfish desires that's when we will begin to experience Christ's precious love gone a little overboard or a little over time I hope this is helpful. 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