Managing stress and avoiding burnout: one UNM physician's journey
The specter of burnout is a constant in healthcare fields. But with awareness, that threat can be managed, according to Dr. Renee Ornelas, professor in the UNM Department of Pediatrics and medical director of Para los Niños (PLN), the state’s only program for sexually abused children.
Ornelas provides medical evaluations for children and adolescents who have been sexually abused and sexually assaulted. The multidisciplinary clinic also provides comprehensive, laboratory evaluations, crisis counseling and anticipatory guidance. Staff is on call 24 hours a day, seven days a week.
It was a field that felt right for Ornelas since her days as a pediatric resident at the LAC–USC Medical Center in Los Angeles.
“They used to drop those files into a pile with everything and everyone else,” she said. “Most people shied away from those cases, but I found from the first that I could talk to children. I speak Spanish and a lot of our patients were Spanish speaking. I could talk to them about what happened without an interpreter. I found that I could do the evaluations. And, once I realized that, I knew I wanted to do them well, to be able to make a difference,” said Ornelas.
But even fervor has its limits. Long hours, tearful families and the specific and daunting records required by the justice system exact a toll.
“I could always tell when it was getting to me,” she said. “The important thing is to recognize what triggers you and then work on those triggers. Otherwise, they will get to you.”
Through the years Ornelas has seen competent, passionate people burnout and leave the field. Developing coping strategies has been paramount in being able to be effective, she said.
“My professional support comes from outside UNM. You get these great connections to people who are doing the same things you are,” she said. “But you have to be able to let go of the job in order to recharge and get back into balance.”
Ornelas sticks to a short but effective list of things that she believes are critical in being able to restore balance and maintain a good personal life.
First and foremost, she said, it is important to know which areas and people are difficult for you.
“One needs to be aware of those triggers and to develop methods for dealing with them,” she said.
“I found that there was a certain type of mother that would get under my skin. I would have a tendency to get extremely irritable with them. So I talked to people about it.”
For some people, such ‘talking’ might mean checking in with a therapist - "fairly common in my line of work,” according to Ornelas. For others, it can mean journaling and talking with friends.
Which leads to the second strategy: seeking out the sane and happy.
“Have a lot of healthy, normal people in your life,” she said. “When my children were younger, it was good to be able to go home and see my kids were doing well and they are having a good life. “
Third is to develop hobbies – especially those that require physical activity such as hiking or exercise classes.
“Go on and pay the money up front,” she advised. “I buy lots of massage packages. There are exercise packages out there. At the end of a long hard day you are much more likely to show up and do those things if you have already paid for them.”
Symbolically finding a place where one can leave a stressful situation can also help, she said.
“A friend of mine used to garden and she would go out with a shovel and plant something to honor the child or family and their suffering. This allowed her to drop the situation in her mind and put something positive in it’s place,” said Ornelas.
“What works for me are those cathedral candles you can buy in the supermarket. They last for three days. I will light one for someone and sort of mark a space in my house. It isn’t like prayer; it is just sort of defining a space and depositing energy, and symbolically leaving the situation there. Then, for the next couple of days, I can walk by and I’ll think about that case when I see that candle, send some positive thoughts to the people involved. Knowing that I’m leaving that case in that space seems to help.”
Letting go is critical.
“You cannot hold onto things,” Ornelas said. “Especially if you have your own history, jobs like this will bring it out and you will find yourself in a space where you are not doing anyone any good.”