Feeling burnt out? Dr Mark Rowe reveals his (surprisingly simple) solutions on how to get your mojo back

“When Covid first hit, we were initially dealing with the immediacy of that,” he says, “but as time went on, it became apparent that while we were really busy seeing patients every day, there were a lot of people who were too terrified to come to the doctor.

“So during Lockdown II, I started doing daily videos which I put out on social media, to try and connect with my patients more effectively. Simple positive messages to inspire hope, lifestyle medicine choices, simple positive psychology exercises such as spending time in nature, mindfulness. And people started to connect. Patients even in their 70s and 80s were saying it was really having an impact.”

During the third lockdown, last January, he posted a video on every one of the 100 days. “Around the halfway point I thought, ‘Why don’t I put these into a written format?’ That’s where the genesis of the book came from.” 

His interest in what is called lifestyle medicine (meaning the use of evidence-based lifestyle therapeutic interventions, including a whole-food diet, regular physical activity, good sleep, stress management, and positive social connection – basically, the kind of sensible, balanced, positive lifestyle we all know we should adopt, but often do not), predates the Covid pandemic.

“I had this passionate interest in lifestyle as medicine, going back a number of years,” he says. “I’d been lucky enough to go to Harvard, spend time with Herbert Benson – the modern founder of mind-body medicine. At the time of the last economic crash, back in 2008/2009, there were so many people that lost their jobs, there was a huge amount of toxic stress. Some were clinically depressed and needed medication, but others weren’t, they needed more than that. They needed a new sense of hope, a new sense of optimism, new ways to get through it.

“That’s when I began to look at lifestyle as medicine. I began to use it with patients and got some great results, and it sparked off from there. What I’ve learned is that no matter where you are in life, you can decide to make today a new start, to be kinder to yourself, to live with more vitality.”

This is at the heart of the book – a plea to make that new start, at any stage of life. And simple, often visual, prescriptions for how to do so. It’s not a lose-weight book, or a get-fit book, not even a be-mindful book; instead it’s something of all these, but always emphasising greater energy, enjoyment, zest, purpose. Rowe is good at connecting many aspects of lifestyle medicine, and showing that there are many options for taking better care of ourselves.

“There are,” as he says, “so many things you could do. And of course health is priceless. The greatest gift any of us has.”

Does he think we are more health-conscious since Covid?

“Definitely. On one level, there’s, ‘I need to strengthen my immune system, because of viruses,’ right through to the way so many people now are interested in how can they stay healthier into old age.

“When I started in practice in the mid-1990s, it was seldom that you’d see someone who was more than surviving into their 80s, it was very much a rarity. Now, I have patients well into their 80s who are thriving. They are doing strength training, swimming in the sea, going to yoga – and why not? Life is to be lived.”

How was his own experience of lockdown?

“Ironically, I have Covid right now,” he says. How is he feeling? “I was pretty bad earlier in the week – a couple of days of temperature, aches and pains, but I’m grand now.”

As far as lockdown went, “Work was very challenging. Before the vaccinations, it was very concerning. But I’ve a pretty simple life. It didn’t change that much personally. In my life in general, I really focus on simplicity, and gratitude. I’m very lucky. I live outside the city in Waterford, I’m around nature. It was a tough time for many others, but it wasn’t a tough time for me. I’m not going to talk about anything I lost. I like to think about, ‘What did I gain?’ The growth mindset. How can you grow from challenges?”

So what did he gain?

“I wrote the book during Covid. I got a lot of time to reflect, time to really think clearly, to appreciate what I have in my life.” He writes about this in the book – the profound benefits of appreciating what we have.

“We can all take things for granted when everything’s going well,” he explains. “It’s hedonic adaptation, and we’re all human so we all fall into that trap, to a greater or lesser extent. When you see the world through how much you have – through abundance and gratitude – it’s a great way to dissolve all those mini problems and stresses.”

There is much in Rowe’s book that we know – or should know – around diet, exercise, sleep and so on, although he is very compelling at reanimating this information with focused examples of studies to back up the assertions, and great clarity of suggestion. And yet, despite the advice being available, many of us do not make the changes. Does he think real change, though reading his book, is possible?

“I hope so. I really do. I can’t change the world, nobody can, but you can start by changing yourself, focusing on your own wellbeing and vitality. And then, particularly as a family doctor, I hope that by choosing to take a leadership position in these types of ideas, that I can have a positive impact on other people. And in that sense, it can cascade and spread.”

Change, he points out, is hard. “Biologically we are hardwired for fear and survival, and to resist change. Building new habits isn’t easy. It’s completely oversold in terms of how easy it can be. It’s difficult for all sorts of reasons: willpower depletion is a huge one. The people you spend time with, the environments you spend time in. The amount of stress you’re under.”

In fact, he insists, “Change starts on the inside. If someone wants to build a new habit – say exercising more, or eating healthily – they need to start with emotions. Start with being kinder to yourself, more self-compassionate. Feeling better about yourself on the inside is a great start for building something on the outside.”

Fear is “a poor motivator of change. If you have a heart attack, god forbid, you’ll stand on your head for the doctor for about a month. But after that, you’ll revert to type. The fear of diabetes, for example, is unlikely to get you off the couch. So we need to move towards positive change.”

Another suggestion? Start small. Very small. “I call it the power of thinking small. What are the small things you can do? It’s really interesting how, if you make one small positive change in one aspect of your health habits, and hardwire it in, it becomes part of who you are – whether it’s exercise, leaving your phone downstairs – it’s amazing how that can become a kind of domino impact over time.”

Of course, timing is everything. And right now, the timing may be spot-on.

“I think generally, a lot of people are searching for meaning and purpose. That overly materialistic culture – a lot of people are disillusioned with it. It has failed. A lot of people are looking for a deeper meaning and fulfilment in life, and that comes from the inside out – from purpose. Ask yourself, how can you serve others? How can you connect more? Get more joy in each day.

“These are the key things. Money won’t give you that. Of course you need a roof over your head, you need to feed your family. But having more won’t necessarily make you any happier, and can be a great source of discontent and unhappiness.”

He is particularly interesting on the topic of burnout – something that feels almost epidemic in a world still reeling from the effects of Covid, and now beset by news of war. Rowe has his own experience of a phenomenon that has just been officially recognised by the World Health Organisation. Initially known as a ‘state of vital exhaustion’, burnout has been reclassified as an ‘occupational syndrome’.

Rowe recalls, a few years into the economic crash, “I’d just built the Waterford Health Park. We had our own financial emergency, we were employing 26 people, there was an endless workload. I began to feel a bit burned out myself. I love my job, I love people, but I lost my mojo for a while. Really, I had to take a dose of my own medicine.”

He took time out, wrote his first book, Prescription for Happiness, spent time with his family, and travelled. “I began to apply the principles of lifestyle medicine to myself.”

And it worked. “I got my spark back. I had to ask myself – what is my own purpose? I felt my purpose had gone a bit stale. I suppose it can happen to people in their 40s – and one in three doctors at any one time might be experiencing burnout, it’s very common in the caring professions.

“But I realised my own purpose was service. Every day when I can go in and help somebody else is a good day. Once I became crystal clear on that, and then understood that I was going to also take good care of myself, everything became much clearer for me.”

His own experiences helped to crystalise his growing belief in lifestyle medicine, and his research has helped to put hard figures on this. “When you learn that exercise is better than 10 separate medications, when you learn that mindful optimism can reduce your risk of heart attack or stroke by 35pc, that spending two hours in nature once a week can have a dramatic effect on your immune system, your mental health and emotional wellbeing – you realise that there are so many simple things immediately available to all of us, to immediately improve our vitality and our healthspan.”

So, what three things would he tell a patient who came to him today, wanting to make positive lifestyle changes?

“Assuming they don’t have anything else going on – their blood tests are clear, they’re not depressed – I would want to look first at their sleep. Giving yourself more sleep can have such a positive impact in terms of reducing anxiety and improving your mindset and energy.

“Second, I would try and get people moving a little more. Nothing as radical as joining a gym, just see how they can move more. I’m not interested in somebody signing up for the marathon in the morning – could you walk for five minutes a day? Start from there and build up over time. And if you can get out in nature, so much the better.

“Third, my inner teacher means I love the idea of writing things down. There are such benefits to journaling. It’s like a brain dump on paper in terms of building emotional wellbeing. Try a written gratitude practice – write three things that Went Well Today. It’s such a simple thing to do.”

And finally, he says, “Be kind to yourself. I meet so many people who beat themselves up. Don’t.” 

‘The Vitality Mark’ by Dr Mark Rowe, published by Gill Books, €16.99, is out now

Burnout, and what to do about it

What is it?
A syndrome resulting from chronic workplace stress that has not been successfully managed. It can also be seen as a response to the previous two years of Covid and lockdown.

It’s not just ‘a bad day’. Burnout is where bad days become the new norm, with feelings of being overwhelmed, disengaged, cynical, emotionally flat and exhausted.

Burnout can be exacerbated by poor lifestyle habits, and particular personality types; Type A, overachieving perfectionist, are most at risk. In the medical and healthcare community, those professionals who are more caring and empathic are most vulnerable.

Physical symptoms
These overlap with other symptoms of chronic negative stress, and may include frequent headaches, abdominal cramps or bloating; change in sleep patterns or eating habits; feeling tired all the time with lack of energy; recurring colds and flu-like viral illnesses. Long-term adverse physical effects of chronic burnout can increase susceptibility to a range of chronic health conditions, from heart disease and high blood pressure to diabetes and depression.

Psychological symptoms
Burnout can lead to poor concentration, reduced focus, shorter attention span and a narrowed sense of perspective. As the amygdala in your brain is on hyper alert, from a chronically stressed state of ‘fight or flight’, you experience diminished productivity and creativity.

Your mindset changes, seeing work as wearing, with many challenges seeming to appear bleak and insurmountable.

You may see tasks as being overwhelming or overly dull. This can lead to feeling cynical and resentful.

A lack of confidence, with feelings of self-doubt and difficulty in coping; this can lead to a sense of failure and futility. Feeling psychologically trapped with lack of motivation. Reduced resilience.

What to do? Some suggestions
Awareness precedes change. Burnout doesn’t come on suddenly like the flu. It’s gradual. Paying attention to the early subtle symptoms and signs is important. If you feel you are approaching burnout, talk to your doctor.

Try talk therapy. Opening up to a trained therapist can be very cathartic and helpful.

Disconnect to reconnect. Leave work at work.

Adopt strategic self-renewal strategies, from short breaks during the day, to slowing your breathing.

Embrace positive lifestyle habits, including regular exercise, restorative sleep and a nutritious diet.

Recharge from stress. Try practising meditation or breathing exercises.

Reach out to others. Look for support at work as well as a supportive network outside of work.

Stay connected to causes or community that matters to you.

If you do one thing for…

Your body: Don’t sit for too long. Prolonged sitting (more than six hours a day) is an independent risk factor for adverse health conditions. Even getting up for a minute stops you “marinating in cortisol” and is like pressing a little reset button for yourself. Aim to do it every hour.

Your soul: Find your purpose. A sense of purpose will reduce the risk of adverse health conditions, enhance relationships and build positive health choices.

Your heart: Practise gratitude. This has been shown to support health. It makes us resilient and responsive rather than reactive, and may lead to the release of endorphins.

Your mind: Be present. Mindfulness can increase brain volume and grey matter in the brain areas responsible for learning and empathy.