Physicians have a big challenge when it comes to managing online reviews: HIPAA. Although patients may say whatever they like, doctors are bound by HIPAA not to release certain information, and the lines can be blurry.

FURTHER READING: It's a huge mistake if you're not on social media

Many doctors don’t respond to reviews at all, which can damage efforts to get new patients. There’s a right way to manage reviews, and I’m going to show you how.

How Does HIPAA Apply to Online Reviews?

Let’s look at a quick example. Have you ever seen a review like this on Google?

“I went to Dr. Abram for severe pain in my abdomen. He ran no tests, gave me no pain medication, and told me to go home and rest. What a waste of time!”

FURTHER READING: Watch out for these HIPAA violations in online reviews

Then, Dr. Abram replies: “Sophie, the symptoms you presented didn’t warrant tests. We ruled out appendicitis and other infections. You had no fever, and the pain was moderate. We don’t normally give out pain medication for issues like yours. If you still have severe pain, please come back or go to your nearest urgent care facility.”

There are two clear HIPAA violations here:

1. Dr. Abram confirmed the individual is a patient.

2. Dr. Abram gave out medical details the patient didn't mention in the original complaint.

Next: I have a negative review, what should I do?

I Have a Negative Review. What Should I Do?

So a patient blasted you online. Where do you start? Below are four simple steps for responding to a negative review:

1.     Figure Out What Happened: Speak with your office manager and your nurse—whomever you need to. But you must understand EXACTLY what happened. There is almost always another side to a negative review that provides more context.

2.     Appeal to the Publisher: Review sites site Yelp, Google MyBusiness, and others have Terms of Service reviewers must follow. For example, many sites require reviewers to be actual customers, not employees or friends of a customer. Most sites ban profanity and harassment. In some cases, you can get a review removed by appealing to the publisher.

3.     Reach Out to the Reviewer Privately: If the review is not appealable, the next-best step is to reach out offline to the customer. Remember, the ultimate goal is to remove the review. Most reviewers leave online reviews because they feel marginalized. When you reach out, make sure you listen first. Once they have had their say, give your point of view. Don’t argue with them or blame them…if you do, the conversation will be over. Offer a resolution to them, then ask if they would be willing to take the review down. In many cases, they will.

4.     Respond as a Last Resort: If appealing and reaching out don’t work, or if you aren’t sure who the reviewer is, you’ll need to respond to the review. Your response should do these things:

a.     Thank the reviewer for their feedback.

b.     Reinforce how serious you are about patient satisfaction and privacy.

c.     Demonstrate you care about your patients and want to rectify the situation. Include how they can communicate with you offline.

Here’s an example:

“Dear Sophie, thanks for your feedback. At Local City Healthcare, we take patient satisfaction seriously. In order to protect our patient’s privacy, we prefer to handle situations like these offline.

“Would you be willing to call my office at 555-555-1212 and ask to speak with me, so I can better understand the situation?

“Thanks in advance for your help. – Dr. Abram”

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Injecting fillers to augment breast nipples is a new trend, according to Allure.com.

But just because it’s a trend doesn’t mean it’s a good idea, according to the October 2017 article. Plastic surgeon Lisa F. Schneider, M.D., said in the article that the aim of injecting hyaluronic acid fillers into the nipples would be to increase nipple projection. Dr. Schneider warns nipple augmentation is not an indication the FDA has approved for fillers, and she would recommend that patient steer clear of the trend. Pain, temporary results and the risk of infection are among her reasons.

Seattle, Wash., plastic surgeon Richard Baxter, M.D., tells The Aesthetic Channel that he agrees.

“I would definitely not do it. Milk ducts could be blocked leading to infection and scarring, possibly interfering with later breast feeding, and other issues,” he says. “It seems like a risk of long-term problems for what is almost certainly going to be a short-term trend.”

Not everyone thinks it’s a bad idea, however.

In an article published last year on DailyMail.com, New York City plastic surgeon Norman Rowe, M.D., is quoted as saying he has seen a surge in demand for aesthetic nipple procedures, spurred, he thinks, by a trend in see-through tops.

Dr. Rowe describes different techniques for achieving designer nipples in the article, one of which is the use of fillers to make nipples project more. Results last from nine months to two years, according to the article.

In addition, a study published in August 2017 in Cutis suggests using hyaluronic fillers to augment nipples might be a good option for postsurgical breast reconstruction.

“The loss of the 3-dimensional contour of the nipple-areola complex… following surgical breast reconstruction is a technical challenge for the physician and a psychological burden for many breast cancer patients,” according to the authors. “The use of injectable dermal fillers to enhance nipple projection is a simple noninvasive procedure with immediate and adjustable volume results that positively impact patient satisfaction.”

Injectable hyaluronic acid filler availability and safety make it an ideal option for restoring the natural feel and contour to the delicate structure of the nipple-areola complex, they write. 

A human placental tissue allograft could be the next hyaluronic acid filler alternative for aesthetic patients, according to Miami, Fla., based plastic surgeon Rian A. Maercks, M.D.

Dr. MaercksDr. Maercks is testing AmnioFill (MiMedx), a product commercially available for homologous use as a placental connective tissue matrix to replace or supplement tissue in acute and chronic wound care, according to the company’s website.

The plastic surgeon has used the tissue allograft as an investigational filler to treat the faces of eight patients and is in the process of monitoring them for outcomes.

There are several draws to having such an alternative to hyaluronic acid (HA) dermal fillers, Dr. Maercks says.

“One, it’s natural, native human tissue. Number two, it’s filled with growth factors, that are important to fetus development and support, which, at least theoretically, should activate some vascular cells and, potentially, stem cells locally when it’s used, causing an in-growth of healthy tissues. That’s the real exciting thing,” Dr. Maercks says.

Another advantage of the non-HA filler: Its proteins are hydrophobic.

“One of the difficulties with hyaluronic acid-based fillers, which are really the best on the market, is that they are very hydrophilic, which gives them the power to maintain volume but also makes them swell a lot and causes that recovery period of swelling,” Dr. Maercks says. “With hydrophobic compounds, there is a much reduced, and sometimes even absent, swelling part of the recovery, which is really important for high-demand patients who want to come in and get something done without recovery.”

NEXT: AmnioFill Research Insights

AmnioFill Research Insights

Dr. Maercks is conducting follow-ups with his AmnioFill patients to gauge tissue response and lasting power compared to treatment with HA-based fillers. He was at about six months of follow-up in late January 2018.

So far, he tells The Aesthetic Channel that use of AmnioFill in the periorbital, perioral, nasal and cheek areas of the face offers a diminished recovery compared to HA fillers.  

“With the technique I use, I don’t get bruising, but the swelling is [also] diminished,” he says.

AmnioFill comes in a powdered form and needs to be reconstituted, according to Dr. Maercks.

“In general, the amount of product that I reconstitute to about 3 ccs, I estimate has about 1 to 1.5 ccs of effect compared to hyaluronic acid. That means that a 3 cc use is going to give you the effect of about 1.5 ccs of hyaluronic acid,” he says. “Right now, the cost-to-volume ratio is not good compared to hyaluronic acid fillers. But the potential benefit of skin changes and tissue stimulation may outweigh that. It’s something that we’re looking into. A lot of patients prefer to spend extra money just to have less recovery and potentially have the positive effects.”

Dr. Maercks offers patients a commercially available human adipose tissue filler product, Allofill (Biologica Technologies).

“[The manufacturer takes] human adipose tissue, removes all the fat and then processes it similarly. It also has some growth factors but not quite the profile of the amniotic tissue,” he says. “I’ve had really good results with Allofill, as well.”

Allofill, according to the company’s website, can be used to fill soft-tissue defects as a noninvasive alternative to surgical fat grafting with one’s own tissue, eliminating the need for fat harvesting with liposuction.

But AmnioFill is a non-viable cellular tissue matrix allograft that contains multiple extracellular matrix proteins, growth factors, cytokines and other specialty proteins present in placental tissue, according to MiMedx. Its shelf life is five years, at ambient conditions. And AmnioFill is processed according to the American Association of Tissue Banks standards, and is regulated as a human cell, tissue or cellular or tissue-based product under Section 361 of the Public Health Service Act, according to Mimedx.com.

Patients are receptive to placental tissue filler products, according to Dr. Maercks, because they tend to like the idea of using natural human tissue. MiMedx’s AmnioFill should be on the market as an aesthetic dermal filler within two years — once there are strong guidelines for aesthetic use, according to Dr. Maercks.

As for dangers or warnings, Dr. Maercks says there are certain risks associated with any procedure.

“There are all kinds of theoretical risks that I’ve never encountered, including thrombosis, tissue loss, even blindness has been reported. As far as specifically with this product, the risks that go along with allograft tissue apply to it. But allograft processing is very highly regulated and is very safe,” he says.

Disclosure: Dr. Maercks is a researcher for MiMedx. 

In early January, Cutera announced its North American launch of an Er:YAG laser device for women’s vaginal health and aesthetics, the Juliet, and a fractional radiofrequency microneedling device, Secret RF.

The Juliet is a minimally invasive device designed to stimulate vaginal area collagen remodeling, as well as treat localized burning, itching, dryness and pain during intercourse. The in-office treatment takes about 10 minutes, with optimal results reported after three treatments, according to a Cutera press release.

“The difference in Juliet from other treatments on the market today, is that this laser has a dual pass mode. The first pass causes ablation and collagen remodeling, and the second is a thermal pass that stimulates collagen reproduction. While the collagen remodeling will assist with overall vaginal tone, the combination of energy modes revitalizes the tissue improving lubrication, itching and pain during intercourse,” says James Mirabile, M.D., a gynecologist in Overland Park, Kansas.

The aim of the company’s Secret RF microneedling device is to nonsurgically revitalize skin on the face and body, remodel collagen, improve mild wrinkling and diminish scars.

The microneedling device can be used on all skin types, and features customizable microneedle tips and two specialized handpieces for treating the face and body. Treatments take about 15 minutes and patients tend to see optimal results after three treatments, according to the company. See photos here.

Radiofrequency technology devices are showing limited but positive results in small studies. A similar technology, Endymed’s Intensif fractional microneedling radiofrequency device was shown in a recent study of 12 subjects to result in “overall improvement in décolletage appearance in regard to skin tightening, wrinkles, and skin texture suggested by overall patient satisfaction (80%) and physician-rated [Global Aesthetic Improvement Scale] GAIS improvement (67%).”

The authors of the study looking at the Intensif suggest fractional microneedling radiofrequency devices are safe and effective approaches for improving overall décolletage appearance with little downtime.

Disclosure: Dr. Mirabile reports no relevant disclosures.

Adding platelet-rich plasma (PRP) to the lipo-graft for facial lipofilling, or fat grafting, shortened patient recovery time but did not improve skin elasticity, graft volume maintenance or patient satisfaction, compared to lipofilling alone, according to a recent study published in Plastic and Reconstructive Surgery.

Researchers in The Netherlands conducted a double-blinded, placebo-controlled randomized study on 32 healthy females, who underwent cosmetic facial lipofilling with either saline or PRP added, according to the study’s abstract. Researchers looked for changes in skin elasticity, nasolabial fold volumetric changes, recovery time differences and patient satisfaction during a one-year follow up. Twenty-five of the women complete the follow up.

They found that while adding PRP significantly improved recovery time after lipofilling, it did not improve cosmetic outcomes or patient satisfaction.

Still, in a recent review of studies looking at adding PRP to fat grafting, French researchers found 11 clinical studies on humans and seven on animals and noted a significant increase of the survival rate of fat grafts in nine comparative studies.

“Our synthesis allowed us to set up the following protocol: addition of 20 [%] of PRP activated with calcium hydrochloride to fat grafts. It may enhance the results of autologous facial fat graft in regenerative and aesthetic facial surgery,” they write.

Some of the same authors of the recent study in Plastic and Reconstructive Surgery published a study in 2014 on the effects of PRP on recovery time and cosmetic outcomes in facial rejuvenation. This was a preliminary retrospective observation of four patient groups, including: patients treated with fat grafting only; those treated with fat grafting and PRP; patients treated with a minimal access cranial suspension-lift and fat grafting; and patients treated with a minimal access cranial suspension-lift, fat grafting, and PRP.

They found that adding PRP to lipofilling decreased the number of recovery days needed to return to work or socializing to an average 13.2, compared to 18.9 without PRP but with lipofilling. Interestingly, they didn’t find an effect from adding PRP to the minimal access cranial suspension-lift and lipofilling. But the aesthetic outcome of the lipofilling and minimal access cranial suspension-lift groups that added PRP was significantly improved compared to those groups without PRP.

Methylnaltrexone could assist in treatment of opioid-induced constipation (OIC) after abdominal surgery, according to a recent study published in the American Journal of Cosmetic Surgery. The drug may offer an alternative to the current treatment protocol of stool softeners and bowel stimulants, which can cause bloating and discomfort for patients.

The drug, which goes by the trade name Relistor, has been used for years for OIC in terminal patients, but more recent studies have focused on its use in non-terminal patients. This study is one of the first to be performed on patients receiving temporary pain relief from opioid drugs.

The study included 26 patients, 13 each assigned to the control and treatment groups. All were female, between the ages of 30 and 55, and undergoing abdominoplasty. If a patient had not had a bowel movement by three days post-surgery, the control group was given magnesium citrate and the treatment group was given a 12 mg subcutaneous dose of methylnaltrexone.

The researchers found that the group treated with methylnaltrexone had a bowel movement about 24 hours post-treatment, as opposed to the standard group, who had one an average of 45 hours post-treatment, a statistically significant difference.

"There is a large amount of research out there regarding the effects of these types of drugs," says Talon Maningas, D.O., Maningas Cosmetic Surgery, Joplin, MO, an author on the study. "However, most of this is geared toward patients that require narcotic pain medications long-term, such as cancer patients. We wanted to evaluate how these medications affect individuals who are using narcotics in the short-term, such as postoperative patients, who experience the same symptoms associated with narcotic pain med use."

The drug reduces GI hypomotility, but does not have an effect on pain relief levels. It is normally given in subcutaneous form (used in the study) but is also available as an oral drug.

"This study looked at a medication that is delivered via a subcutaneous injection. An oral medication option would be much more convenient for our patients if it was proven to work as well," Dr. Maningas says.

As for future studies, "There are multiple opioid receptor antagonists available. I would like to see head-to-head studies evaluating the effectiveness between the different available routes of medication."

What will shape cosmetic medicine in 2018? We asked industry leaders to weigh in with what they think will drive aesthetic medicine’s evolution this year. 

Jeffrey E. Janis, M.D., president of the American Society of Plastic Surgeons (ASPS)

Dr. JanisFat grafting safety, multimodal pain management and nerve decompression for migraine headaches will make big impacts on plastic surgery in 2018, according to Dr. Janis, who is professor of plastic surgery, neurosurgery, neurology and surgery at Ohio State University Wexner Medical Center, Columbus, Ohio.

Fat Grafting Made Safer

“Fat grafting to correct reconstructive deformities or augment cosmetic surgery results is a growing part of everyone’s practice. What’s going to be new this year is technical refinements on how to make fat grafting as safe as possible,” Dr. Janis says. “I think that’s going to be a major issue, especially with regards to fat grafting to the buttock or what’s otherwise known as the Brazilian Butt Lift. There are going to be scientific recommendations that are going to be made this year that are going to be beneficial for anyone who performs this procedure.”

Multimodal Pain Management

“I think we’re all aware of the opioid epidemic that has really ravaged the county. The question is: How can we apply procedure-specific multimodal pain management strategies to our patients and our practices?” Dr. Janis says. “I think that, as we all become more aware of alternative strategies to curtail opioid use in helping to treat acute postoperative pain in our patients, we will be able to provide safer, more effective pain control to our postsurgical patients.”

Migraine Surgery

“There are 35 million Americans who suffer from migraine headaches. It’s actually more common than asthma and diabetes combined,” Dr. Janis says. “…plastic surgeons can help treat these patients by doing nerve decompression of nerves in the head and neck [in appropriate candidates for the procedure]. We have published results behind it and are continuing to come out with additional scientific evidence to support this procedure. This year, I think you’re going to see this become more main stage because we have position statements about to come out from the American Society of Plastic Surgeons that basically define indications and provide scientific evidence to support its safety and efficacy.”

NEXT: Predictions From the AAFPRS

Predictions From the AAFPRS

William H. Truswell, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)

Facial plastic surgeons predict filler refinements and injectable rhinoplasty will be among the top 2018 trends, according to a recent AAFPRS press release.

Stem Cells for Filler Longevity?

Dr. TruswellMore flexible fillers that respond when the face animates, refinements in the use of stem cell injections and increased use of volumizers for facial rejuvenation could make important strides in 2018, according to Dr. Truswell.

“Embryonic stem cells are pluripotent cells — that is, they can turn into different cell types,” Dr. Truswell says. “Stem cells exist in the adult human in fat and bone marrow. These are multipotent stem cells. They have the ability to turn into bone, cartilage, muscle and fat.

Adipose-derived stromal cells (ASCs) are similar to stem cells in fat and are being scrutinized for use in aesthetic surgery, notably fat grafting.”

Fat grafting is used to add volume to the lips and other areas of the face that would benefit from increased volume, but fat grafting’s permanency is debated in the literature, Dr. Truswell points out. The hope is that enriching fat grafts with adipose-derived stromal cells will increase fat retention.

ASCs are also being studied as a means to rejuvenate aging skin, as well as in areas beyond cosmetic surgery. But stem cell use remains under investigation and not all claims are legitimate, Dr. Truswell says.

“Some companies tout plant stem cell uses for collagen rejuvenation. This false cross-species therapy simply does not work,” he says. “This is a very complicated subject…. There are many claims of success but still ‘let the buyer beware’ is sage advice.”

Injectable Rhinoplasty

Nonsurgical rhinoplasty has become more popular because it can be performed in minutes and results in a fraction of the downtime, bruising and swelling associated with traditional rhinoplasty. The trend will continue in 2018, according to Dr. Truswell.

Injectable rhinoplasty is a method of altering the shape of all or part of the nose with an injectable hyaluronic acid filler, he says.

“This technique is commonly used to fill or lift dips, camouflage irregularities, elevate the nasal tip and so on,” Dr. Truswell says. “The technique is fairly straight forward. The material is injected slowly with careful observation. It should be done by a skilled injector, as should all facial injections.”

While effective in the right patient, nonsurgical rhinoplasty doesn’t address every nasal deformity. The approach won’t alleviate nasal obstructions or straighten crooked noses, he says.

NEXT: Prejuvenation, Selfies & Millennial Men

Prejuvenation, Selfies & Millennial Men

The AAFPRS also predicts rising popularity for “prejuvenation,” the concept that younger patients have age-prevention cosmetic procedures — from skincare and injectables to laser and light therapies.

Social media selfies will continue to fuel patient demand. More than 40% of AAFPRS members noted in the AAFPRS member survey in 2016 that patients were requesting facial plastic surgery to look better on social media.

The New Year will feature a greater focus on transgender/feminization procedures at academic centers.

Millennial men will continue to want to maintain. A survey by the AAFPRS, found that nearly a third of men surveyed said they are "extremely likely" to consider a surgical or nonsurgical cosmetic procedure. Of those men, 58% were between 25 and 34 years old while 34% were 18 to 24 years old.

Next: Breasts, Botox & Eyes

Breasts, Botox & Eyes

In a recent press release, ASAPS-member plastic surgeons from across the country have made several predictions for what they think will make big waves in 2018:

Laser-Assisted Breast Reduction & Lift

Grant Stevens, M.D., believes that an outpatient breast reduction and lift procedure he pioneered, called Laser Bra, will be trending, given that small breasts are in.

Dr. IshiiThe Laser Bra differs from a traditional breast lift, in which a portion of excess skin is removed and discarded from each breast. Using the Laser Bra technique, Dr. Stevens keeps this skin, treating it with a CO2 laser and placing it inside the breast to provide additional support from the breast to the chest wall. The resulting “internal bra” lifts the breasts and creates cleavage. There are no drains or external sutures that need to be removed after the Laser Bra procedure, according to a 2010 press release from Dr. Stevens’ Marina Del Rey, Calif., practice.

ASAPS President Clyde H. Ishii, M.D., a Honolulu-based plastic surgeon, tells The Aesthetic Channel that many women seeking breast augmentation want a more natural look — specifically, to avoid the obvious augmented breast look. And many large-breasted women are seeking breast reductions at earlier ages — not waiting until their 50s and 60s to do it. 

“The popularity of an active lifestyle probably contributes to this trend,” Dr. Ishii says.

Botox Dethroned?

Troy, Mich., plastic surgeon Anthony Youn, M.D., says 2018 might be the year Botox (Allergan) is dethroned by a better-than-Botox product.

“I predict there will a product better than Botox released in the next year. Although Botox is still the top cosmetic treatment in the world, there are similar products in the pipeline that will likely come out in 2018. Once they do, watch out — we may have a new king of the cosmetics on our hands!”

Prettier Private Parts

Labiaplasty procedures increased 23% in 2016 and demand among women was even higher in 2017, according to ASAPS. The stigma is fading and more women are looking to increase confidence and comfort for their private parts, according to New York City-based plastic surgeon Tracy Pfeifer, M.D., M.S.

Filler-Fueled Eye Rejuvenation

This year, doctors will increasingly use fillers to restore volume in the upper and lower eyelids, says Dr. Pfeifer.

“Noninvasive treatments are very popular and this includes treatments to the periorbital area,” Dr. Ishii says. “Soft tissue fillers can mask many signs of aging in this area, since volume loss is a part of the aging process. There is less margin for error in this area, so patients must seek treatment from qualified practitioners.”

Amid serious safety concerns associated with gluteal fat grafting, a plastic surgeon task force has investigated the risks and factors that appear to make gluteal fat grafting safer or more dangerous. Based on its findings, the Aesthetic Surgery Education and Research Foundation’s Gluteal Fat Grafting Task Force released new recommendations for making the procedure safer.

The American Society for Aesthetic Plastic Surgery reports member surgeons performed more than 19,000 fat transfers to the buttocks in 2016 — up from 18,487 in 2015.

The problem is the numerous anecdotal and published reports of fatal and nonfatal pulmonary fat embolism associated with gluteal fat grafting. The task force published survey results from 692 plastic surgeons, worldwide, who had performed 198,857 gluteal fat grafting cases. The task force concluded that gluteal fat grafting has a significantly higher mortality rate than any other aesthetic surgical procedure.

Among the survey findings: During their careers, respondents reported 32 fatalities from pulmonary fat emboli and 103 nonfatal pulmonary fat emboli. A total of 3% of the surgeons experienced a patient fatality and 7% indicated they experienced at least one pulmonary fat embolism in a patient. The task force reported 25 U.S. fatalities in the last five years, confirmed through autopsy reports and interviews with surgeons and medical examiners. American Association for Accreditation of Ambulatory Surgery Facilities reported four deaths from 2014 to 2015 from pulmonary fat emboli, according to the abstract.

The practice of injecting into the deep muscle significantly increases the incidence rate of fatal and nonfatal pulmonary fat emboli, according to the abstract.

“Based on this survey, fat injections into the deep muscle, using cannulae smaller than 4 mm, and pointing the injection cannula downwards should be avoided,” the task force concluded.

Other task force recommendations, according to an American Society for Aesthetic Plastic Surgery press release, are:

·       Position patient and place incisions to create a path that will avoid deep muscle injections.

·       Maintain constant three-dimensional awareness of the cannula tip.

·       Only inject when cannula is in motion.

·       Consider pulmonary fat embolism in unstable intra- and postoperative patients.

·       Review gluteal vascular anatomy and draw landmarks to identify and avoid injection into the pedicle.

·       Include risk of fat embolism and surgical alternatives in the informed consent process.

Physician burnout continues to plague the medical industry, according to the 2017 Medscape Physician Lifestyle Survey.

The survey of over 14,000 participants found that 51% reported burnout, which is an increase from 46% in 2015 and 40% in 2013.

Moreover, 55% of women noted burnout in the most recent survey, compared to 45% of men.

Perhaps not surprisingly, only 39% of women reported being happy at work versus 45% of men.

Tackling this issue, the pros at myhealthtalent.com, a resource designed by trusted provider of medical content Elsevier, offer their advice on how to avoid, navigate — and survive — burnout. According to the source, there are five things that can cause burnout:

1. Long, demanding hours

2. Pressure from patients or colleagues

3. Employer issues

4. Work overload

5. Excessive administrative challenges

Not to mention marital concerns, family problems and financial worries can also contribute to burnout.

Existing medical conditions, nutritional imbalances or lack of sleep? Those can be culprits too.

Fortunately, there are preventive coping mechanisms to minimize physician burnout, according to the source, and it all starts with step No. 1: acknowledging that you may be suffering from it. Beyond that, there are other specific recommendations for coping with burnout:

Get a professional perspective. Meet with another physician trained in stress management for a different perspective and to help identify issues that may be aggravating burnout.

Be aware of how you’re feeling. Be present in the moment to isolate triggers of burnout, such as stress, anger, being tense or tired.

Exercise to relieve stress. Even just 10 minutes in the morning of something simple like jumping rope or yoga can help.

Reach out to friends, family and colleagues. Telling someone out loud how you feel at the moment can help you to better understand how you feel.

Know you’re not alone. Simply knowing that you’re not the only one to suffer from burnout can help.

Take a break. If you’re burned out from work, a weekend break can do wonders. A change of scenery is sometimes just what the doctor ordered.

Make a change. There may be career options that offer more flexible hours, fewer patients or a rural setting to minimize burnout. At the same time, leaving your current position for a new job is no guarantee that the grass will be greener.