What doctors and Abraham Lincoln have in common

I have a colleague who has lost his capacity to continue practicing pediatric critical care medicine. It didn’t happen suddenly; it came on gradually over a year or so. It also didn’t follow from a single event or bad experience. It was just a creeping uneasiness that culminated in his unwillingness, after two decades, to go on doing this. Even though I’ve been practicing pediatric critical care for thirty years, I don’t share his discomfort, at least for now, but I understand it. I can’t say much about other specialties because I’ve only done this one. So I don’t have much insight into the specific stresses other kinds of physicians face. I assume that these specifics matter to some extent.

There is a large body of research on occupational burnout in general and physicians in particular, one which I don’t pretend to know very well. You can find a good recent example here. That study, a survey of over 27,000 physicians, defined burnout as the presence of a loss of enthusiasm for work, feelings of cynicism about the work, and a low feeling of personal accomplishment. Those strike me as pretty broad categories, things that would include most of us from time to time. So I am not surprised that an average of 46% of physicians reported at least one of those symptoms. I would have thought it would have been higher. Still, compared with the general population, physicians were around 50% more  likely to report these symptoms.

The physician group most likely to experience these feelings were emergency physicians, with  primary care practitioners close behind. This particular study didn’t say anything about my specialty of pediatric critical care, or even critical care generally, but did note that general pediatricians were among the least likely to report such feelings.

It is my impression that critical care medicine as a specialty has a fairly high burnout rate. By that I mean something more than the survey: I mean people who actually leave the practice of critical care.  Some of this comes from the hours we keep and some comes from the continual crisis mentality you find in many ICUs, but I think mostly the reason comes from within us. Each of us has a finite capacity for tolerating stress, a fact known for many years. Old studies of combat fatigue from World War II even estimated precisely how large that capacity is, on average. When that limit is reached, we are done and our bodies make us stop, even if we may not want to. This is something worth remembering for everyone — not just ICU doctors, but everyone.

My own view is that this individual well of resistance to burnout varies a great deal from person to person. Perhaps this is innate, perhaps it is greatly modified by our past experiences. What I think, after many conversations with colleagues about it, is that nobody knows when they choose a career how deep is their well for tolerating this. I don’t know of any way of determining this, either, although perhaps psychologists have some tool or other for assessing it.

What doctors and Abraham Lincoln have in common

What doctors and Abraham Lincoln have in common

What I do know is that the effects on the individual can be very grave, especially if that person has no choice but to carry on as best he can. Have a look into the eyes of Abraham Lincoln in portraits taken at the beginning and at the end of the Civil War. His trial was a terrible one, far worse than any of us face. But if a man like him was so used up in four years, how can any of the rest of us avoid it unless we find ways of sharing our stress with others. It may be a blow to our medical egos, inflated as they often are, but if you feel it happening to you, it must be done if you want to continue on.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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  • drg

    These blogs are wonderful but i find and would say talking about it is not much of a solution in and of itself. If we can’t find a way to have an organization that supports us and looks out for our best interest then that is the fundamental problem. There really is no such thing as “private practice”anymore because there are too many third parties –insurance, government, hospitals dictating and micro managing. Blogging is great but really does not accomplish change. Acting and organizing to change a very disturbed healthcare system is the only possible solution I can see.

  • DavidBehar

    Lincoln was our most catastrophic and idiotic president. This lawyer was offered peaceful ways to end slavery, done by all other civilized nations. He chose war, and consumed 600,0000 or even 850,000 deaths. Mr “Please, Do Not Sue Your Neighbor,” invented the draft, income taxes, ended habeases, and exploded the size and powers of a central tyrannical government. We would have all been better off had he been assassinated at the start of his term, like the death of Hitler in 1935 instead of 1945. Then this idiot’s mistakes resulted in 100 years of racial oppression and discrimination.

    This entry is deeply offensive to the struggling physician by comparing him to an idiot lawyer.

    • http://twitter.com/ChrisJohnsonMD Christopher Johnson

      Of course I do not share your opinion of Lincoln, nor do historians of 19th century America.

      Do keep a sharp lookout for those black helicopters, though — they might be anywhere.

      • Docbart

        You forgot to mention donning the tin-foil hat.

        • DavidBehar

          From the fact free, personal attack, I am going to take a wild guess. You boys are government dependent workers. You are not in the fifth grade anymore. Try finding a fact and using it in a simple sentence. For example, Lincoln was a racist who did not object to slavery that much.

          • Docbart

            Get over yourself. I suppose you did not go to school, don’t drive on paved roads, hope that you get protection from military, police, fire department and that you won’t collect Social Security or Medicare. No gummint for you, right?

  • ninguem

    “…..What doctors and Abraham Lincoln have in common…..”

    You need a hole in your head to go into medicine?

    • drg

      good one!