Hostile dependency: The real reason for physician burnout

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say at the outset, that I do not disagree with the concept that doctors should not be more attuned to the circumstances for which they are being trained. But the overall argument that such “mindfulness” practices can repair his so-called “McDonaldization” of medicine is somewhat disingenuous concept.

It skirts the very real challenges doctors have today when caring for patients and the many layers of bureaucracy and paperwork, both electronic and manual, along with the hidden costs that their patients are subject to as a result of doctor orders entered on a computer as they try to follow certain care standards.  Blindsiding one’s patients doesn’t make for the best of relations.  Still, as bad as these realities are, they are probably not the reason most doctors are turning away from medicine.  I think there’s another issue that is even bigger.

I believe the overriding reason doctors leave medicine is because there is a  growing hostile dependency patients have toward their doctors.

I have mentioned this concept of hostile dependency before.  The theme is like an adolescent who realizes his parents have feet of clay.  In adolescence, he comes out of his childhood bubble and realizes his parents have failures and limitations because they are human beings.  This results in the adolescent feeling unsafe, unprotected and vulnerable.  Since this is not a pleasant feeling, narcissistic rage is triggered toward the people he needs and depends on the most.

Yet (and this is important) none of this occurs at a conscious level.  Most of us understand this behavior simply as “adolescent rebellion,” not understanding the powerful issues at play.  So when we spotlight doctor burnout, or, say, the lack of patient safety in hospitals without acknowledging the realities health care workers face like looming staffing shortages and pay cuts, we risk fanning the flames of narcissistic rage against the very caregivers whom we depend on the most — the very caregivers who are striving to do more with less, check boxes while still looking in the patient’s eyes, meet productivity ratios, all while working in a highly litigious environment.

A comment from “Victor Edwards” posted after Mr. Bornstein’s article demonstrates this growing hostile dependency toward doctors perfectly:

Doctors? I no longer afford that kind of respect: I call them “medical services providers.” They and their families and the medical cabal created this mess when they got control of med schools so that the wealth of a nation would remain in the hands of a few medical elites and their families. The very notion that doctors are smarter, more productive, more anything than others is ludicrous. They are among the worst sluff-offs of our society, yet the richest at the same time. It is an unreal world they have created themselves and they are now watching the natural outcome of such a false system.

How do we fix this attitude toward doctors?  Who would want to work in an environment where patients perceive their doctors so?

Yet this is what we’re creating with our increasingly consolidated “McDonaldization” of medicine.  Given where things are heading, I’m not sure this will be an easy fix as doctors are shoved farther away from the patients.

But let me be perfectly clear: if you want to keep doctors from getting burned out quickly  in medicine, it is this growing hostile dependency that patients have toward their doctors that must be addressed head on.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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