Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and actually promotes quality of death? What type of son would potentially hasten his father’s death by suggesting antibiotics be withheld? I was quickly silenced and ostracized by my family, destined to become the scapegoat if Dad passed before his time.
As my faith and hope waned through Dad’s progressive peripheral neuropathy and frequent urinary infections, my family seemed to have little use for my counsel. They seemingly accessed a higher power while I assumed a higher watch from a distance. Oddly, this manifested through my living in Arizona while Dad was dying in Illinois. Dad had preferred little attention be given to his demise, and my presence would have suggested that something was terribly wrong. I had to play it cool, but this likely came across as being cold and uncaring. Someone that others could readily point to and say, “The doctor should be doing more.”
Physicians are often the scapegoats for many of the ills in the world. Similarly, the POTUS gets all the blame for what is wrong with the United States. We generally receive more blame for what we do wrong than praise for what we do right. We have handlers who attempt to promote us as being better than who we are and patients who require us to be top-notch mind readers and miracle workers. No one treats us like we are Gods, but many perceive us to be God incarnate. We are often called to heal the terminally ill and raise Lazarus from the dead.
Physician burnout naturally arises from being society’s scapegoats. When something goes wrong with a patient, we take it on the chin and feel less than almighty. Nevertheless, true power rarely comes from being all-knowing, but rather through remaining reasonable and centered. As scapegoats, we need the ability to take the good with the bad, find a higher purpose and maintain a higher watch. We might watch for those windows of opportunities that open lines of communication between physicians and caregivers, paving the path toward mutual respect. Seeking affinity over opposition nurtures the lives of physicians, enhances patient satisfaction and ultimately achieves the goal of making a real difference in the lives of others.
We spend more time playing by the rules than bringing our hearts into the field of medicine. Sadly, burnout occurs when the heart becomes depleted. Stress reduction transpires through elevating the heart (actively or passively) and quieting the mind. If we — as physicians — are experiencing burnout, chances are that our patients may be getting the best of us — rather than us giving our best to our patients. By becoming less focused on mental upsets and more heart-centered, we are less susceptible to feeling like scapegoats and more like we are all in this together. Blame does not exist when personal responsibility is taken to the level of the heart.
I was taught early in my residency that it takes a good patient to make a good physician. While practicing emergency medicine, I often confront unreasonable patients who attempt to sabotage my being a good physician. I have learned to not take it personally and become the helpless scapegoat. However, sometimes I do choose to be the know-nothing scapegoat and give patients the power to discover what they need to learn for themselves. Through bobbing and weaving, I deflect what is wrong with the patient and not assimilate it into my being. By maintaining a higher watch and awareness, I am less likely to take blame personally and experience physician burnout while caring for the many ills of society.
Kevin Haselhorst is an emergency physician and author of Wishes To Die For: Expanding Upon Doing Less in Advance Care Directives. He can be reached at his self-titled site, Kevin Haselhorst.
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