A guest column by the American College of Physicians, exclusive to KevinMD.com.
We are just now beginning to recognize the impact of isolation and loneliness on the health of our patients. Recent cultural and societal changes have led to markedly increased levels of isolation of our patients with a dwindling size and activity of their social networks. Loneliness – the resulting negative emotional response to their perceived degree of isolation – is growing rapidly. Former Surgeon General Vivek Murthy has called this an “epidemic of loneliness” that is estimated to be nearly as prevalent as obesity, and we are just starting to understand the markedly detrimental effects that these increasing levels of isolation and loneliness are having on both individual and public health outcomes.
But what is often not discussed is the isolation and loneliness that physicians experience and the impact this has on our personal and professional lives. It’s increasingly evident that both play a significant and often unacknowledged role in the increasing rates of physician burnout. Alarmingly, recent surveys have shown that up to a quarter of physicians regularly feel isolated in their professional lives, and that this sense of isolation correlates directly with increased rates of burnout at a time when this “moral injury” to medical professionals is already at extremely high levels with associated consequences such as depression and suicide.
When talking with colleagues I’ve been impressed at the extent to which they feel both isolated and lonely regardless of location or their professional circumstances. The mental image that often comes to mind when we think of physician isolation and loneliness is the individual doctor in a small practice, toiling away caring for patients with little support by or connection to other physicians. But isolation and loneliness can affect all doctors, ranging from that independent solo practitioner to specialists and subspecialists in the largest of groups or medical institutions. And it’s difficult to imagine anyone delivering high-quality, compassionate care or experiencing professional fulfillment when feeling alone and alienated from others.
So what is it about being a physician that leaves us vulnerable to isolation, loneliness, and potential burnout? On the surface, it’s difficult to imagine that doctors who are typically around patients and their colleagues all day long could have these feelings. But having also experienced the sense of being alone in the midst of a multitude of others in healthcare settings, I believe there are multiple reasons why.
It seems that many of the traits that draw us to medicine in the first place and help us succeed as physicians also serve to separate us from each other. People in medicine tend to be highly intelligent, inquisitive, and compassionate with a commitment to others that entails significant personal sacrifice. But we are also extremely driven, competitive, and perfectionistic, even to the point of being somewhat obsessive-compulsive. Thus, we effectively self-select for those things that may make it more difficult for us to connect to others, including our own colleagues.
And the nature of our medical training also doesn’t help. Getting into and succeeding in medical school requires an extraordinary amount of solitary work. Our clinical training also consumes a tremendous amount of time that separates us from the social activities and life experiences of our friends and colleagues which can further enhance our social isolation. Plus, medical training necessarily places strength and equipoise at the front and center of what we do. And while this may be essential to navigating the frequent and intense emotions involved in patient care, it doesn’t encourage us to express or manage the way they affect us on a personal, human basis. We consequently often hesitate to talk about our fears, the daily challenges we confront, and the mistakes we make. This can erode our ability to develop and sustain healthy professional relationships which may isolate us even further. At the bottom line, we’re trained to take care of others – but ourselves, not so much.
Yet, there is a strong, innate sense of community among physicians that likely results from the shared values, world view, and experiences of those who have navigated the pathway into medicine. The road to becoming a physician is long and hard, and the communal purpose, intense emotional experiences, and the collaborative spirit we share in the process creates a natural bond between physicians not experienced by many other professions. And this inherent fellowship with our medical colleagues may be the key to combating our feelings of isolation and loneliness and restoring joy in the work of doctoring.
Unfortunately, maintaining, sustaining, and growing a sense of community with our physician colleagues as we move through our careers in medicine is not easy. The reasons for this are many in the complex world in which we work, including how our practice settings are structured, time pressures, and the dehumanizing implications of an overwhelming administrative burden, among others.
But regardless of the causes, this loss of community severs a vitally important connection to others who think like we do, can understand and relate to the daily trials, tribulations, and joys we all experience, and most importantly, who can support one another. I think our older colleagues understood this better than we do, and is why they mourn the loss of such things such as the doctor’s dining room and the time and space it afforded them to connect and network with one another.
I firmly believe that nurturing our doctor-to-doctor relationships is key to rebuilding this sense of community and decreasing the isolation so many of us experience. Increasing our connections with like-minded colleagues facing similar professional and life challenges can help fend off feelings of loneliness by knowing that we aren’t alone and help us renew our purpose as physicians. There are many ways to do this, be it through informal social or professional gatherings or more dedicated efforts at coming together in the communities in which we practice.
There is also great value in our connecting with the greater house of medicine, both locally but also through our professional societies and associations where we can not only foster relationships with others, but also have our collective voice as physicians heard. And because building our relationships with other physicians is something tangible we can do right now, coming together can empower us at a time when most of us feel powerless.
Doing this won’t fix the many challenges confronting each of us in medicine today, but it can be a huge first step in bringing back much of the humanity we seem to have lost in our personal and professional lives.
Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.
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