Burnout isn’t our fault. However, since we can’t change the inner workings of large institutions all at once, if at all, how do we push through? How do we do more than just survive?
“More and more doctors are coming to believe that the pandemic merely worsened the strain on a health care system that was already failing because it prioritizes profits over patient care,” wrote Eyal Press in the New York Times article “The Moral Crisis of America’s Doctors.” “They are noticing how the emphasis on the bottom line routinely puts them in moral binds, and young doctors in particular are contemplating how to resist.”
So, how do we resist a system that prioritizes corporate greed and operates against our moral values? The first step is for each of us to recognize that even in the midst of the storm, even before a single aspect improves, we can find peace with what we can control: our state of mind.
Many of my colleagues are working on solutions to bring about systemic changes, e.g., raising awareness with the public, organizing conferences to discuss these issues, lobbying, and unionizing. All are much-needed and timely.
But systemic change takes time, and most of us have to keep working day-to-day within the dysfunctional system to take care of patients we care about. And as a society, we need compassionate and healthy physicians to continue caring for our ailing parents and loved ones.
To continue serving our patients and not further morally injuring ourselves in a way that compromises our health and well-being, I believe there are ways in which we can broaden our perspectives and develop habits that help us thrive even as we face moral challenges every day.
Moral injury. That’s the term some medical professionals use to describe their mental state after prolonged exposure to situations where they feel compelled to make choices they wouldn’t if they were acting alone. They feel it is a major contributor to their burnout.
Yet, there is hope. There are inner practices that can help us develop inner clarity so that we can discern when we need to take a break, make a change, speak up, or even leave before we break due to this injury.
For me, the first step was to recognize that many of my own coping mechanisms, reactions, and habits were conditioned by being educated and trained in a dysfunctional system that does not normalize self-care or allow time and space for contemplating the deep questions that brought me to medicine in the first place.
It is also important to recognize the effects of working in a system that prioritizes efficiency over connection and care on my psyche and the way I show up at work moment by moment. By taking a deeper look at my own inner processes, I gradually discovered how I can better meet the challenges of everyday medicine while keeping an eye out for changes to which I can contribute.
One practice that I adopted early on that helped me tremendously was to make an intention to lean into at least one point of connection per shift. I allowed myself to find a moment of delight while briefly chatting with a 93-year-old woman about getting back to dancing one day, or a moment of empathy and care while speaking frankly with a patient with substance use disorder. Then, on my way home from work in my car, I would make a point to review this moment and let it remind me why I do what I do, despite any problems I might be facing at the moment.
I feel that it is important to empower the individual physician to take responsibility for our own internal state and reconnect with our intentions to serve our patients, which can be a tremendous source of strength. The narrative of only focusing on blaming it all on a system that isn’t changing anytime soon (although it does deserve most blame) can be very draining and disempowering.
The fact that many of us have to keep working in this system, holding the belief that we have no power to change our own experience of it, puts us in the victim narrative and is unhelpful and stifling. It is also impossible to be true change-makers if we keep thinking and acting as the system has conditioned us. This is why I think it’s even more important for the next generation of physicians to start thinking about these issues in a healthier way early on to create ideas around “how to resist.”
I write more about this in my book, Inner Practice of Medicine, so more of us can begin to have these realizations, ultimately starting on the road to reversing burnout. Of utmost importance to me is that the individual fights the natural urge to blame themselves for their burnout and clearly sees the systemic problems that caused it.
Also, I want to be clear that we are not using inner practices to make the abusive system more palatable. Instead, I want physicians to feel empowered to see their own responsibility in their experience of this work we do that can be extremely meaningful. And with the support of the appropriate tools, be able to make healthier choices for themselves and also for the systems they work in as leaders of their community.
When needed, stand up to resist. I believe that despite all its problems, being a physician is still one of the most meaningful works one can do. One of the best ways to resist is to not allow that meaning to slip away from us.
Wendy Lau is an emergency medicine physician who has worked in some of New York City’s busiest hospitals. She is the author of Inner Practice of Medicine, a primer for working and thriving in the challenging space of modern medicine. She can be reached on Twitter @wendylaumd, Instagram @innerpractices, and Facebook.