Time was baffling. It seemed like just yesterday; I sat in a posh auditorium in Chicago as an enthusiastic young adult during my first day of medical school orientation at Northwestern in 1995. Eighteen years later I was a forty-three-year-old burned out physician, practicing in Boise, Idaho, doing Google searches on the most effective way to end my life. During my time of maximum burnout, I observed that I was becoming the type of physician that I never wanted to be. I was impatient and sarcastic. Occasionally, I was dismissive of my patients. I was making caustic jokes about some patients in the lunchroom. I was not happy.
As I learned about the problem of physician burnout, I came to recognize I was not alone. While researching the topic for a book I recently wrote about the topic, I realized burnout is not some psychological abnormality to be embarrassed to speak about in public — quite the contrary. For example, survey results in the past five years show 87 percent of American physicians experience symptoms of burnout. On the extreme spectrum, female physicians have a successful suicide rate of 250 to 400 percent higher than their counterparts in the general population. Something very alarming is going on in the American health care system nowadays. Doctors aren’t happy, and neither are patients. The proverbial admonition “Happy doctors make for happy patients” comes to mind with the caveat that the reverse is also true.
During my last several years of practice, each day seemed like a monumental struggle similar to that of the Greek mythological character Sisyphus. I tried simply to survive each over-scheduled, jam-packed clinical day, but it was fruitless since I would just have to go through the same ordeal the next day and the day after that. Like Sisyphus, I felt condemned by the burden of rolling a heavy boulder up a monumental hill only to have it roll back down, repeating this process for the rest of eternity. Christina Maslach, one of the early pioneers in the field of job burnout, has succinctly characterized the problem as “an erosion of the human soul.”
Burnout impacts not only the physician experiencing the problem, but also their families. It also has dramatic implications for the patients the burned out physician treats. Increasing time constraints, burgeoning bureaucracy, increased patient expectations, and technological advances have made the challenging, stressful profession of medicine even more so. In fact, given the current state and the demands of the American healthcare system, I have realized burnout is an almost inevitable response. Something needs to be done about it.
My journey saw me go from an enthusiastic medical student to a burned out middle-aged physician in the span of nineteen years. Patients suffer too because a disabled doctor can’t deliver the type care patients deserve. Sure he can go through the motions, can prescribe the appropriate meds, etc., but that’s all he does. And patients intuitively sense his lack of commitment. Whereas some kind of magical placebo effect occurs between an engaged doctor and a sick patient. “Hands on” was the way the profession referred to this magic. No visit to a sick patient was complete till the physician placed his “hands on the person.” The physical touch of a committed physician was thought to promote healing, to give the patient confidence in his care. Maybe this practice strikes us as a little hokey today, but the general principle still holds true.
Patients need to believe in their doctor. An empathetic touch can make all the difference and also be the key to medical success. Danielle Ofri exemplifies this point in her book, What Doctors Feel, when she notes that the rate of severe diabetic complications in patients of doctors who rate high on a standard empathy scale is a remarkable 40 percent better than those cared for by physicians with low empathy scores. Ofri observes that this difference is comparable “to the benefits seen with the most intensive medical therapy.” The tragedy of burnout is that it effaces genuine empathy, spirituality, and commitment. Nietzsche put it best: “Physician, heal thyself: Then wilt thou also heal thy patient.”
At some point in almost every physician’s career, we had a powerful desire to help others. When suffering burnout, many of us become so disillusioned by our failure to achieve these aspirations that our passion is replaced by a strong contempt, bordering on hatred, for the profession we chose and once loved. My goal is to reignite that flame as I have been able to do for myself and give physicians a chance to rediscover a sense of joy, pleasure, and fulfillment from this noble profession.
In my case, burnout started insidiously like a nagging pain and I chose to ignore it. I hope others can learn from my example. I am a runner. One time last year while running on a treadmill, I was really pushing myself at a fast pace, and I started to notice some mild discomfort in the back part of my right leg. As I kept running the twinges in my leg morphed into severe, agonizing pain but I pushed through and ignored what my body was trying to tell me, just as we as physicians do with burnout. We “tough it out.” We “play with the pain.” What was the result with my leg? I partially tore my right hamstring and could not run normally for over three months. Don’t repeat my mistake with your own burnout, waiting until it is too late to acknowledge the problem. If you feel it creeping up on you insidiously, the time for action is now. If those little twinges you feel are becoming more severe and frequent, stop at this moment and do something about the problem for yourself, your family and your patients before you find yourself in an emergent situation, before something irrevocable happens, before you tear your hamstring.
The best analogy I can think of when it comes to physicians who continue to suffer through burnout in unhappy work environments involves a parable I recently heard about circus elephants. Grown elephants in the circus do not run away because of a small metal chain attached to one of their legs. The chain could not possibly contain these mammoth creatures. What prevents them from trying to break out of their shackle? When the elephant was a baby, a chain was affixed to its leg and connected to a peg hammered into the ground. If a baby elephant tried to break away, the chain and stake were strong enough to hold it. The baby elephant soon learned its lesson and accepted its confinement. It stopped trying to escape. The small chain and stake would never be enough to contain a full-grown animal if it tried to escape, but by the time the animal has reached adulthood, it has relinquished all hope for an escape and freedom.
The adult elephant has grown to accept its fate and is fooled by the little chain around its leg. The same is true for your medical career. You can remain confined by an artificial barricade, or you can experience a new found freedom. The choice is up to you.
Tom Murphy is the author of Physician Burnout: A Guide to Recognition and Recovery.
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