The word “burnout” perpetuates medicine’s cycle of abuse


Illustration by Jorge Muniz, PA-C.

We enter medicine with our hearts and souls on fire ready to serve humanity. By the time we complete medical training many of us have anxiety, PTSD, depression — even suicidal thoughts. Why? Medicine is stressful. Many of us work 100-hour weeks surrounded by suffering and death. We may deliver a stillborn, try to save a teenager with a gunshot wound, and then rush into the next room to help a lady having a heart attack — all within an hour. With no debriefing or emotional support. Medical training glorifies physical and emotional self-neglect and endorses teaching by intimidation and public humiliation. Bullying, hazing, and sleep deprivation is the norm in many of our finest hospitals and clinics. And if we seek psychological support, we’re mandated to report it on all job applications.

Doctors who complain about inhumane working conditions are often labeled with “burnout,” a “resilience deficiency” or even “disruptive.” They’re mandated to resiliency classes so they can learn mindfulness, deep breathing, or yoga. Victims get instructed in work-life balance, boundaries, and other ways to conform to their workplace abuse.

Anger, grief, and depression are normal responses to a sick medical system that forces us to submit to inhumane working conditions. “Burnout” blames the individual. Physicians may then feel unfit for the profession they once loved. The most vulnerable among us may leave medicine. Some may consider suicide.

“Burnout” and similar labels are dangerous to the individual and also distract from the real diagnosis: human rights abuse. (FYI: Meditation, yoga, and taking deep breaths are not treatments for human rights violations.)

The United Nations Declaration of Human Rights Article 5: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24: Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

Doctors, if you on a 36-hour shift in the ICU and have not eaten or pooped all day, you are experiencing multiple human rights violations. Patients, if you’re in the hospital, and your doctor is bullied, abused, hypoglycemic, and sleep deprived, you should be very, very concerned. Human rights violations will adversely impact your care.

So docs, how do you know if you’re experiencing human rights violations at work? 1) You don’t get lunch or bathroom breaks. 2) You are forced to work multiple-day shifts. 3) You are not allowed to sleep. 4) You are forced to see unsafe numbers of patients. 5) You can never seem to find “work-life balance.” 6) You are threatened verbally, financially — even physically. 7) You are bullied. 8) And if you ask for help, you’re called a slacker or worse.

If any of this seems familiar, it’s not your fault. You are a victim of abuse. So what should you do? Your goal should not be to cope with abuse. Your goal should be to stop it. Taking deep breaths will not end your abuse. If you’re being abused, speak up. If you’re complicit with abuse, you perpetuate the cycle on the next generation.

Other countries get in big trouble for human rights abuse. Why should U.S. health care get a pass?

Here’s what happens when we are complicit with medicine’s human rights violations:

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Physician Suicide Letters — Answered and Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.

Jorge Muniz is an internal medicine physician assistant, illustrator, and author of Medcomic: The Most Entertaining Way to Study Medicine.

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