I have a confession to make. I don’t understand the concept of burnout. I mean, I get the idea. Medicine is, at least when you are the kind of doctor who deals with life and death, inherently stressful. And I feel the stress. It’s as if someone applied a vice grip to my insides in the middle of medical school, and it has never let up since. The pressure is unrelenting, progressive, and downright painful. It has gotten worse with every successive career milestone.

Brutal. It’s brutal. I knew it would be after a few weeks of rotations on the medical wards. The more responsibility I gained, the worse it got. And I guess I entered the profession knowing this. There was no expectation of reprieve. No belief that I would be let off the hook. I assumed that it was my cross to bear, my burden to shoulder. As the burden became heavier, I learned how to amble through hospital halls with a stooped posture.

I just don’t know if it could be any other way. I can think of no relief from the burden of making life and death decisions. What we do. What we do matters. A wrong turn, a flip on the ideological scale, can have devastating consequences for those we care for. There is no escaping this responsibility. No blunting the effect. You can’t go half way. You can’t stand in the middle of the road. You either make definitive decisions with definitive consequences, or you get out of the business. There is no such thing as sleeping peacefully for a physician.

So why are doctors committing suicide? Why are doctors leaving medicine in droves? It’s not burnout. A small part of the reason is wrong career choice. A young doctor realizes quickly that they didn’t know what they were signing up for.

For the rest, it’s external. It’s not the stress of caring for people or even making life and death decisions. This is part of our genetic makeup. Part of our training.

It’s everything else. It’s the paperwork. It’s the meaningless paperwork. It’s the droves of administrators and clerical staff thwarting us at every turn. It’s the government and endless regulations, and rules, and threats. It’s the loss of respect, loss of standing, and loss of confidence that we feel every day from our community. It’s economic distress.

We won’t fix this by training our young people about burnout or haranguing them with some odd belief in resilience. They made it through medical school; they already are resilient.

You want doctors to be doctors again? You want us to love our jobs again?

Simple. Get out of the way.

And let us do what we were trained to do.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.

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