“I wish this were not the case, but I am concerned that your disease is getting worse, and your time may be very short.”
“I know you are angry and upset at how you were treated — I will do my best to make sure that does not happen again.”
“I am sorry, but I cannot write a prescription for your pain medication.”
“I know you are confused — I will try to figure out what is going on and work to communicate it clearly to you.”
“I am sorry to say that I do not know what is wrong with you. I will be there for you, but I am not sure what we need to do next to help you.”
The comments above were not spoken to me, thankfully. These are words I have had to say to patients in the past few weeks. I am a primary care physician and the administrative leader of a large practice. Most of my work week is pretty mundane, but quite frequently, I am in a situation where I am telling people news that is very hard to relate. My job is amazing, and I am privileged to be in that space. But over time, saying these words to patients — scared people, angry people, people in pain — can take its toll. In fact, in the past few months, I have found myself increasingly burned out and stressed by my roles, feeling like the job of “doctor” places too much stress on one person. I have honestly considered leaving the profession.
I’m currently reading Colossus, a history of the building of the Hoover Dam, by Michael Hiltzik. At the time it was conceived and built, the Hoover Dam was the largest and most ambitious undertaking ever conceived by man. The scale of what was accomplished in this effort to permanently bend the will of one of America’s great rivers is overwhelming to consider.
One interesting element of the Hoover Dam is the shape. Up to that point, the standard shape for dams had been linear. You would build the biggest thickest structure you could build, from one side of a valley to the other. The needs of the newer generation of dams built in the early 20th century, specifically Hoover Dam, demanded a different strategy. One simply could not build a dam thick enough to withstand the forces to which the Hoover Dam would be subjected: it would collapse of its own weight. In order to allow the dam to be effective, they built it in the shape of an arc, bowing inwards towards the lake that would form behind it. It turns out that this design reduces the stress on the center of the dam, and transfers much of the stress to the solid rock on the sides of Black Canyon.
As I considered what to do about my burnout, I started hearing voices. I heard people saying, “Let me help you.” “I can do that.” “You are taking on too much.” “We can manage this.” These were the voices of my coworkers, staff, kids, wife, friends, and patients. People who cared noticed that the dam was under some serious stress, and that cracks were appearing. Once I heard them, I came to appreciate that their voices had been there all along– I had just not been tuned into them. But since I started listening to them, I have been more willing to delegate, to allow the members of the teams around me to take some of the stress off the dam. This has afforded me the opportunity to exercise, think, read, and plan– to try to be a better doctor, husband, father, and friend.
We are all a bit like that dam. There is no way to do your job(s) if you try to manage the burden with your own strength alone. You need to bend and flex and spread out the work. And I think of those voices like the walls of Black Canyon — stable and sturdy, there all the time, but now recruited into a critically important role in supporting the hard work going on between the walls. It is important for us to acknowledge those voices. They are the forces that are there to help us shoulder our loads. It turns out that is really the only way to do the important, challenging, and rewarding tasks that make up our lives.
Jeffrey R. Jaeger is an internal medicine physician.
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