Tuesday, February 14, 2017

I Don't Understand Burnout

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 new 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 everyday 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.


justwantanaccount said...

Sorry to be a devil's advocate - I've been reading enough blogs by physicians to understand their perspectives, but - since not everyone can afford healthcare, I think that means that there will always be health insurance. That means that there will always be controls by insurance companies / governments to control healthcare costs, since in the past healthcare costs went out of control somehow, as shown by healthcare costs increasing faster than the rate of inflation, that made the government implement the DRG / managed care system, and now the ACA for "value-based" reimbursements. So doctors/nurse practitioners/etc. will need to either make sure to keep down healthcare costs so that the government / health insurance companies will stop butting into how care should be done, or get rid of health insurance companies / government altogether and somehow come up with another way to enable care to those who might not be able to afford them. Unless either of those two are done, I don't see what you're suggesting to be possible. Doctors aren't the only ones at play in healthcare, patients (and their bank accounts, their insurance company, elected representatives, etc.) are, too.

Maybe there's a way to deal with those issues effectively, in a way that's more pleasant for the physicians. We should definitely work toward that goal. But you can't dismiss those issues entirely and suggest that insurance companies / governments stop butting into how care should be done and solve that particular dilemma for physicians, without suggesting how all patients can get the needed care without breaking their bank account.

Bill Boyd said...

Hi Jordan, Your blog came to me in Australia through a medical news feed and it is so valid here in Queensland where the burning topic is doctors doing self-harm. You absolutely hit the spot and I'll be spreading the message.

Please note the easynet.net.au address is invalid. I give you my contacts below.

Very best wishes, Bill Boyd

Dr William Boyd M.B.Ch.B., F.R.C.O.G., F.R.A.N.Z.C.O.G., G.A.I.C.D.
Suite 11
Medical Centre
Mater Hospital
76 Willetts Road

+61 7 49423588
+61 7 49423500 (FAX)


Anonymous said...

This is spot_on. Its not medicine that ate my soul. It's administration and bureaucracy.