burnout

I've been thinking about burnout lately. Partly because I read this article about burnout in medical students/young docs by Dr. Richard Gunderman. And partly because I've been feeling it lately--I know that the weather doesn't help (it's super hard for me to be excited about anything when it's freezing outside) the situation any. But anyway, I found this to be an interesting discussion about the way we are teaching our doctors. Some especially profound paragraphs below.

On the 'why' of burnout...

It is tempting to invoke the usual suspects: too many hours of study, too little contact with patients, and overwhelming anxiety concerning grades and test scores. Such stressors are compounded by exploding rates of change in medical science and technology and the general cloud of socioeconomic uncertainty hanging over the profession of medicine.

Yet the real roots of the problem go far deeper, and it is only by plumbing their full depth that we can hope to formulate an accurate diagnosis and prescribe an effective therapy. On closer inspection, burnout turns out to be a symptom of a more fundamental disorder that calls for curative—not merely symptomatic—therapy.

Nothing is more needed than nourishment for the imagination. Medical educators, learners, and those who care about the future of medicine need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. Humanly speaking, are we enriching or impoverishing students? What alterations are we asking them, explicitly or implicitly, to make in the ways they act, think, and feel? In what ways are we bringing out the best elements in their character—courage, compassion, and wisdom—as opposed to merely exacerbating their worst impulses—envy, fear, and destructive competitiveness?

I see with my new class a much more pervasive feeling of competitiveness than the one I felt last year (likely just due to different personalities of each class). But I definitely have moments each day where I fear failure. Not in the sense of failing to properly treat one of my patients in the best way possible that may end up hurting them, but rather in the sense of failing to remember this list of 25 enzymes in the correct order that help in the synthesis of the various steroid hormones. While I may use those pathways once or twice in my career, is it more important for me to fear my inability to rote memorize molecules or my inability to communicate with others on the healthcare team and with my patient and their family?

He goes on to discuss the novel Middlemarch by George Eliot. A young doctor (Dr. Lydgate) moves to a small town in hopes of treating the poor, but instead ends up abandoning his dreams to treat the rich. This causes him to be unhappy about how his life turned out.

To paraphrase the novel, Middlemarch not only swallowed Lydgate whole. It assimilated him very comfortably.

It's nothing radical that made Dr. Lydgate feel the disappointment of losing his way, but rather it was just the repeated compromising to "...please the world and bring in money."

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course.  

The goal is to become physicians. To think, work, live, love and be physicians. Perhaps instead of becoming assimilated into a culture of cynicism and fear of reimbursement, we need our mentors to reinvigorate the love of medicine. To resuscitate the sheer awe and wonder of the miracle of the human body. We need reminders of the beauty of sitting in silence with a grieving patient; instead of reminders about productivity quotas. We need to be told that more often than not it is how you are a person and a doctor and interact with others, not the millions of facts you know that ultimately makes the greatest difference in the life of a patient (yeah, those facts don't hurt...but they aren't the only thing that makes incredible physicians).

The culture of medicine (yes, it is a culture all of its own) has so many wonderful facets. I don't mean to belittle the work of thousands of doctors who are doing exactly what they hoped to do in helping those who are sick and needy, but it seems as though that they are no longer the majority. Although some aspects of the future of healthcare are still up in the air in this country, there is definitely a future. And a future that is in desperate need of physicians who are not burnt out because they're just not "in it" solely for the money.

There's a program offered here at UNMC that I think does a wonderful job of combating burnout. It's called Healer's Art and is offered at many medical schools across the US. Sometime this weekend/next week I'll write about why it's such a refreshing and re-invigorating curriculum. And about why I recommend that ALL medical students take it.