The Point Blog ARCHIVE
All articles found in the archive are more than three years old.
The purpose of this blog is to stimulate thought and discussion about important issues in healthcare. Opinions expressed are those of the author and do not necessarily express the views of CMDA. We encourage you to join the conversation on our website and share your experience, insight and expertise. CMDA has a rigorous and representative process in formulating official positions, which are largely limited to bioethical areas.
May 19, 2016
by Autumn Dawn Galbreath, MD, MBA
It was a relatively slow evening at work when I got the text. My phone vibrated on the clinic countertop as I was looking over a chart.
“Are you busy? Can you talk?”
I figured those words couldn’t be good, coming as they did from a young intern I mentored when she was a medical student. I found myself wondering if she had lost a patient. Or did an attending blame her for a bad outcome? Was she stuck at the hospital having to miss out on an important life event because she was on call? Maybe she was just worn out, given that it was May of her intern year-that time when the light at the end of the tunnel still isn’t quite visible, but the months’ worth of fatigue have built to the point of exhaustion.
I finished with my patient and called her back, feeling grateful it wasn’t busy that night. As I listened, several things stood out to me.
- “I don’t know why I’m so tired. I’m not even allowed to work more than 16 hours at a time during my first year.”
- “I always get a day off every week.”
- “There has only been one rotation when I really think I was going over my 80-hour-a-week limit.”
Physician burnout is a recognized problem in the profession, and it is growing, increasing significantly over the last decade in both Europe and the United States. And my intern friend illustrates the speed with which our expectations are warped by the medical culture. Working two “normal” work days per day, working two “normal” work weeks per week and having half the weekly days off of a “normal” job, she was frustrated with her own fatigue and confused by why she felt so tired in spite of such a “great” schedule.
This is not intended as an argument for or against work hour restrictions in training. My concern is much, much broader than that. I’m concerned the toxic brew that is medical culture is eating us alive-leaving us without physical, emotional or spiritual reserves and rendering us ineffective as healers.
Only a few weeks ago, Surgeon General Vivek Murthy, MD, voiced the same concerns, “Medicine is a profession in which emotional well-being is sorely lacking…The suicide and burnout rate is very high, and this is concerning to me because we’re at a point in our country where we need more physicians, not fewer; we need more people entering our profession, not fewer…If we have people burning out, it really goes against our needs.” In other words, burnout is a fatal disorder, and one that impacts the lives not only of the affected physician, but also the patients he can no longer care for.
The AMA recently published an article called “How to beat burnout: 7 signs physicians should know.” As I read the article, it struck me that over half of these 7 warning signs are actually qualities we were taught to admire in training!
- “You have a high tolerance to stress.” – Isn’t that a good thing?
- “You’re the emotional buffer.” – We call it supporting our patients, and it’s a skill we worked hard to perfect.
- “Your job constantly interferes with family events.” – Ok, we certainly don’t say aloud that this is a good thing. But haven’t you at least thought that someone’s request for time off was “weak,” especially during a busy season?
- “You lack control over your work schedule and free time.” – Of course we do. People can’t control when they get sick and need our services, can they?
- “You don’t take care of yourself.” – Once again, not explicitly encouraged…but we all spent at least 11 years (and some of you many more than that) subjecting our wants and needs to a long and grueling training process through college, medical school and residency. Then we were overrun with patients whose needs were “more important” than ours. Who has time for massages, for goodness sake?
What is wrong with a profession that teaches its practitioners to honor the very way of life that ultimately burns them out? And why have we let this culture continue in our profession for so long? The medical literature is increasingly acknowledging this contradiction: “For physicians, burnout is the inevitable consequence of the way that medical education is organised and the subsequent maladaptive behaviours that are reinforced in healthcare organisations via the hidden curriculum.”
I do not pretend to have the answers to these questions about the profession as a whole. But I do have an answer for each of us as individual Christian healthcare professionals: We have to stop playing God. Pretending to be God is presumptuous, even for an atheist. But for those of us who know God-the hugeness of His grandeur and the personal touch of His compassion-it’s almost delusional. How is it that we who have experienced God’s presence in our lives as He carries us and cares for us can ever lapse into thinking ourselves able to do what even Jesus, God Incarnate, could not?
Jesus did not have a “high tolerance to stress.” I’m not talking about His suffering and crucifixion. I’m talking about how He lived His daily life here on Earth. He worked hard doing the work He was sent to do. But He also knew when He needed time away. He regularly left the multitudes, the sick people who needed Him, to rest and pray (Mark 4; Luke 5; Matthew 14). If He wasn’t responsible to treat and heal everyone who needed Him, how can we believe ourselves to be?
There will always be needs around us. There will always be people pulling at us. There will always be more work to do. If we are to be around to continue to serve, we need to learn from Jesus’ example to stop thinking we can do it all for everyone every day. We need rest and refreshment, and we need prayer and support. Pretending we don’t is playing God-which is not a good position for anyone to be in, not even a healthcare professional.