We are almost sort of not quite half-way through the year. It’s about the time that the new-feels excitement wears off and the next opportunity might feel far too far away. It’s also a time when people (you!) might be re-assessing your career path as job applications loom in the coming months.
Why did you get into medicine? Were you a post-doctoral cancer researcher looking for coal-face interactions with patients rather than laboratory mice? Were you a fresh-faced teen choosing between law, accounting, medicine, and engineering? Were you driven by hopes of taking your love of science and turning it into a way to help people every day?
I personally have no grand story of being destined for medicine. In fact, I distinctly remember a walk between classes in high school as my friends asked if I had ever considered medicine. “Ick,” I told them, “blood is so gross. I wouldn’t want to get dirty.” Several years later, walking to the train station with one of my best friends, she asked if I had ever considered surgery. “No! And if I ever do, could you please hit me over the head with a saucepan to knock me back into my senses!” I responded. It turns out people, and minds, change.
A lot of us, at our roots, love solving problems. We see patients come in with chest pain and know to do an ECG, a chest X-ray, and some blood tests. We know which questions to ask of patients with lower abdominal pain to break down the differentials to general surgery, urology, gynaecology or gastroenterology. We are trained to follow protocols, though they may differ slightly across hospitals, that have the same basic tenets.
The problem, of course, is that patients are not complex mathematical problems. Applying the answer of chest X-ray, two sets of blood cultures, a sputum culture, nasal swabs and empiric antibiotics to the patient with likely pneumonia does not help that person deal with the scary reality that they are in fact a mere mortal. It doesn’t help us explain in simple terms what is happening. And much of our medical training does not prepare us for the patients who flatly refuse our management guidelines. We are in the wilderness with patients who wish to tailor their own care. That is, in spite of all the buzz in the media about precision- and patient-centred medicine.
Instead of working through these issues with patients, it can often feel like an “us” against “them” situation. The patient just doesn’t “understand” what is best for them. As if we are their parents and they are an ill-informed child to be protected from themselves. The system doesn’t give us time to have the conversations that matter – conversations about the patient’s health-care views, or their previous frightening experiences in hospital, or the fact that their cat is unwell and the patient cannot fathom being separated from their most special friend (it’s incredible how many people have discharged against medical advice because of their pets, until you consider what you would do with your own pet in the same situation). And some people, despite all of your wisdom and many years of experience, just don’t want whatever it is you have to offer.
To make matters worse, for all the time we spend at work, the time spent with each patient is in the minutes. Probably in as many minutes as can be counted on one hand. Patients wait all day to talk to us, only to forget their most pertinent question when we arrive. And we feel pressured to get back to the computer, where we can assess and treat the patient as if they are a puzzle rather than a human with an entire life story. If the observations go this direction and the imaging looks like this, and the bloods look like that then we do this other thing… And often forget to communicate these changes with the patient and their family.
Above and beyond this, there appear to be growing numbers of checklists, electronic notes to write, and administrative tasks that are miles away from actual patient care but constantly divert attention and time from patients. The reasons for exhaustion make us all sound like broken records – the patients are sicker, more complicated, and living longer in a hospital system that can provide more care at more expense and with greater time required, with minimal growth in the number of people to provide that care. We give time and energy because it pains us to see our patients and colleagues suffer.
How many sporting activities, family dinners, study dates, or other personal pleasures (yes, I did just lump studying in with personal pleasures) have you given up because you got stuck at work a few hours late (again)? And how do you calculate the (recurrent) sacrifices compared to the suffering of each of your patients? And because there is no replacement-you to take over when 5pm comes around (or 7am, or…), you stay because there is a need. Walk outs and sit-ins are not options when lives are on the line.
So why did you decide to do this? And how can you make your daily life look more like the world of which you dreamed? If there was one small thing you could do to make this week better, what would it be? A reasonable night’s sleep? A more collaborative work environment? A lunch break? What small thing can you do to help make the coming work week seem that little bit easier? Because planning a holiday and going to see a movie on your day off won’t change the root cause of your fatigue.
If you’re looking for other reads on the topic, check out this recent article from the NY Times.
And if you’re feeling tired and burnt out, here are some resources for you:
- Physician burnout – the three symptoms, three phases, and three cures
- Physician burn out – why it’s not a fair fight
- Avant’s burn out guide
Let us know if you have other burn out guides or suggestions. We would love to support you and hear your stories.
