Monday, September 19, 2011


Wow, what is it? Last I checked physicians were not allowed to "burnout".  Burnout is even somewhat poorly defined, since it is not a clinical concept. Everybody knows what it is but it looks different in different people. Consider it a chronic state of emotional, physician, intellectual and spiritual exhaustion-In this case induced by ones job, or occupation or in this sense I still use the term profession. It can manifest with more cynicism, physical health problems, addictions, calling into work sick-(doctors don't get to), anger, irritability, slowed cognition, anxiety, marital and relationship problems and of course the catch all term "depression". Sometimes the depression is a clinical depression.
People end up hating their work, retiring early (if they can) switching careers( if they can) and a whole host of other consequences.
The fact of the matter is just a few years ago, almost all physicians wanted their son(s) or daughter(s) to become doctors. Now only some 30% encourage their children to go into medicine. Most docs over fifty years of age want out ASAP.
There are lots of little initiatives to help physician burnout, often run by para-professionals, psychologists, nurses, you know people that didn't go to medical school, didn't give up all of their adolescence and most of their adult lives to serve. Interestingly enough many of the physicians who lecture about physician burnout have gotten out of the game, they have gotten out of direct patient care.
Now I will tell you the rest of the story, that no one seems to comprehend, even most physicians, the anti-physician New York Times media type outlets, and the general anti-physician mainstream society. make that ALL doctors who make it (WHO MAKE IT) IE gotten through school, residency etc. want to serve others, they want to help patients. They are also as a whole very self-punitive, very even shame based, we are our own harshest critics. Most take it very very hard and suffer in silence when things do not go well with a patient. Moreover we are not allowed to whiners, it is politically incorrect, and just plain wrong if you are a physician, this blog is just plain wrong- because it talks about the things the smiley faces whom have gotten out of the clinical world and make a decent living, as well as all the physician despisers annoyed-  it is uncomfortable to think about.
Most docs are perfectionist by nature, everyone whom isn't this is WEEDED OUT in the 12 year process. The integrity and commitment is phenomenal, and yet their is something profoundly masochistic and self-punitive about the culture and very nature of the indoctrination of becoming a physician. In other words you pretty much give up yourself, it is selfless. That is in the backbone of any good physicians, and most are good. The not so good one 'wannabes', did not have the intellectual or spiritual or emotional commitment.

So here is a secret, maybe not a secret but a taboo statement within society.- a lot of physicians want out of direct patient care, this is where the stress and burnout comes from. Why? There is more pressure than ever, to see patients- as many as possible, that pressure comes from payers, administrators etc.
There is literally a bulls eye on physicians backs in regard to litigation, when we don't get the outcome we want we immediately want to sue the doctor. We want retribution, accountability. We want our doctor to be perfect, to know everything and have a wonderful bedside manner.
But nowadays we live in such a physician-hostile climate, we are ready to sue if something does not go our way. It is another pressure. Also we really place no actual value on the doctor. We know how much it costs to get our oil changed in our car or to get a crown on our tooth at the dentist, but we never really know how much a doctor's appointment costs. Moreover we get huge uncovered bills from institutions and the general assumption is that all that money is going into the doctors pocket. I will never be able to convince anyone outside of medicine that the doctor does not see that money. It helps us devalue and hate the physician even more.
And here is another concept- there is generally a breakdown of the family more social media, less human contact and intimacy and perhaps as a society we treat each other with less respect than ever. Call it a post-war pervasive narcissism except know we are about 5 generations post war, and have been busy indulging ourselves for decades, feeling good putting ourselves first, convincing ourselves that the destruction of the nuclear family is cool and politically correct. what does this have to do with physician burnout???
NO ONE WANTS TO PAY TO BE CARED ABOUT. The physicians office is one of the few institutional bastions left in our ever-advancing society where a person is supposed to and can feel cared about.
With that said a person can never feel cared about from the nurture they didn't get from their fragmented family of origin.   Now couple that with a doctor whom you don't pay- (insurance does or does it?) and that doctor is working hard to be good enough and help you as much as they can, but it will never quite be enough given the combination of factors conscious and unconscious between patient and doctor. It is a perfect storm for an -anti-physician society to advance their distaste towards doctors and an even more perfect storm for physicians whom actually take care of patients all day, to become really really burned out.
But since we are so shame-based, it is completely taboo to say we dont' like treating patients anymore. That is a sign of being bad, and that is the LAST thing a doc wants. So we burnout or quietly switch careers, except most docs have no marketable skills outside of medicine.
Physician burnout is more complex than eating right, balancing work and play, getting enough sleep, prioritizing family, exercising. Yes all that stuff is crucial to avoid burnout but it really needs to be understood, from a developmental and personality-character perspective to be able to do something more about it. One must also consider what has happened to society in the last four generations, to understand why there is more physician burnout.
I would love to see a doctor that still takes care of tons of patients all day speaking on burnout, except they don't have the luxury. Sorry I'm just whining, I must stop. I know like all good docs all over this great nation of ours, I will just keep trying harder every time.

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Talking about the book with the Lake Superior wind....... a calm day