Dr. Guilt and the Physician Burnout – updated

During long shifts at the hospital it is common for a resident to push aside basic urges in order to get the work completed.  These urges may include eating, drinking, using the restroom, and definitely includes taking a break for relaxation of any sort.  Once the work day ends many more sacrifices are made and may include anything from time spent with family and friends, to just basic life needs such as buying groceries and doing laundry.

I ashamedly admit that I frequently skip meals or hold my bladder to get through a long work day uninterrupted.  Recently, during the beginning of a long sign-out with several people, I realized that I had neglected to go to the restroom during prepping for the sign out.  As I sat envisioning my enlarging kidneys and the imminent hydronephrosis that haunts my future, I thought consciously how I was choosing these other people over myself.

I admitted to the group, “Please excuse me for a moment, I have to use the restroom”.

A long annoyed sigh was let loose and someone mentioned, “Oh yeah, we wouldn’t want to keep anyone from using the restroom.”

The point wasn’t spoken but it was made clear that no one was happy about my interruption to the workflow.

It is an unspoken theme that we sacrifice such things in the name of patient care.  When asked pointedly, most will deny that they would ever expect that of anyone.  But I theorize, if surveyed anonymously, many in the medical field will tell you that they have made these sacrifices many times over, especially during residency.  I would bet that many do so daily.  With this engrained during training, it makes sense that it continues into our careers.  It also makes sense that this culture of sacrifice bleeds into the rest of our lives.  If taking a few moments to eat or use the restroom produces guilt, how do we expect physicians to take time out for themselves to relax or focus on something other than medicine?

I have begun to write a blog about this subject multiple times.   Is it ironic to say that I haven’t yet found the time for its completion?  I was before inspired by a recent study at Mayo Clinic published in the Archives of Internal Medicine entitled “Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population.” This study concluded that “burnout is more common among physicians than other U.S. workers.”  The report stated, “In aggregate, 45.8% of physicians were considered to be experiencing at least 1 symptom of burnout based on a high emotional exhaustion score or a high depersonalization score.”  These results spawned many printed and online articles, including one from Medscape News entitled “Why are M.D.’s Burning Out in Record Numbers?

Recently, Medscape News reported the most frequently read article by pathologists was “When Is It Time to Live for Yourself?”  The articles states: “Physicians have a tendency to put the needs of other people, including patients and their families, before their own, and the demands of their professional activities can become all-consuming.  The result?  The simple pleasures that doctors need to nurture their own happiness can get pushed aside.”

It goes on to discuss the importance of finding a work-life balance.  They encourage the gauge to determine how much time should be spent at work versus home, not by strict numbers but by how you feel.  If you’re stressed out, frazzled, thinking of retirement, or feeling angry towards your job, then you are potentially not putting enough energy into your life outside of work.

These articles speak to more than just the happiness of the physician.  Several recent European studies have shown that along with burnout comes decreased integrity in patient care. (Please see hyperlinks for references)  

So even if you’re unconcerned about your doctor’s overall well-being, you may be interested in this for your own.

So why do we as doctors feel the need to sacrifice ourselves so deeply in the name of patient care?  To gather a little insight, I was pondering about a blog (unpublished) that I wrote a while back called “Dr. Guilt”.

An excerpt of this blog stated:

I have always wanted to be a student all of my life and I’m starting to feel that slip a little.  A lot of my time has gone into one aspect: medicine.  To be honest, I find when that happens, it makes me feel a little bitter towards my career.  I understand the importance of being a doctor. I know that every decision I make is important.  Every decision has the potential to change the course of a person’s life.  If I miss your cancer, you may not find out until too late.  If I catch your cancer, you may undergo treatment and live a longer life.  These are big things.  Someone out there has put their faith in me to diagnose their potential illness and they’re anxiously awaiting my determination.  Shouldn’t I spend every waking moment of every day studying and looking at slides and practicing??  So, is it selfish of me to want to enhance my own life instead of putting all my energy into being a doctor?

No.  No, it is not selfish.  It is not selfish for me to covet the few hours I have outside of work for other things.  As it is not selfish for a mother or father to spend a few hours away from their children, enjoying other things.  As it is not selfish for a caregiver to have some time off and spend it relaxing and letting go of stress.   This is a concept I think we’ve lost as a culture.  We lay this huge slather of guilt upon ourselves and give everything away to the detriment of our true selves.  Then we feel tired, drained, useless, and bitter towards the very thing we wanted to help.  Depression, anxiety and apathy are fueled by such circumstances.  I find that I blame medicine for the same things that some people blame on their children or ailing parents… the lack of time for myself.   What I am realizing is that it is my choice to make this sacrifice.  It is I who chooses to skip lunch to get more work complete or to ignore my urges to go to the bathroom because I need to take care of something.”

In reviewing what I had written, I was shocked that I so strongly defend myself for wanting to have time for other things.  It also made me realize that this is likely a common feeling among physicians.  While it is my responsibility to make these decisions for myself, I can’t help but wonder if we shouldn’t also question the culture of medicine?  Perhaps we need to be discussing these topics out loud so that other physicians may benefit.

Physicians in particular know the importance of perfection all too well and the system is completely unforgiving.  We are held accountable by our own ethics, our peers, and the legal system any time we make a mistake.  We strive so hard to be the best doctor for our patients.  The enigma is that by putting off our own needs and desires, we actually do less for our patients.  Perhaps we as a culture, both in America and in medicine, need to put our foot down and say “No more”.   No more will we crack this whip on our own back and those of our peers.  No more will we be silent about these issues.

I frequently hear justification for these sacrifices because it was experienced, almost as a tradition, by the senior staff.  Statements in response to changing the system often sound like, “Well, when I was in training we worked even harder and we survived”.  Yeah, maybe you did survive and you don’t have hydronephrosis from holding your bladder for hours, but does that make it okay to inflict and encourage that lifestyle on others?  Was that the BEST way?  Maybe you could have done more than just survive and instead you could have THRIVED and enjoyed a lot more of your life.  Do these sacrifices really make you a better doctor?

Asking these questions is scary because it brings forth the idea that many lifetimes of sacrifice were made for little purpose.  Avoiding that potential truth, is a strong motivator to prescribe it meaning. I think, however, change is on the horizon and with more and more patients and busier hours, this lifestyle is becoming less and less sustainable.

I have ideas on how to implement some changes to the system.   I am not sure, however, if we can really start discussing those thoughts until we openly admit that this is really a huge problem.  Whenever attempting to make change and provide solutions we must first have insight and enlightenment into what is the actual problem.  That is the purpose of this blog.

But for fun here are a few thoughts: 

1) Physician training in how to combat depression and burnout – probably the simplest and quickest way to help.  2) Increase the amount of physician training programs (med schools, residencies, fellowships).  3)  Decrease the cost of medical school to relieve some of the huge debts we must afford.  4) Hire more physicians requiring fewer work hours (this could result in getting paid less, but with less debt and more time off to enjoy what we have, my theory is that most doctors won’t mind as much- you can always work more if you really want that moolah, but at least there will be an option for the rest of us).  5) Change the training programs so that they are more gradual but at a higher pay.  You would be required to spend a longer time in training but get paid more for that time and work fewer hours.  

I know there are a lot of arguments for and against these ideas.  But they’re just ideas, and we have to start the discussion somewhere.

I would LOVE your opinions and stories. :) Please keep them kind.Doctor time

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4 thoughts on “Dr. Guilt and the Physician Burnout – updated

  1. Pingback: Quick thoughts on Physician depression and suicide. Re: Why Do Doctors Commit Suicide? | Everything, almost.

  2. Hey girl!
    I totally agree! I catch myself feeling guilty for silly things like that. We as doctors gotta quit being so hard on ourselves. People make good decisions when they are relaxed and calm and in the groove….

  3. I love your blog. Everything you say is so, so true. I often feel so angry at the culture of the medical field because a lot of the time we spend sacrificing our own needs to “take care of the patient” doesn’t actually even help the patient.

    Your idea to hire more physicians so we could each work fewer hours is one I have thought of over and over again because I long for that solution! Glad to hear that someone else has also heard of such a logical possibility for improving the quality of life of physicians.

    • Thank you for your comment! I hope that the more we vocalize these issues, the more likely change will occur. I think a lot of people are scared that if there are more doctors or we work fewer hours, we won’t make as much money or be able to pay back our loans. But I think we would still make good money and have more time not only for ourselves but also for the patients (because we would see fewer of them, we could hypothetically give them better care). Also, in the Mayo study they listed not having enough time with patients as an additional cause for physician dissatisfaction. I found it interesting that one of the articles suggested using how we feel versus the number of hours worked as a gauge for what is healthy. I guess the only issue is that if you realize you are working too much, there is often little opportunity to adjust. Perhaps that is something to fix, at least having the opportunity to work less. Very interesting topics! It feels good to talk about it.

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