Another random rant:
It’s no wonder we have been hearing more and more about the problem of “burn out” among health care professionals as we witness the premature exodus of capable, dedicated physicians and nurses from a system that defies excellence in patient care by virtue of its unspoken battle cry: Bigger. Faster. Greedier.
Burn out is defined as:
“…a state of physical, emotional, or mental
exhaustion accompanied by
doubts about one’s competence
and the value of one’s work.”
But it doesn’t have as much to do with fatigue as it does with frustration. The problem isn’t about keeping up with technology or advances in diagnostic and treatment modalities. We can do that. The problem is that we are forced to compromise thoroughness in favor of efficiency. Connection in exchange for productivity. Compassion in lieu of profit.
Dedication, fulfillment, and integrity are no longer part of the equation.
When I gave up after thirty years in Family Medicine I told my patients and colleagues I was retiring…when I meant I was quitting. I didn’t put it quite that way, of course. It wasn’t as though I simply got fed up with things, turned in my stethoscope and tongue blades, and slammed the door on my way out of the office. I wasn’t impulsive about it at all. I agonized over the decision for years.
I didn’t leave because of the long hours, or the fact that I’d been running hopelessly behind schedule all day, every day for three decades. I didn’t leave to take an easier position or to make more money. I didn’t ask to be excused because of fatigue or forgetfulness or ill-health.
No. What finally got to me was the erosion of my authority as a physician by self-proclaimed intermediaries who had neither knowledge of nor concern for my patients’ wellbeing. When I started out in medicine the problem was oppressive paperwork; now-a-days it’s an oppositional defiant electronic medical record system. A baffling coding and reimbursement system. The ever-present threat of litigation. A pharmaceutical industry that invests as heavily in marketing as it does in research. A health insurance industry whose number one priority is corporate profit…which translates into seeing more patients faster regardless of the complexity of the presenting problem. I worried I would miss something, and I feared for my patients because of it. It scared me. I had to leave.
“The very concept,
I would say ministerial function of being a physician,
is to be attentive, is to be present,
is to listen to that story,
is to locate the symptoms on the person
of that patient,
not on some screen,
not on some lab result,
but on them."
It's no wonder we worry about competence given the constraints imposed on our ability to deliver excellent care to our patients. It's no surprise we question the value of our work when we measure it in terms of quality and compassion while the system is busy tallying the receipts.
Physicians are encouraged to manage their stress…when they are helpless against it. To get outdoors more. To meditate. To eat better and to get more sleep…when, some days, we don’t have time to eat at all. When we can’t break away long enough to poop on the pot. When we don’t have the strength to blink at the end of the day…not because the work has gotten any harder, but because the hoops we have to jump through have multiplied…and somebody in a fancy office is holding them higher.
“America’s healthcare system is neither
healthy, caring, nor a system.”
Looking back on thirty years of practice in the American medical system, I can only say, "It weren't broke." But it sure needs fixin' now.
For more on professional burnout, check out https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/