Burnout: A Hidden Epidemic

At 27 years old, I look around at my non-medical friends with envy at times. They have paying jobs, financial independence, spouses, even children! Most luxurious of all, the majority of them have weekends. Actual weekends that are guaranteed as personal time to accomplish chores, relaxation, or any other obligations not attended to during the week.  What do my medical school friends have? Long, unpredictable schedules, an immense pressure to perform well on standardized exams, and a national median of $183,000 in debt. No wonder medical students often feel like they have sacrificed their 20’s for their career. With an upcoming test always on the horizon and the pressure to perform, after I started medical school I figured relaxation time would equal lower performance. Weeks and weeks of 12-plus-hour study days for licensing exams became my new normal. This no rest “logic” of mine was the beginning of a slippery slope that so many medical students fall into.

I started medical school excited to become a future healthcare provider, elated actually. However, after I finally arrived at the clinical rotations in my third year, I was scheduled first on the inpatient internal medicine team. This is a service with some of the most acutely ill patients, often with multiple unrelenting chronic conditions. I began to realize over the next few weeks that many patients couldn’t truly be saved, at least not in the way I imagined. Sure they could often be stabilized, temporarily treated with the proverbial band aid, but modern medicine could only get us so far. I was devastated because I came to medical school to save lives! Without actual cures, I started to feel like maybe I could make no difference at all. Luckily, later that same semester, I found my passion for psychiatry. As a medical student I had the unique privilege to spend more time with my patients than the residents and attendings, and I found that getting to know my patients was my favorite part of the job. What amazed me was that simply talking to the patients seemed to lift both their spirits and mine.

However, it was still hard to be around the sick and dying because I often felt like I had no one to talk to about the hard parts of my job. During a clerkship, I watched a first time mother hold her severely premature new baby for his short few minutes of life before he passed away. It was back to work within minutes. We never discussed this newborn’s death; it was like it never happened. I was surprised that none of my superiors seemed interested in processing the stressful situation we’d just experienced. This is when I first heard the term “physician burnout”. What I understand this concept to mean is that when you give so much of yourself to others on a daily basis, empathy and compassion can easily become replaced with cynicism and indifference. Further exacerbating the issue of burnout is the stigma in society associated with pursuing treatment for mental health. In fact, physicians are especially reluctant to seek help for themselves. I believe the reason for this is that physicians assume that if we are expected to be healers, then we must have no room for weakness. Further intensifying the problem, some state licensing boards and hospital credential applications require physicians to report if they have ever received mental health care. Physicians afraid of the repercussions of seeking help may resort to seeking treatment in hospitals under fake names, or worse, not seeking treatment at all. I recently saw a post on the popular Humans of New York blog on Facebook from an anesthesiology resident that exemplifies this issue. He states, “The stress just erodes people. There’s a lot of tension and anger…And the culture does real harm…There’s got to be a better way”.  I agree; there has to be a better way.

As healthcare providers I believe that physicians need to lead by example. A physician must take care of their own physical and mental health in order to best provide for their patients. Also interested in this topic is Dr. Pamela Wible, a family medicine doctor who unabashedly raises awareness about physician burnout that can ultimately result in physician suicide. Dr. Wible recognizes the impact that treating the chronically ill daily can have on the health of both the patient and the physician. After learning about more than 300 cases of physician suicide, she published a post aptly named “How to graduate medical school without killing yourself”. She suggests several tips that I have found extremely helpful. For starters, she states that you should feel comfortable to cry freely and share your emotions. Along the same lines, start a Balint group. This group is where colleagues can gather to present a patient’s case. However, the focus is not on the differential diagnosis or treatment of the patient, but rather to focus on how it felt providing care. You can’t and shouldn’t overburden your family with the tough stories you see on the job, so this group could be a way to let your emotions out in a safe place.  In addition, if you witness any form of abuse, report it. If we are complacent in the abuse of ourselves or our colleagues, it could ultimately result in the mistreatment of patients. So remember to treat your patients and your colleagues the way you would want to be treated. Have a zero tolerance policy for bullying, hazing or any form of cruelty.

We came to medical school to be healers. In order to become a healer you need to take care of yourself and reach out to your friends and classmates who are in trouble, or seem down. Ask for help when you need it. Don’t wait until your problems become too much to bear. Instead, I encourage you to focus on your personal mental health from a preventative medicine standpoint, by utilizing resources set in place to help you early on. Many schools offer confidential, free counseling. Ultimately, know that if you are feeling burned out, it is not your fault. Don’t be tempted to blame yourself and perpetuate the problem; rather, become a part of the solution by vocalizing your feelings and seeking help. As medical students we have more power than we give ourselves credit for and if we make a concentrated effort to follow these suggestions we could all become better doctors and avoid burnout.

If you would like access to any of the sources I referenced in this article, you can find links below:

• 2016 Education Debt Manager For Matriculating Medical Students
• Humans of New York  and their Facebook page
• How to graduate medical school without killing yourself