Burnout in Medicine

Yes it's inspired by the slogan in Burger King ads for the Whopper. But I thought I'd build on some of my blog posts about physician burnout, and share my thoughts and feelings on the subject. This is only my personal experience, having struggled with burnout twice until I finally threw in the towel. What I describe might not align with what's in the peer reviewed literature, but few things in medicine ever do at the individual level.

I wrote a post describing what I named the "killer B's of burnout" in medicine, namely bleakness, boredom, and bureaucracy. Both times I went through burnout the cycle started with boredom. I found medicine so full of the mundane most days, after about five years in practice I grew restless. There's only so much time after your office is done, the kitchen is clean, and the kids are in bed to socialize or pursue other interests. I'm someone that needs to enjoy what he does to keep doing it, and medicine just wasn't "it".

So I decided to shift gears in my career, starting part-time work in Public Health and pursuing a Master's degree. While it reignited my enthusiasm for a time, it was a misguided decision. In effect, I responded to stagnation in my career by working myself to the bone. While it was completely in keeping with the culture of over-achievement in medicine, it left me with no "slack" in my life...no time for building a social life, connecting with friends, or just taking an evening on the couch to veg. All it took was a minor sports injury, and the fuse to the bomb was lit.

About two years into the Master's, juggling two jobs, my wife noticed that I angered all too easily. The chronic pain definitely contributed, but this was a different phase of my burnout "syndrome". Things I would ordinarily laugh off - hospital privacy policies, College of Physicians correspondence - put me reflexively in a foul mood. I lost my temper with patients, firing some of them on the spot, in what I can only in hindsight call a tantrum on my part. To borrow from the original name for the blog, this wasn't patient care but impatient care.

As time wore on, my physical health deteriorated. The injury kept me from exercising, but I was still dropping weight to a point I hadn't been since high school. My blood pressure was climbing as well, spiking into the 180s without my knowledge. More than that, though, my emotional health was in a shambles. The only thing that brought me to work each day was my duty and obligation to my patients. I ceased to have any identity outside of "chronically pissed-off slave to medicine". It didn't matter what patient was in front of me 90% of the time, because all they were getting from me was a facade, a persona saying whatever needed to be said to get them out the door.

So I did the only thing I could - I closed up shop and rested. I saw my doctor - there's a novel idea, had my injuries dealt with, and thought about getting back in the proverbial saddle. Still, I couldn't face the prospect of being back at the pace of regular practice. I was damaged goods.

I landed a spot at a local Community Health Centre. I'm a huge proponent of the CHC model, with team-based care that's 100% necessary given the population. The CHC patients were very, very needy, and many of them struggle with mental health and addictions - this was not medicine for the faint of heart. The CHC gave me the time I needed to work with them constructively, but I had no idea how long I'd last.

I made it about three years before boredom started to settle in, and I ended up leaving Public Health for reasons that aren't relevant here. I grumbled on another 6 months, bored but satisfied, when the other Killer B's came a-hunting with a vengeance. The paperwork and government meddling were starting to suck the enjoyment out of the job, and the neediest patients' problems were starting to suck the life out of me. Even an amazing holiday barely refilled my tank, and I was tired and bitching within days of being back at work.

So the cycle of burnout came back. I started snapping at people around me, started groaning about patients that created only minor nuisances. I was sullen and withdrawn coming home at the end of the day, reaching for a drink instead of a kiss from my wife and kids. I saw no value in what I was doing, and grew furious with the proverbial "faceless bureaucrats" that decided I couldn't even try to provide proper care. One tantrum later, I gave my notice.

As I write and record this, it's been almost a year since I've seen a live patient. I once thought I'd be able to go back, even made plans for temporary gigs or permanent part-time work. But I don't enjoy medicine, and never did for very long, and even a six figure income isn't worth 30 more years of cyclical unhappiness.  

More importantly, burnout has left its mark. I am irretrievably cynical about the future of the profession...though in fairness, the government shoulders a good chunk of the blame there. That part of my pride and my identity attributable to medicine is essentially gone from my life. And I suspect I'll never be free of my guilt over leaving practice - twice now. No matter what I might have gone through, it's always the patients that lose out in the end, and I took responsibility for, and formed attachments to, some of the most frail and traumatized people in my community. That regret is a humbling but truly shitty feeling to live with.

So to anybody reading or hearing this: if any part of this sounds like you, or a colleague, or a loved one, get yourself or that person help. Not a meditation retreat, or a yoga class, or a chakra adjustment, or a pat on the back and a pep talk, but meaningful, professional help. Yes, all that stuff can work, even turn lives around, but no one method works for everybody. If you choose a "path to wellness" that's not right for you or the person you care about, there's a risk of increasing the sense of hopelessness, and making matters far, far worse. The good news is that the help is out there, just a click or a phone call away. Seek it out. You'll be far better off for doing so.

I could obviously go on and on about this - and I have, to the tune of about 83,000 words. If you want to read the entire story, in all its gory glory, subscribe to the newsletter, follow my website at drwarsh.blogspot.com, connect with me on twitter @drwarsh, or head over to Amazon for your copy today!


4 comments:

  1. Frank;
    Like the proverbial phoenix of legend, you arise, yet once again, in a new personna. Stay well my friend.
    marty

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    1. Thanks Marty! It's been way too long.

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    2. Dr Warsh, I am a pain patient and have been for most of my life. Things got very bad for me in the 1990's, I am 73 yrs old.

      I read your story and understood what you went through (as much as one can when not walking in their shoes). Was there anything that your patients could have done to make it easier for you? Your wife and my dear husband are saints.

      I am always in a lot of pain, thank God I am not a depressed person! Pain is all encompassing as you know. I am unable to do much of anything anymore, I find that TV helps take my mind off of my pain. I found a list of many good ways that may help people. https://www.aci.health.nsw.gov.au/chronic-pain/painbytes/pain-and-mind-body-connection/how-can-distraction-be-used-to-manage-pain

      Pain patients can not find a Dr that will take them anymore. I have been on oxy since the early 90's, I'm on a low dose. For me the following works. If my pain med stops being as affective I take one pill away for a couple of weeks. Doing this helps bring my body back into line so when I add my pill back it works as well at before. I've only had to do that twice. My pain is very bad, too many to list here; I know the pain will never go away.

      I am extremely angry at what the government is doing to pain patients, we have been thrown in with addicts. I don't know what will happen to us or how far the government will go to stop opioids; it is very scary.

      I hope you find ways to help your sciatica, my husband and son have problems with their back and the inversion table helps a lot. Have you tried one? https://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/inversion-therapy/faq-20057951

      I hope you find a "happy medium" to use your Dr skills to help patients and yourself. God Bless You and yours.

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    3. Mermaid2, thank you for these very kind words. I don't think there's any blame I would lay on my former patients. Nor can I ever recommend that someone seeking help try to make life "easier" for their doctor. We're trained as best as we can be, and have to take responsibility for ourselves, our colleagues, and our families. The outcome of my career was as much a function of bad luck as anything, especially with regards to my problems with chronic pain. And for the record, I 100% agree with your comments when it comes to government mishandling of the opioid problem. Nobody knows what they're doing, and as the saying goes, the road to Hell is paved with good intentions.

      Thanks again for your feedback, and I will look into your suggestions.

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