Medicine Is Unique (Good, Bad, Ugly)
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I want to shed some light on why clinicians have a high burnout rate. Although burnout can happen in every profession, there are particular things unique to those in medicine (in no particular order):
Certain beliefs that were necessary during your training will no longer serve you.
Patients usually only see you when they’re sick.
It's normal to work more than 40 hours a week.
After residency, a physician becomes an attending.
Patients aren't always responsible for payment.
Every day you work, you put yourself at risk for litigation.
Let's dissect each of these in a little more detail.
Certain beliefs that were necessary during your training will no longer serve you.
“This is how humans are: we question all our beliefs, except for the ones that we really believe in, and those we never think to question.”
- Orson Scott Card
Belief #1: Work more. Work harder.
You were told that the more you work, the harder you work, and the less you sleep, the more dedicated you are. In medicine, behaving this way is considered a badge of honor. But, your sleep deprivation will only hurt the patient.
Belief #2: You should know everything.
The culture of pimping has undoubtedly led you to believe that you should know everything. This practice of publicly asking questions until the student is left without an answer only makes the student feel inferior and embarrassed.
Belief #3: Become a perfectionist.
This goes hand-in-hand with having to know everything.
Belief #4: If you want it done right, do it yourself.
This teaches the student they shouldn’t ask for help and to not rely on anyone for guidance or assistance.
Belief #5: Don’t question how things are done. Just follow orders.
If an attending tells you to get a lab, you order the lab. You must follow orders without second-guessing or questioning authority. The problem with this concept is that it leaves little room for improvement and refinement. The only way to improve is by continuously questioning your beliefs to find a better way. But you can't learn this skill if you are never allowed to ask questions.
People only see you when they’re sick.
Your patients don’t come to see you when everything is going great (unless it’s a routine preventative care exam). This means you’re seeing people at their worst. If you constantly see one case of depression after another, eventually, you’ll start to carry some of that baggage.
Energy is contagious.
It's normal to work more than 40 hours a week.
In 2003, working conditions were so bad for residents that an 80-hour work week was imposed and limited shifts to no more than 24 hours.
Even after these reforms were implemented, many residents still found themselves working more than 80 hours per week. Attendings in leadership positions were trained without restrictions and believed this was necessary to practice medicine.
This train of thought goes back to the normalization of never questioning a belief.
Keep in mind that there isn’t a universal amount of hours you should be working. Everyone is different. We all function differently and want different outcomes for our lives. Being on call is also a variation of this because although you may not be at work, you are still not allowed to be truly present during your time off.
After residency, a physician becomes an attending.
When a physician becomes an attending, they also become a leader.
The problem stems from the fact that the attending is forced into a leadership role. Finishing a residency doesn’t automatically make them qualified to lead. That’s an entirely different skill set altogether.
Suppose the attending has no desire to learn how to become an effective leader. Inevitably, the attending will regurgitate methodologies they once disagreed with because it's all they know.
Patients aren't always responsible for payment
In other professions, the client pays when a service is delivered.
When the clinician delivers their services, the patient (aka the client) is rarely the only person involved in the payment (there are exceptions). Most of the time, their health insurance takes the lead.
This means two parties must be convinced of your plan: the patient and the insurance company.
Even if the patient agrees with your workup and/or treatment, their insurance may still deny what you're proposing. You’re often required to have a step-wise approach for coverage.
Sometimes the algorithm makes sense, and sometimes these steps are not in the patient’s best interest. If the latter occurs, the clinician may feel forced to lie or deliver subpar care.
Every day you work, you put yourself at risk for litigation
Medicine is an imperfect science. It doesn't matter if you know what you “should” do in any given situation. It also doesn't matter if you did the “right” thing. Humans come with unpredictable variability, and statistics don’t matter when you’re the outlier. Because of this, mistakes are inevitable.
For example, it’s common practice to order an abdominal CT scan for every patient who goes to the emergency department with abdominal pain for fear of a lawsuit. Doing things you don't feel are necessary or that goes against your beliefs will eventually affect you.
It can lead you to question your abilities, self-worth, and ultimately, your identity.
You’ll be mad at the system and start to group all patients into the same box. Viewing everyone as a potential threat will inevitably change how you practice.
What are things you find unique to medicine (not found in any other profession), that contribute to burnout?