Why working more isn't the answer
“I’m sitting in a quiet room at the Millcroft Inn, a peaceful little place hidden back among the pine trees about an hour out of Toronto. It’s just past noon, late July, and I’m listening to the desperate sounds of a life-or-death struggle going on a few feet away.
There’s a small fly burning out the last of its short life’s energies in a futile attempt to fly through the glass of the windowpane. The whining wings tell the poignant story of the fly’s strategy—try harder.
But it’s not working.
The frenzied effort offers no hope for survival. Ironically, the struggle is part of the trap. It is impossible for the fly to try hard enough to succeed at breaking through the glass. Nevertheless, this little insect has staked its life on reaching its goal through raw effort and determination.
This fly is doomed. It will die there on the windowsill.
Across the room, ten steps away, the door is open. Ten seconds of flying time and this small creature could reach the outside world it seeks. With only a fraction of the effort now being wasted, it could be free of this self-imposed trap. The breakthrough possibility is there.
It would be so easy. Why doesn’t the fly try another approach, something dramatically different? How did it get so locked in on the idea that this particular route, and determined effort, offer the most promise for success? What logic is there in continuing, until death, to seek a breakthrough with “more of the same”?
No doubt this approach makes sense to the fly. Regrettably, it’s an idea that will kill.
“Trying harder” isn’t necessarily the solution to achieving more. It may not offer any real promise for getting what you want out of life. Sometimes, in fact, it’s a big part of the problem.
If you stake your hopes for a breakthrough on trying harder than ever, you may kill your chances for success.”
- Price Pritchett, You²
At some point, we have all been that fly. We’ve all tried to achieve something different by doing more of the same. There may have been times in the past when that tactic fixed your problem. But success is a lousy teacher. It tricks you into thinking that you’re better than you are.
Don’t default to solving new problems with old solutions, even if they worked in the past. Instead, seek to identify the thought process behind the solution.
Sometimes more isn’t the answer. Sometimes we need something entirely different.
Like the fly, we usually default to this type of thinking when there isn’t a plan and we are subsequently forced to make last-minute decisions. It’s hard to make the right choices when there isn’t any sense of direction.
But unlike the fly, you can plan. You can also ask for help and seek counsel. Getting an outside perspective on your situation is one of the most valuable things you can do.
Although I can’t give you that perspective through this publication, I can challenge your beliefs. It’s my goal (over time) to provide you with more tools, show you the many ways of using those tools, and then show you which tools work best, depending on the project.
If you’ve been following my journey, you’ll know I am now sitting on the patient side. The lack of communication, care, and empathy I’ve experienced stems from the work environments many clinicians endure. The day-to-day makes it nearly impossible to provide the care some patients need.
If you work in medicine, take a second to ask yourself if you’re overworked and burnout.
If so, then it may be time to re-evaluate some things. Doing more of the same does not yield different results. You can’t power through this.
I want to emphasize that burning out is completely unrelated to your intelligence and/or clinical acumen. It’s an entirely different skill set.
I came across an article titled “Medical Burnout: Breaking Bad,” that illustrates this point.
Here’s a short snippet:
“The year was 2007, and I was a surgical resident at the University of Nebraska Medical Center. Joseph Stothert, MD, Ph.D., was the chief of trauma service.
“Dr. Kaushik, did you see the consult in the ER?” Dr. Stothert looked into my eyes as if staring into my soul.
“Not yet, Dr. Stothert,” I replied, picking up the patient’s chart. “They paged me two minutes ago.”
Dr. Stothert shook his head and headed to the ER, where he saw the patient even before I did.
Joseph Stothert was a phenomenal trauma surgeon, the medical director of the Omaha Fire Department, and a brilliant leader who saved countless lives throughout Nebraska.
He died by suicide in March 2021 after spending more than a year on the front lines in the war against COVID-19.
For me and countless other residents that Dr. Stothert trained, his death will never be just a tragic statistic among so many during this pandemic.
Rather, he will be remembered as one of the finest surgeons in the country, whose skill was matched only by his kindness and compassion.”
- Dharam Kaushik, MD, “Medical Burnout: Breaking Bad”
Your primary role as a clinician is to prevent and treat disease. Because of this, most of your continuing education revolves around guidelines, evidence-based medicine, new studies, and novel treatments.
But that can’t be the only thing you’re focused on. I hope it’s clear that your ability to prevent burnout isn’t tied to your clinical abilities; it’s an entirely different skill set that you need to master.
Like any disease, preventing burnout is better than treating burnout. So, the sooner you master this skill set, the better off you’ll be.
Depending on the sources you look at, 40 to 60 percent of clinicians will burn out at some point in their careers.*
The effects of burnout (to name a few):
Decreased quality of care
Poor patient satisfaction
Decreased trust from the patient also increases the chance that they don’t adhere to a plan. I know I wouldn’t listen to someone I don’t trust
Medical errors
High clinician turnover
Relationship difficulties
Colleagues, patients, admin, spouse, children, parents, and friends
Substance abuse
Suicidal ideation
Many feel they can just tough it out. But when you zoom out, you’ll realize you’re not the only person involved.
The way you feel affects performance regardless of what you think. Burnout affects you and your patient.
Patients aren't just a random group of people, either. They consist of every single human being on the planet.
You are a patient
Your wife is a patient
Your child is a patient
Your attending is a patient
Your colleague is a patient
Everyone is a patient at some point in their life.
Therefore, every human being suffers when a clinician isn’t putting their best foot forward.
So, do me a favor, and please put yourself first. It’s the most unselfish thing you can do.