As she lay on the gurney telling me she was tired and having vaginal bleeding yet again, I was doing my own biopsy of her medical record. It stated very clearly that palliative care and hospice had been recommended to her for her end-stage gynecologic cancer. So, why, I’m thinking, highly annoyed, is she now in the ER, late at night, creating problems for me? Why could she just not accept that she was dying and there was nothing left to be done? I babbled some nonsense about how I would check some lab work and get back with her, but in truth, I was thinking only of the stack of patients yet to wade through, the lab, x-ray, CT results that needed my review, and charts that needed to be completed. This, on the heels of attempting to resuscitate a 40-year-old cardiac arrest to no avail, and still awaiting his family to arrive. The constant barrage of phone calls, hallway interruptions, and overhead pages guaranteed I would not be leaving the hospital anywhere close to the end of my shift. I was thinking nothing of her or her plight. To have compassion is to have feelings of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering. My compassion well had run dry. I was beyond exhausted, defeated really, and now full of self-loathing. Had I really become angry that a patient would not readily accept a terminal diagnosis? Was I so callous, so self-absorbed, that a person’s end-of-life medical issues meant nothing to me other than messing up my workflow? When I finally placed my weary head on the pillow that night, I lay awake pondering whether I had fallen prey to the often cited physician burnout. It’s typically characterized by exhaustion, cynicism, and doubt. I was definitely depleted on all levels. Holding a handful of spades, I just needed a serious medical error to complete my royal flush of a career meltdown. My poker face had long abandoned me. It was time for change. After 15 years of slogging away in the ED, night after night, this was not going to be my 2500th ride on the same hamster wheel. It’s ironic really that physicians of all specialties work day in and day out trying to help people live healthier and better lives, when the very professional pulpit from which we preach results in physician burnout at an alarming rate. Corporate America has gotten the message. There are many corporate wellness programs dedicated to making employees happier; after all, happier workers are more productive workers. Somehow, medicine has never seemed to think that it would benefit. If occupations had personality traits, medicine would be labeled a narcissist. Today’s reality is that administrative leaders are not concerned with physician wellness, only patient satisfaction scores, time to patient seen, and decreasing throughput times. If it’s not a box on a form that can be published showing how your institution is superior to another, it’s not an important issue. So what’s the answer? A handful of academic centers have started physician wellness programs, but no amount of exercise, meditation, or yoga can change the root cause of physician burnout. Until there is real dialogue on how the pressures of patient satisfaction and administrative nonsense are actually limiting the quality of care that clinicians strive to provide, the only immediate solution for doctors is a decrease in clinical time to ensure some longevity within their field. I know many outstanding physicians facing this dilemma, a true crossroads between metrics versus quality care and personal wellness. These are highly motivated patient advocates who are current on the most evidence-based practices, but who can see no way forward other than restricting their schedules, a real disservice to the patients they serve. Personally, since there is no initiative yet to change the factors driving this epidemic of physician burnout, I’ve decided to cut back in the hopes this will recharge my batteries and refill that compassion well within me that has been dried out for so long. I still feel a sense of shame when I think about how I felt towards that patient facing the end of her life, but I am grateful to her. Now when I sit down at the poker table, I have a handful of low cards and couldn’t be happier to fold. Source
