“Doctor, you’ve been duped,” she said as she took slow, careful breaths of oxygen from the heated high-flow nasal cannula. These were definitely not the words I was expecting to hear. Responding to the perplexed look on my face, she added, “I mean I can tell that you are well-intentioned and a good person. But Bill Gates and the Minnesota Department of Health have altered the databases. Bill Gates wants half the world’s population to die. That’s why he is pushing this and other vaccines.” She did not have a psychiatric history and exhibited no signs of encephalopathy. I searched my mind for what it does best, found a diagnosis for this condition, and it landed on “shared psychotic delusion. ” In this case, the shared delusion is that of millions of people. And no amount of yoga, meditation, and wellness exercises are going to help fix the brunt from this for physicians. I started on my journey of understanding physician burnout in 2016, largely thanks to the Bounce Back conference in 2016. Supported by many well-intentioned organizations, I found words for what I was witnessing around me at that conference. I learned about everything that was right and everything that was wrong with me ( and all physicians) that was causing us to get burnout. It had a price tag, almost half a million dollars for every unexpected physician loss. We needed to be more resilient. We needed to invest in self-care. We needed to find more time for ourselves in already full days. We needed to spend more time with our families. We needed to learn to be less critical of ourselves. We did forgiveness exercises in which we apologized to ourselves and thanked ourselves. We learned about gratitude. We needed to become more “resilient” I left the conference full of enthusiasm, and I was on a mission: I had a laundry list of weaknesses I needed to build bulletproof armor. I had to become Super Woman. Next few years, the same conference and “physician burnout” phenomenon in literature started to take a different tone. The brilliant thought leaders who had walked down this path started to realize that something was wrong with this picture. This picture painted of a burnout physician, the delicate, inept human being who didn’t feel right due to self-neglect had asked for this affliction. Come to think of it, we are pretty darn resilient people. I mean we went through an average of 7 years of just medical education that demanded discipline, financial hardship, ridiculously difficult exams, the constant sacrifice of missing holidays and weekends, never-ending days, the constant threat of malpractice. I mean, we write more legal documents daily, more than an average lawyer does, and in less time in the form of medical documentation. We also write in a special constantly evolving language that allows the chart to act as an invoice for coders. We answer dozens of messages, attend countless meetings, meet never-ending practice criteria and keep up with practice guidelines, constant medical education, and have to re-earn our board credentials every few years. We also take care of 15 to 20 very sick patients when not doing everything else. Then we also have families. So, we are resilient. What is this burnout then? It is “moral injury,” said ZDoggMD — that hit home. Suddenly everyone was angry on the internet. We did feel injured. ZDoggMD had hit the nail on the head. It was not that I needed to be more resilient. The responsibility was off me; I had been injured. When there is an injury, there is a culprit. Who was the culprit responsible for this injury? The next Bounce conference and other thought leaders elaborated that the broken health care system — the corporate encroachment, the profitable nature of health care in the United States, the insurance companies, the ever-increasing administration, and the EHR — had caused all this injury. Physicians worldwide practiced medicine but didn’t have this kind of burnout. Something about the health care system in the United States was doing this. So it wasn’t the fault of American doctors. They are not broken. The system is. I breathed a sigh of relief. I was OK. I was a pretty resilient human being and need not spend time scolding myself for internal inadequacies that could be fixed by yoga, meditation, gratitude diaries, for which I never seemed to have time (my fault again). Then came COVID-19 — a nightmarish beginning straight from a Hollywood movie, followed by a mantle of hero-dom and then never-ending conspiracies and misinformation. The vaccine ended nothing. It has added another angle to this burnout. People are suffering from a largely preventable disease in front of our eyes, at least in the hospital Physicians are suddenly facing pay cuts of enormous proportions. At the same time, other health care workers have created an immense market and demand for their services that ironically has to come out of the physician’s work. Some health care systems are reporting record profits in 2022. Add economic uncertainty and future to this profound mess. Sometimes, this profession seems to have no joy left anymore. I did not know Dr. Matthew Lieser or his exact circumstances, but I found the news of his death in such a tragic way absolutely devastating. It somehow felt personal. He was a beloved physician, father, and community member. I don’t know what took away his resolve to be alive. But this is a reminder that very high rates of physician suicide are a reality. This moral injury is only getting worse. I did want to share the obituary with all the hospitalist colleagues in the system. He was a regular ordinary “hospitalist,” just like me. He was one of us. May his soul rest in peace. Source
