Time is baffling. It seemed like just yesterday that I sat in a posh auditorium in Chicago, an enthusiastic young adult on my first day of medical school orientation at Northwestern University in 1995. Eighteen years later, I was a 43-year-old burned out physician, practicing in Boise, Idaho, searching Google for the most effective way to end my life. During my time of maximum burnout, I was the type of physician that I never wanted to be: impatient, sarcastic, and occasionally dismissive of my patients. I made caustic jokes about some patients in the lunchroom. In short: I was not happy. Dear Doctor: Are You Stressed Out? As I learned about the problem of physician burnout, I came to recognize that I was not alone. While researching the subject of burnout for a book I recently wrote on the subject, I learned that burnout is not some psychological abnormality too embarrassing to speak about in public. Quite the contrary. For example, a 2011 survey of over 2000 US physicians found that 87% reported feeling moderately to severely stressed or burned out on an average day.[1] On the extreme spectrum, female physicians have a successful suicide rate of 250%-400% higher than their counterparts in the general population.[2] Something very alarming is going on in the American healthcare system nowadays. Doctors aren't happy, and neither are patients. The proverbial admonition, "Happy doctors make for happy patients" comes to mind with the caveat that the reverse is also true. What Does Physician Burnout Look Like? Three defining symptoms characterize physician burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment. If a physician is suffering from all or even just one of these symptoms, he or she likely is experiencing symptoms of burnout. A physician with burnout may experience all three of these symptoms simultaneously or only one at a time. Emotional exhaustion. This is manifested by a physician feeling overstretched by the professional responsibilities of the job and having absolutely no reserve left. Emotional exhaustion is somewhat akin to a car that has run out of gas. As an example, when I was in practice, I came home every day psychologically drained. I had no emotional resilience for response to the normal, mundane hassles of everyday life outside of work. My young daughter becoming sick with a virus felt overwhelming and burdensome. Physicians suffering from emotional exhaustion have frequently invested so much energy into taking care of their patients and worrying about their patients' problems, as well as dealing with work-related issues, that they simply have nothing left for themselves or their families. Further compounding the problem of emotional exhaustion are the incessant work-related demands imposed on physicians outside of their daily work schedule. Physicians are frequently on call at night and on weekends. Medical students, residents, and fellows in training have to take call and sleep in the hospital, and they may work up to 30 hours in a row without a break. Additionally, physicians are expected to spend their limited time away from work keeping up to date with the myriad medical advances in their field and to constantly be studying to maintain their board certification status. Depersonalization. The second telltale sign of burnout is depersonalization, a process of detachment from others. Physicians experiencing this symptom view their patients as objects or things rather than actual human beings. Physicians experiencing depersonalization have described feeling robotic. Their interactions with patients focus primarily on controlling how much time they will be forced to spend with the patient instead of addressing the patient's underlying problem or medical condition. It's as if the names on the physician's daily schedule are no longer people but rather tasks to be checked off a list. Physicians have likened the experience of depersonalization to participating in a movie or TV show, acting out a role that doesn't seem authentic to them. The physician is cognitively present but emotionally absent. Depersonalization is a coping mechanism, albeit a dysfunctional one, in which physicians try to protect themselves from their patients by distancing and emotionally detaching themselves from them. Depersonalization is very common in modern medicine. Doctors suffering from burnout can become extremely cynical and jaded in part as a defense mechanism. They don't like it when patients are noncompliant, rude, or needy and seek emotional protection by detaching from them. One could argue that the very process of medical training serves as a fertile training ground for depersonalization. If doctors invest too much psychological energy in patients, then they would be completely overwhelmed every time a patient became severely ill or died. When a physician loses empathy and is unable to feel compassionately toward his patients or himself, depersonalization is taken to an extreme. Compassion and caring are replaced by caustic jokes and sardonic remarks in the break room. One example that exemplifies depersonalization occurred when I saw a physician speaking on the phone with a patient who had called to thank the physician for his care. After getting off the phone, the doctor shook his head and said, "Senile old joker." Depersonalization can also be described as "compassion fatigue." A perfect example of compassion fatigue occurred when a burned out physician told me about an encounter he recently had with a patient. The physician stopped by the patient's room and informed him that an MRI had confirmed that the patient had a mild stroke. When the patient tried to elicit more information, the physician grew frustrated because he was behind schedule and felt he had already provided the pertinent information. The patient then began to cry, and the physician became exasperated, frustrated because the matter was taking up a lot of his time. The physician told me he was incapable of putting himself in the patient's position and that his "empathy reserves" were depleted. After this episode, the physician came and talked to me, eventually seeking help. Lack of personal accomplishment. The final characteristic of burnout is a lack of feelings of personal accomplishment, deriving no personal joy or meaning from work. Many physicians have described losing or shrouding the youthful idealism that characterized their time as medical students as a consequence of the stress and anxiety associated with the practice of modern medicine. They no longer derive any satisfaction from work. The job has become solely a source of income in which a physician attempts to dodge the possibility of potential litigation from any missteps. The physician is no longer proactively looking for solutions and is just trying not to miss anything, checking off the necessary boxes on a computer monitor. He is in survival mode. Physicians in this stage may begin to doubt the quality of the care they are providing in addition to their growing belief that their work lacks meaning. Many physicians report that they went into medicine to help others, but the joy of that ethos was lost during the course of their career. On a personal level, when I lost my joy in the practice of medicine, going into work literally felt like a prison sentence. While helping other physicians navigate through burnout, I have been amazed at how frequently I hear that exact same analogy. One physician told me, "Driving to the office everyday was a jail sentence, but I told myself at least I have my weekends and nights off. I hope to retire in my mid-fifties so I have about a 14-year sentence left." Source
