The Burnout Crucible

For the past three years, I have had the privilege every month of meeting with a remarkable group of medical students. I precept a group of about ten, discussing topics that range from death and dying to social media. The class meets regularly during the students’ third and fourth years. Through blog posts and discussion, they share stories from their clinical rotations and personal lives, things they witness and how they think and feel on the wards. We talk about culture, technology, and work-life balance, among other things. These students consistently inspire me with their passion, insight, and honesty.

My last group, members of the Class of 2015, set the bar very high for their underclassmen. Over the two years we met monthly, we shared myriad stories and loads of food. They came to my house and knew my children. We slogged through residency applications and interviews, and celebrated engagements, weddings, Match Day and graduation. I loved them. Being with them fed my soul and I could not imagine another group feeling quite the same.

In that time I was also growing my own interest in physician wellness and resilience. In 2014 I had the honor of presenting on physician burnout to the primary care providers at the Cook County Jail, one of the largest correctional facilities in the nation, with an average daily census of 9900 detainees. Can you imagine? I learned infinitely more that day than anyone in my audience—God bless each and every one of them!  Since then I have presented similar talks to members of the Chicago Medical Society, the American College of Physicians, and at the University of New Mexico. I have connected with other physicians similarly interested in helping our profession uphold its principal call to heal, starting with ourselves.

I can joyfully report that I am already in love with my new group of third years. They had me from, “This is why I came to medical school,” when they wrote about their first impressions of clinical rotations.  I could palpate their exhilaration and glee at finally getting to help take care of patients, rather than just reading about it and practicing on actors. In July I found myself practically commanding them to, “Print these essays out and hang them all over your apartment for later, when you hit the inevitable wall!” As if it were a foregone conclusion that the fire of passion in their training would dwindle and burn out.

Since the summer I have wondered, is it necessarily better to enjoy an ever-roaring fire? Or could there be greater value in the flagging smolder, and the attention and work required to re-ignite the flame? As the students progress in their training, we talk about behaviors that they witness—many inspiring, some not so much. We examine the potential origins of the latter. I ask them to assume that all of us, physicians, nurses, therapists, and other clinical staff, come to medicine to help people, and that we are all kind and compassionate people at heart.

What then, drives people like us to behave in such unloving, unkind, dismissive, and undermining ways? Emergency room doctors and nurses crack jokes and exchange snarky remarks about trauma patients, teams rounding on wards refer to patients by their diagnoses rather than their names. The students know the causes—they are the defining markers of burnout: emotional exhaustion, depersonalization, and low sense of accomplishment. It’s not intentional, it’s insidious. It’s toxic, and the medical community is waking up to the costs, both personal and institutional, of burned out physicians. It resembles a plague, infectious and potentially life-threatening, with few reliable treatments.

While I would never wish burnout on anyone, I also think that the process of rising from its depths to a new mesa of joy in medicine can be a good thing. For my students who articulate so clearly their Why for being here, maybe all it will take is reading their class blogs or med school application essays over again. Or maybe it will take deeper soul searching and acquisition of new skills, in mindfulness and stress management, prioritization and boundary-setting, to get them out of a burnout funk. Will those surviving this crucible be better physicians, better people, than those for whom the fire never dwindles? I don’t know.

I’m reminded of a TED talk by Ester Perel on infidelity. As a researcher, she’s often asked if she recommends that people have affairs, because she studies the personal growth that can result from the experience. She says she would no more recommend having an affair than having cancer. And, that cancer survivors will often tell you that they now live more fully and authentically because of their illness. Maybe burnout is the same? We don’t want it, it’s painful and destructive, but if we can come through it, we may be better for it.

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out. In my last session with the students, we ended by asking ourselves:

  1. What do I need (to take care of myself)?
  2. How will I get it (without harming someone else)?
  3. How will I be a contribution?

Maybe this is a good place to start.

23 thoughts on “The Burnout Crucible

  1. Hi Cathy,

    You raise several interesting points here while looking at burnout from different angles. In fact, that is one your strengths: turning an issue this way and that and picking out the perspectives that are less common or even counter-intuitive. I’m seeing now what a complex issue it is. There are internal and external forces at work that cause & perpetuate burnout and all sides must be addressed. Gosh, it must feel like being at the base of a mountain and looking up, wondering how in the world do I make it to the top? Although I think you’ve certainly come to a base camp and are ready to tackle the next leg. It will be interesting to follow your journey, even as a non-medical person since we all face burnout at some point or another.

    Liked by 2 people

    • Thanks as always for your thoughtful comment, Nancy! It does feel a bit overwhelming sometimes… And your base camp analogy feels right. To take it further, none of us can climb Everest alone, and competing against or racing one another to the top puts everybody at risk. So we need to go thoughtfully, together, one segment at a time.
      I’m excited to continue finding fellow climbers. We can each bring our unique experiences and gifts to the journey. I consider you to be one of those climbers, even though you’re not in medicine! As you say, we all experience burnout sooner or later, and I believe the essential solutions are the same no matter what our work: It’s about relationships.

      Liked by 3 people

  2. Thank you, Catherine, for another thoughtful and thought-provoking post. Regardless of tenure in the profession, reading this would be ideal to help any medical professional revisit their why and get in the habit of asking those three important closing questions. Your lovely post reminded me of a quote from Albert Schweitzer: “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” Thank you for being a spark for so many flames!

    Liked by 2 people

    • Thank you, Donna!
      This quote is perfect; I think Sir William Osler said something similar. There is a Schweitzer fellowship that medical students can apply for, I think, aimed at expanding humility and humanity in medicine. I found out about it after I graduated, and I really need to learn more about him! I think his writings and legacy could guide us well these days. Thank you for the reminder! Have a great week ahead! 😊

      Like

  3. Just the fact that someone is asking these questions gives me hope. I have always thought the brutal practices of medical school and residency akin to torture with impossibly long hours, little sleep and constant competition. It seems the last place compassion would be fostered.

    Liked by 1 person

    • Thank you, Sandy Sue! I think more and more of us are asking similar questions. We just need to find one another, pool our concerns and exercise our voice in education and policy. Movements like this start slowly, no doubt, and flourish most when grown from grass roots. So let’s keep watering the grass! 😀

      Liked by 1 person

    • Oh and despite the physical stressors of the long hours and such, there is no substitute for the relationship bonds forged through those intense, late night patient care experiences. It wasn’t all bad, and the work hour restrictions have not made it all better. *sigh* two sides to every coin, just gotta keep flipping it, I guess?…

      Liked by 1 person

  4. Once again, a wonderfully-intelligent post that applies in many areas besides medicine.

    I tend to think that cancer, affairs, and burnout are all things that no rational person would choose, as far too many don’t survive them and the damage they do. For the survivors, I’ve not known anyone who DID survive any of these and say they were glad they had to do so. Those who speak of their lives being better after may well have been ill for quite some time — or they rationalize the trauma into a chrysalis period, rather than the crisis it actually was.

    On the other hand, I haven’t known that many survivors of these conditions, so my experience may be atypical.

    Liked by 1 person

  5. Dear Catherine,

    This is a wonderful post–thought provoking and inspiring. I feel as awareness will increase people will get less burn-out. You are doing a great job in your profession and I feel many people are getting inspired by reading these articles as well. A little candle can light many millions up.

    Have a lovely day ahead.

    Love and light ❤

    Anand 🙂

    Liked by 1 person

    • Hi Anand!
      Thank you so much for your comment, and so sorry for the delayed reply! It’s funny you use the candle metaphor, I have always liked it. Because one person’s candle does not diminish, as long as there is enough fuel, no matter how many other candles it lights! So is the way of love and light, no? There is always enough, so we can always give away what we have! 😀

      Liked by 1 person

  6. Stumble upon your post today and read this very interesting and insightful article. Well written! I shall take time to explore more of your articles and looking forward to read more of your future ones too!

    Keep on sharing!

    Like

    • Hi Kally!
      Thank you for visiting, and I like what you’re doing on your blog, too! Isn’t it interesting how our strengths and gifts present themselves to others, sometimes even before we realize it? It looks like you’re doing a lot of good for people around you, yay!

      Liked by 1 person

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