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:
- What do I need (to take care of myself)?
- How will I get it (without harming someone else)?
- How will I be a contribution?
Maybe this is a good place to start.