Burn Out: The Opposite Of Fun
In this opinion piece from The New York Times on February 8, anthropologist, psychoanalyst, and physician Eric Reinhart argues it is not burn out that is devastating medical personnel, but demoralization-“a sense of helplessness and loss of purpose.” He quotes that in 2021, “about 117,000 physicians left the work force, while fewer than 40,000 joined it.” He also notes that “nearly two-thirds of physicians report they are experiencing its (burnout’s) symptoms.”
Doctors may well be demoralized and that may manifest itself as “burnout.” But I think it is something even more fundamental.
For you doctors out there, tell me how you felt when you made a difficult diagnosis, or saved a patient’s life, or rendered care to a patient’s family in need. It felt good, right? It was, dare I say it, fun.
One of my therapists defined fun this way—pleasure, engagement, meaning. I think that gets it right. Many of us went into medicine not just to help people or for the intellectual challenge, but because we thought it would be fun. I can recall many times during my days caring for the ill that were fun even though so many days were anything but fun if a patient died (after all I was an oncologist).
Here was one that was fun.
One of my lymphoma patients at the National Cancer Institute was in complete remission. He came to clinic for his regular check-up as per the experimental protocol he was on, but he was feeling awful. He was lethargic and very concerned that his lymphoma had recurred. His blood counts were normal. I did what any good NCI Medicine Branch fellow would do. I restaged him with scans and blood work and x-rays. He was disease free. At that point I put on my internal medicine hat and asked myself what else could this be. To make a long story short, he had apathetic hyperthyroidism which was hinted at by his rapid pulse and a normal but tachycardic EKG. With the help of the endocrinologists, we fixed his hyperthyroidism and he was a very grateful patient. That was fun for me. It was the pleasure of really helping someone; the engagement of a challenging medical case; and the meaning of knowing that I had really made a difference in someone’s life.
In today’s see a patient every 15-minute world, it is very hard to enjoy caring for patients. There’s so little time to listen to them.
Doctors have ceded control of health care to administrators, insurance companies, and the pharmaceutical industry. Hospitals put profit above patient care and we, the doctors, have let it happen. In academic medicine the press for more cash on the part of the institutional leadership has crowded out research and education time for the clinical faculty. I know doctors at MD Anderson delivering patient care every day of the week. How can you develop an academic career this way? And how can this not degenerate into tedium? Being an academic physician is supposed to be fun. I believe that it has become anything but.
Programs in wellness are fine, but more yoga is not going to make being a faculty member at a major academic center the fun that it was when it was my turn to do it.
I have loved my job at times and dreaded it at others, but the constant grind of battling administrators, human resource departments, attorneys, and the electronic medical record suggests to me that the fun has been driven out of patient care and supplanted by burnout. The results of the recent faculty survey at MD Anderson bear this out.
If the leadership of academic medicine wants to address the underlying cause of burn out, it will have to do far more than just acknowledge the fact that the physicians are demoralized as Dr. Reinhart suggests. Institutional leadership needs to worry less about its own fun and try to return fun to the practice of medicine.
This may seem like a long stretch, but there is nothing more important that the academic centers have to do. It will also be good for the patients, not just the doctors.
A career in medicine used to be a calling. I fear it has become just another job. If anyone can change this, it is the doctors themselves. It has never been more important for academic faculty to push back against the conditions in which they operate and demand a return to good patient care, time for research, and demonstrating and appreciating concern for the education of the next generation of academic leaders. We should do this because it’s the right thing to do. And, it will be fun.