Physician burnout may not happen. But “burn in” is guaranteed.

12.04.2017
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I saw a new residency graduate post about how balanced she will choose to be and how not taking work home would keep her idealism alive. Like a woman who has been pregnant and gone through delivery and postpartum, I wanted to tell her the truth about how emotions get changed in practice and how the emotions become physical ailments at times.

I wanted to tell her birthing and raising a baby isn’t always lavender and lace.

When I started practice ten years ago, I would hear the seniors talk about taking call and traveling from office to hospitals and how a high census was draining their “old bodies.” I felt like a fresh packet of Pop Rocks. I rolled my eyes and asked to double the load for side money. I had a one-year-old then, and she was built to be my daughter. My husband was supportive, and my soul was intact. Never did I see an end to my stamina.

Four years later I dug deep while pregnant with my son and took all my call ahead and performed the entire pregnancy in the top 5. I left for maternity leave and for the first time thought I missed a lot of my first child’s childhood.

Then it happened. After my son was born, I was vulnerable and tired. The juggle of home and now the full practice was weighing on me. It was surely the hours, but it was also the mounting nature of medicine. I had proudly and nobly crafted a practice based on individuals and their specific needs. They came often desperate to have someone hear them. Some came with looks on their faces as if it was the first time in their entire lives they were heard.

I had aged. A lot. I dare say acceleratedly so. Cortisol broke down collagen, and I felt bone on bone in my joints at times. My hair and skin felt dry. I was drying up like a desiccated leaf broken off the tree of life.

I kept going. While pushing through my son’s first year, talk of cutting back hours and duties was a frequent conversation. Part-time doctoring is a misleading concept. You have to run a full-time concern regardless. By the time the director called me to discuss it all my son could eat solids and I was pumping 64 ounces of milk a day; often 15 ounces in 5 minutes so I felt awake again.


“No, I’m OK,” I said.

Eight years into practice and the EMR kept changing, and each EMR had new features and new blanks to fill up and boxes to check. Prior authorizations were sent for drugs older than me and cheaper than a movie ticket. Then the utterly crazy happened and the prior authorizations were being scanned into the EMR and to fill them out required a dozen clicks to create a virtual signature. I stumbled along feeling like I had seven thumbs and no ink in my pen all the while I felt I had experience and a lot of knowledge.

“I know stuff!” but I couldn’t seem to empty my inbox because I was having an error message come up. I had to make patients 2 or more separate appointments to cover everything.

The office got new phones, and they forgot to correct the prompt message and the phones wrongly instructed people to dial “1” which circled patients around again to the greeting. My new phone had a strange cord that was only 12 inches long. When I picked up the receiver as I had done 10,000 times before and placed it in the crook of my neck then turned to type on the computer or sort through papers on my desk the phone crashed to the floor yanked hard by my time saving.

I wanted to laugh, but I was late for the next patient that was double booked because of a potential 10 percent no-show rate. Overhead has to be paid despite decreasing pay to the physician and cost shifting to the patients. Each Congressional session held hostage decisions to revamp, revise, and decrease revenue. Sometimes the threat was a more than 20 percent reduction in payments. I felt tired. I got gastritis.

But that was not the nature of “the burn.” I woke up realizing who the enemy remained as my phone crashed and startled me. Disease, suffering, anxiety, uncertainty, early death, sudden death; these lay as the real combatants. I would still go home mourning patients’ stories of lives changed and broken. I lost by then a hundred patients who had become friends.

What has not changed despite the years is I still listen, and when I listen I absorb and what I absorb are feelings. These feelings make me remember details, try to fix problems with urgency, and try to win against dying and death. Like a water wheel at a mill, I begin to generate the electricity to generate action once I hear and feel my patient. Their feelings give me reason and alertness to think and organize and execute.

And it’s a burn … in. It is a burn into me. And I’m taking it home or wherever I go. It’s caring. And when those moments happen where the problem can’t be fixed failure and loss chip away a little of my effervescence. Thankfully the right perspective or peace despite loss or occasional success will rewick my soul.

Burnout is not what will happen to us all, but burn in is guaranteed. Being aware of the burn in will let doctors continue to stand to defend what is beautiful about medicine and not burnout. The burn in is the branding of journeying fully with another human. Never should we call an end to it happening but certainly some awareness it is the by-product of medicine and some latitude to allow its’ occurrence will save more souls than the new EMR, the new phone system, a meager 12 inch cord of communication, and cost cuts and shifts.

Feel the burn new grad. Welcome to the profession.

Image copyright: Derek Gavey/flickr/CC BY

Article last time updated on 18.04.2017.

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