Physician burnout has reached critical proportions. It has been shown to affect more than 1/3 pf doctors. Many of them are depressed and feeling like the profession has not lived to their altruistic, humanitarian expectations. Some feel trapped in a health care system that mistreats them and their patients. What to do?
I left the system. I did it for me and my patients. I only make ¼ of what my colleagues make, but I am happy to spend more time with my patients. We jointly decide on trimming off the fat, the unnecessary bloated treatments designed to do little more than increase profits and treat the very fear the system plants in the hearts of patients.
I knock off early to take a nap. I get up to answer messages and then I read and write for the rest of the day.
References
Physician Loneliness: Just Me and My EHR –
Brandon Cohen, Medscape – Mar 14, 2019.
“A recent article by Dr Gregory A. Hood examined the issue of isolation among physicians. In particular, Hood was concerned about professional isolation and posited that modern doctors found less support and friendship among colleagues than had been the case for previous generations. He also wondered whether contemporary modes of learning and practicing medicine contributed to this increased loneliness. This led to lively, and often anguished, discussion in the comments.
Many felt that the article was spot-on and shared their own pain. An internist kicked things off: The joy of medicine is dying, and the art of medicine is also a thing of the past… Medical school was challenging, but it could be fun. The two residencies that I chose to do were even more challenging, but the love of learning and growing as a physician made it a magnificent time… Whenever asked if I would choose medicine again, I never hesitated to say “absolutely” until three years ago. If I knew then what medicine was going to be like once I hit my 50s, I never would have chosen this.
A urologist also recalled better days: The hospital used to be a place to interact: I would call a referring person with my consultation recommendations and discuss the patient’s care with nursing. Everybody benefits… Now, many specialists wouldn’t recognize their referring physicians and vice versa if they passed them on the street.
An emergency physician agreed: When I was in medical school we studied in groups, in clinical we all hung out together and talked about the patients on our services and compared the way our attendings treated the same diagnoses so we could learn from each other… Nowadays there are less and less of these gatherings… We used to have medical society meetings, hospital staff meetings and general monthly get-togethers… It is a shame, we all could benefit from the shared knowledge of our peers.
A psychiatrist took the baton from there: I miss medical school and residency. I never, ever see the other psychiatrist I work with. In residency, I would have time to stop by my colleagues’ offices and talk or just vent. Now it is just a race to get to leave the office at a reasonable time.
Many colleagues looked to pinpoint the source of the problem. A psychiatrist spoke for many: The emphasis on salaried hospitalists in academic centers, on speedy discharge, financial focus on discharge planning as well as the harried comportment of today’s paperwork-skewered physician has greatly contributed to this [increased isolation].”
How Healthcare Is Causing ‘Moral Injury’ to doctors,
Leslie Kane, Medscape – Mar 13, 2019.
“Pressured Into Situations That Violate Their Beliefs. Being a physician is not like any other job.
Doctors witness suffering among people they’ve come to care for. They’re intimately involved in decisions involving life and death, pain and suffering, and quality of life. Many of the situations they face involve wrenching, frustrating ethical quandaries. At the same time, physicians are overworked, pressured with productivity targets, and stymied by regulations and rules. Today’s healthcare system often prevents physicians from being able to deliver the care that they feel is right and best for the patient.
The impact of dealing with feelings of dismay and helplessness over not being able to “just be a doctor,” and the inability to resolve frustrating ethical dilemmas in a positive way, assault a person’s emotions and psyche. Some have called it a “moral injury” that is being inflicted upon physicians.
“Working in healthcare is not like working at Google or some other corporation,” says Carol Bernstein, MD, a psychiatrist at New York University’s Langone Medical Center. “Physicians are dealing with people who are really frightened and scared. You’re trying to help them, trying to make them better. That’s why many doctors think of this profession as a higher calling.”
“Physicians talk about the corporatization of medicine, with the imposition of all the guidelines and regulations,” says Bernstein. “It makes doctors less able to deliver the care they want to deliver, which contributes to burnout and stress, which harms physicians and their relationships.”
Moral Instead of Physical Injury
The concept of moral injury arose in relation to military situations, in which soldiers in time of war were required to participate in situations that violated their own moral and ethical codes. Jonathan Shay, MD, PhD, psychiatrist in Colrain, Massachusetts, described a form of moral injury that occurred when service members were forced to do something that violated their own ideals, ethics, or attachments. Soldiers could experience the moral injury effect simply from witnessing or learning about acts that breached their own moral beliefs and expectations, according to Michael D. Matthews, PhD, professor of engineering psychology at the US Military Academy in the Department of Behavioral Sciences and Leadership.”
Too much medicine
BMJ 2015; 350 :h1217
“Overdiagnosis means different things to different people, say S M Carter and colleagues in their exploration of the social and ethical dimensions of too much medicine (doi:10.1136/bmj.h869). Born out of the Preventing Overdiagnosis 2014 conference in Oxford, their article and others in this special collection (thebmj.com/specialties/digital-theme-issue-overdiagnosis) serve to presage the next conference in Washington, DC, in October 2015, for which registration is now open (www.preventingoverdiagnosis.net). There is much to discuss: how should we define overdiagnosis and its ugly siblings, overtreatment, medicalization, and disease mongering; what do we know of their causes; and what evidence-based solutions are available, both general and specific? Above all, who gets to judge when care is inappropriate in any individual case? Pulling this theme issue together, Helen Macdonald and Elizabeth Loder conclude that decisions on what constitutes “just right” medicine are best made by individual patients in true collaboration with their doctors, armed as far as possible with relevant, reliable, and independent information about benefits and harms (doi:10.1136/bmj.h1163).”
