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Physician Burnout and the Cult of Medicine

Posted on 16 March 2016 by Adam Kovacs-Litman

I want there to be no mistake. Medicine is the most incredible profession. It intertwines a divine understanding of scientific principles with their very human application. It is one of the few professions that starts with atoms or cells and ends with people and emotions. It begins with universal laws and ends with subjective truths. Medicine is science, but it’s also poetry. Medicine exists in cosmic balance, but that balance is temperamental.

Those working within the health care profession are well aware of a phenomenon known as “physician burnout”. It is characterized by emotional exhaustion, depersonalization, cynicism and a lack of fulfillment. Studies estimate that physician burnout can affect as many as 65% of physicians. Many are surprised that such an intellectually and emotionally rich vocation can leave one drained and unfulfilled. Dr. Christina Maslach, an American psychologist and creator of the Maslach Burnout Inventory (MBI) perfectly described burnout as “an erosion of the soul”.

Maslach’s description makes a lot of sense to me because medicine is not a profession in the traditional sense. Medicine is a religion. It demands long hours and years of study – it demands sleepless nights and tireless days – in some aspects, it demands indoctrination.

We do not wear religious shawls, but we do wear white coats. We do not worship stars, crosses or crescent moons, but openly revere snakes coiled around a winged staff. Our holy text is the Hippocratic Oath and our prophets are many: Hippocrates of Kos, Galen of Pergamon, Lister of West Ham, and Koch of Clausthal are but a few. We even have modern day prophets like William Osler and Atul Gawande and false prophets like Ben Carson or Eric Hoskins.

Viewing medicine as a religion makes physician burnout easier to understand because a religion demands that life be made secondary to the divine. Medicine demands that patients always be put first and it demands that you live your life in the shadow you cast. Some have called medicine a Black Art and in some ways it is. It is perhaps the only profession that consumes the soul of the practitioner. The quest of medicine is Faustian. Many medical practitioners will pay a heavy price for the miracles they work.

I’ve read much of the literature on physician burnout and while the conclusions are accurate, they are often uninsightful. Deckard et al. (1994) correctly identify emotional exhaustion as the leading cause of burnout. Gundersen (2001) correctly concludes that certain personality profiles are more at risk of burnout. Shanafelt (2009) even claims that we can combat burnout by realigning organizational values such that patient care be given equal importance to physician well-being.

Shanafelt’s study best addresses the crux of the issue. Nothing will change unless we reorganize the value structure of medicine. Doctors burn out because they practice a toxic ideology. A man may subsist, but they cannot survive without a soul.

I believe that people really do go into medicine for noble reasons. They want to make a difference, help people… change the world, and are often willing to sacrifice themselves in the process. Unfortunately sacrificial offerings will not make the elusive “work-life balance” any easier to attain.

This is not a critique of medicine. I repeat that medicine is an incredible profession and one that I am grateful to be a part of. This is instead an invitation to examine one’s values and the values that are thrust upon us.

A man cannot sustain himself on ideology. Anyone who eats the body of Christ and nothing else will receive poor nutritional value. Surprisingly, the blood of the Lord is not rich in iron.

References

Deckard, G., Meterko, M., & Field, D. (1994). Physician burnout: an examination of personal, professional, and organizational relationships.Medical care, 745-754.

Gundersen, L. (2001). Physician burnout. Annals of Internal Medicine,135(2), 145-148.

Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual. Consulting Psychologists Press.

Shanafelt, T. D. (2009). Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA,302(12), 1338-1340.

Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., … & Oreskovich, M. R. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of internal medicine, 172(18), 1377-1385.

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