MD Musings

Physician Resilience: a Cause or a Symptom?

physician resilience burnout wellness awareness physician suicide

Physician Resilience: a Cause or a Symptom?
by Dr. Nadia

Do you ever wonder
what compels someone to walk away from their current life
to leave all they worked for—jobs, spouses, kids—behind?

The community around them are caught off guard
of how unhappy or unfulfilled or
the silent suffering
that made their life so hard.

We say it is shocking and act so surprised.
But that seems a pretense.
It’s no secret 
that compassion fatigue and physician burnout
are both on a steady rise.

For us in the medical community,
this can be an opportunity to reevaluate
To allow us to open the windows of hearts and souls
so our healers do not suffocate.

Medicine is an art, not a fast food service.
Stop telling us that’s how we should do it.

They are more than a number, so
please respect each patient.
This is a contributing factor to the rates
of rising disillusionment.

Being a physician
is an honor and a privilege
but it takes its toll
on a physician’s mind, body, soul.

How long can we ignore
the complex emotions that are not shared but stored—
the difficult cases, the trauma, the days of sleep deprivation,
the long hours, cumbersome electronic medical records,
the disconnect between ideal and real-world medicine
the pressure to be perfect
the physician dehumanization?

Over time that suppression
translates to cynicism and fatigue.
But because we’re doctors,
there is no time be weak.

When we were residents, we didn’t have a voice
But as board certified attendings, we have a choice
Keep our heads down and let things happen
Or speak up and take positive action.
I urge all of us in the medical community do do the latter
our physician decline is no laughing matter.

#physicianwellnessmatters
#nomorephysiciansuicide
#takebackmedicine

Why does this matter?

Recently, there has been a lot of discussion on physician wellness, resilience, the focus on burnout prevention, self care and the like. Certainly, those are great points. Physician wellness matters. Read more on things to know about physician work life balance.

However, putting wellness and resiliency in the same category is misleading. Calling it a resiliency issue makes it a personal problem, a deficit that needs correction. Read more on why physician burnout should not be linked to resilience.

Having gone through the rigorous training of medical school and residency, the choice of ‘resilience’ seems incorrect. If a person made it through all of that, decades of hard work, sacrifice, sleep deprivation, he is certainly resilient. Maybe it’s just semantics but word choice is important as is the message that it conveys.

Many people outside the medical profession may not be aware that the rates of physician suicide are staggering and the highest of any profession. In the US, there about 400 suicides per year, which is more than one completed suicide per day.

This is shocking and unsettling on so many levels.

Why is this happening?

What would lead someone who has dedicated multiple decades of their life to serve others to just end it all?

The canary in the coal mine

This expression originated from the days when miners would take canaries into the coal mines to detect the conditions of the mine. If dangerous gases were present, the canary would become symptomatic, ill, or pass away and the miners would understand that to be a reflection of the toxic conditions of the mine. They did not call the canary weak, blame it on a delicate constitution or a lack of resilience on the part of the canary.

Let’s bring this back to physician burnout and resilience. Are we minimizing the real issues? Isn’t it about time that we as a medical community take a giant step back and consider why these so called deficits–these resiliency issues–are occurring in the first place?

Is it really an individual physician issue?

Read more about the culture of wellness and resilience in medicine.

Could it be a symptom of a much larger issue, a systems problem?

Maybe it is time to assess the healthcare mines, the conditions to which physicians are routinely exposed during their training and careers.

How many more canaries will take it to make some positive changes to the culture of medicine?

*****

Thoughts? Experiences? I’d love to hear your perspective. Please share.

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30 Comments

  • Reply
    Mama, M.D.
    May 19, 2018 at 8:23 pm

    Couldn’t agree with you more! Resilience is one part of such a complex whole, glad to see some exploration of it.
    Just started following but wanted to say how much I admire what you’re doing in this space— keep it up!

  • Reply
    Lisa Sylvester
    May 20, 2018 at 3:20 pm

    Nice article looking into the minds of physicians and other “caretakers”. I’m sure most people completely miss this “burnout”… when a client/patient enters the office, she is focused only on her issue or problem.

    • Reply
      themindfulmdmom
      May 28, 2018 at 11:31 am

      That’s so true. Unfortunately, the media portrays physicians in a negative and dehumanized way so people forget that beyond our medical degree, physicians are people too. They have a lot of pressure, stress, and really are trying the best they can. Thanks, Lisa!

  • Reply
    youbethree
    May 21, 2018 at 3:10 pm

    I can’t find the like button lol. but this was great! “Medicine is not a fast food service” SO true. Love the honesty and the frankness of the way you addressed the topic. We need to talk about this more, get down to why burnout actually happens, and stop blaming doctors for not being good enough/strong enough!

  • Reply
    Crystal
    May 21, 2018 at 3:55 pm

    I think taking care of yourself is very important

  • Reply
    Aletha Oglesby, M.D.
    May 21, 2018 at 3:58 pm

    I recently shared a guest post on my blog by a woman physician who has chosen to leave medicine to have a better life with her family. While I applaud her courage to make a change that she feels necessary, I am sad that we are losing yet another caring competent physician. I do believe that the majority of physician “burn out” is a system or culture problem, not an individual clinician problem. Physicians are by nature and training resilient people, but everyone has their limits. Physicians should not have to pursue “wellness”, it should be a normal part of our world. The healthcare system should naturally do everything possible to support and nurture physicians so we can do our jobs to the best of our ability. We should not have to fight for this support. When physicians feel productive and practicing to our highest level, we feel energized not burned out. The current system seems more concerned with profit that with professionalism. I agree that it appears physicians will have to make this happen for ourselves, the system has no incentive to do it for us.

    • Reply
      themindfulmdmom
      May 28, 2018 at 11:29 am

      You are so right, Aletha. It is a systems issue and should not be lumped in the “personal problem” category. I am glad we are finally recognizing that we have a voice. Advocation will start with us and hopefully we can help add some positive changes into our field.

  • Reply
    heidi
    May 21, 2018 at 11:52 pm

    This is beautifully written. I am an RN in primary care pediatrics, and I can see the burden that is placed on the providers–they are pulled in so many different directions. In addition, between the insurance companies and other requirements and laws, they are limited in their ability to actually practice medicine how they choose. There are some days when I am so thankful I am the nurse and not the doctor!

    • Reply
      themindfulmdmom
      May 28, 2018 at 11:21 am

      Thanks, Heidi. There is a lot of pressure in the medical field and many folks feel overextended for the exact reasons you mentioned. Along with the increased demands, there is no outlet or focus on wellness and many physicians feel trapped. I hope as a medical field will take this topic seriously and fix these holes in our system to made it a healthy environment.

  • Reply
    Kristen Stuppy
    May 22, 2018 at 6:34 am

    I often wonder why some smart people end up doing very little with their life, yet those with less ability do so much. I think resilience is a key. Now the hard part is how to teach resilience to our kids … and to help those who are resilient not take on too much and eventually break. I think physicians are the type of people who are ingrained to work harder each day. That can only go on so long. Great post!

    • Reply
      themindfulmdmom
      May 28, 2018 at 11:18 am

      Thanks Kristen! Resilience is so important. Additionally, the right set of environmental conditions need to be present for anything to thrive. Even the most resilient person can have a breaking point. Physicians as a group have shown to go through very difficult conditions in training and hope it ends once they are in the ‘real world’. However, speaking with older physicians, it never ends. So, along with resilience we need to ensure the surrounding structure is one where physicians thrive.

  • Reply
    Amanda
    May 22, 2018 at 8:36 pm

    I had no idea about physician suicide. I can only imagine all the information and knowledge you guys have on a multitude of people at all times. How exhausting it is!

    • Reply
      themindfulmdmom
      May 28, 2018 at 11:15 am

      Thanks, Amanda. It is a sad fact. Unfortunately, administration puts pressure on them to see more and more patients and more demands. However, wellness of physician is not taken into account. It is a loop of unwellness. However, this conversation is being shared more now so hopefully changes will be made for the better.

  • Reply
    Safi
    May 23, 2018 at 8:44 am

    Wow such an important topic. Thank you for bringing this to light and for sharing your perspective!

  • Reply
    Holly
    May 24, 2018 at 12:45 pm

    It is the same in the vet world. I think it’s a shame, but I can see how someone who goes into a caring profession could get overwhelmed by all the demands.

  • Reply
    Marjie Mare
    May 24, 2018 at 12:59 pm

    Thanks for sharing such a great post. I feel like healthcare providers care for everyone but themselves, your post has brought light to me and I am seeing this issue with new lenses.

  • Reply
    Nanna wiik
    May 24, 2018 at 4:07 pm

    This was so interesting to read!

  • Reply
    Dena K Hubbard MD
    May 24, 2018 at 9:51 pm

    It’s like you are reading my thoughts. I appreciate your perspective and recognition that this is not a personal failure of 50% of our profession. How do we go about making systems changes and getting our autonomy back? I’m happy to collaborate! Neonatologist here and think AAP needs to help us advocate for ourselves and our profession.

    • Reply
      themindfulmdmom
      May 28, 2018 at 11:11 am

      Thanks, Dena! It is so important for this conversation to move to the forefront. I am glad that we are finally starting to take a step back and start advocating for ourselves. Let me know what you are thinking about collaboration. I think the first step is to label is as what it is: a systems issue and not personal problem. Then, changes can be made on a wider and more systemic level. Let’s keep the conversation going, share with friends and colleagues, and start advocating with our professional organizations. Keep in touch!

  • Reply
    Debrah Wirtzfeld
    May 28, 2018 at 2:17 pm

    I do agree that the terms resilience and burn out should not be related. They are often studied simultaneously with in the organizational behaviour literature. Burn out is a situational and limited condition, although this may stretch out over many years. Resilience is a trait which can be developed over time.

  • Reply
    Stacia
    July 24, 2018 at 9:57 pm

    Yes! Beautiful use of the canary metaphor. Calling us weak rather than addressing the conditions is neither accurate nor fruitful. Thank you for these thoughts.

  • Reply
    marshaled
    March 12, 2019 at 5:05 am

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