From passion to burnout: When a doctor’s love hurts

If only I had managed Mrs. Smith’s blood pressure better, she wouldn’t have had that car accident.

If I had made the case for a statin better, Mr. Wu would not have had the diverticulitis episode.

These types of thoughts have been with me for all of my decades of practicing medicine. Somehow, I’m supposed to blame myself for things that are less than ideal about my patients’ situations and about which I have no control.

Regardless of their irrationality, they come again and again, delivering their relentless message: “If only I were a better doctor or tried harder, the world would be better for my patients.”

The upside is that patients, malpractice lawyers, and people who manage health care systems love doctors like me. The downside is that these trains of thought are unpleasant journeys to nowhere. Despite this, it has only recently occurred to me that I should get off of this train. Staying on the train has made me do lots of double-checking and extra research that has benefited my patients. Getting off the train felt scary.

The pandemic has changed that train. The train now looks like it has an engine fire that’s putting me at risk of burnout.
I never used to worry about the possibility of burnout. I found my job to be fun and engaging. That’s why I became a doctor. Everything would be OK as long as I didn’t take on too many hours or too many patients.

It never occurred to me that the health care system might start falling apart. The support I could once rely upon has become unreliable. Now that this has happened, I no longer have energy to spare. Now, I not only have responsibility for my patients; I’m also responsible for keeping the system from falling apart. Habits of mind I could previously tolerate because of their patient benefits now risk burning me out. I must re-examine my priorities.

In this re-examination, I have come to understand that the main reason I have taken responsibility for things that are obviously out of my control is because the true nature of the world is too painful to acknowledge. I would rather believe that if bad things happen to my patients, it is because I am not a good enough doctor, than face the unpleasant truth that bad things happen all the time – and I can’t do anything about it.

The result of embracing my comforting myth is that I have created a hamster wheel of impossible labors. All I need to do is learn more facts, get a better understanding of obscure diseases, and become more persuasive in my recommendations that patients should lose weight, control their sugars, and stop their bad habits.

Prepandemic, this myth may have been helpful. It isn’t anymore. Now, I have patients who are at risk of death because no specialist can see them in time. Unlike in the movies, I cannot jack into the Matrix and become an experienced endocrinologist in just 5 seconds. The labor shortage is so bad that the reason I have time to write this essay is that my morning appointments had to be canceled because there was no medical assistant to run me.

In this new era of perpetual scarcities, I find I can no longer afford the luxury of my myth.

Mary Braun is an internal medicine physician.

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