With recorded rates of burnout up to 85% in medical students, nearly 50% in qualified doctors overall, and burnout rates reported to be up to 65% in some specialties our profession is in crisis. We cannot truly serve ill people if we ourselves are ill, and the doctors that are not burnt out are not necessarily truly well either.
In medicine diagnoses are based on laboratory tests. There is this notion that if there is a test for it, it must be real, and if there is nothing showing on a test then somehow it is not so real. Burnout doesn’t show up in a blood test or an x-ray, so how real is it for a doctor? Can we say that we have a condition for which there are no positive tests results? The medical profession has a tradition of dismissing and ignoring symptoms and conditions for which there are no ‘test’ results.
Doctors are not allowed to be sick – in particular they are not allowed to be sick about their work! To be sick about your work implies somehow that you are not good at your work and that you have failed. To fail at your work is a big ‘no no’ for doctors.
There is a culture in medicine that says that doctors have to be superhuman, they have to be masters of everything, know everything and be everything to everyone at all times. They have to be able to survive on no sleep, be courteous and professional at all times, know everything, give the best diagnoses, be able to cure everyone, along with the social expectation they should do it all for free as some sort of charity, simply for the ‘privilege’ of being a doctor, unlike every other profession where it is understood that you deserve to be paid for your expertise…
Doctors are supposed to be ‘the ones’ with ‘all the answers’. If you are a sick person, treating sick people, then how can you possibly have all of the answers?! Well, this is how the culture goes. To admit sickness, is to admit human frailty and acknowledge the fact that you are not the one with the answers.
In medicine, if you show signs of humanity and sensitivity, in particular signs of not coping, or finding things difficult, you are not supported: you are instead at times bullied, mocked, demeaned and labeled ‘impaired’. There is this culture that has you in fear of being bullied, of being thought to be less than capable and less than reliable by your colleagues.
There is a real stigma in medicine of mental illness, higher in medical students than colleagues where in particular colleagues with mental distress are thought to be less capable and less reliable than people with a physical condition. But, there is also stigmatization and a perceived stigmatization of having a medical condition.
Doctors are well known for not taking care of their health, for not having a GP, and to boot, there is the culture of ‘mandatory notification’ to the medical board of ‘an impaired colleague’ which tells you how much of a crime it is to be unwell!
There is no culture of support in medicine for doctors who are struggling, but rather an expectation that you will be able to cope and to handle everything and if you can’t, there is no system of support but rather a punitive system.
Under these systems and in this culture, it is not a viable environment for things to be discussed openly. There is no space for the honesty and vulnerability that is needed for health to be discussed and for issues to be addressed in a sensitive way. There is no room for professional honesty and true collegiality, nor for the offering of true collegiate support. Everyone is just doing the best they can to survive and get the work done.
Colleagues may tell each other they are tired, but more often than not what they are more likely to say is that they are ‘busy’. If you are ‘busy’ it means you are very successful. And this is what you are supposed to be as a doctor.
If you say you are burnt out, it somehow implies that you have failed as a doctor; it is like saying that you have a mental health condition where you somehow cannot cope with life. There is a huge stigma in this for doctors who are trained to be ‘the copers’ in life, the people who are tougher and stronger than others, the surviving gladiators so to speak, the last ‘man’ standing in a time of crisis. If you cannot cope, there is the very real fear that ’the system’ will see you as an inadequate doctor and remove professional endorsement from you, and cast you to the wolves metaphorically speaking, leaving you with nothing, no job, simply your mental and physical distress.
If there is a culture that does not support doctors, then how can they possibly be free to even admit or consider that they may somehow be struggling or need assistance?
In fact, why admit it if you already know there is no assistance available for you…
As doctors we are well aware of the limitation of counseling and psychiatry and medications. We are already primed to know the limitations of the type of health care that we provide and we already know there is no solution to burnout to be found in our profession, and of course naturally no understanding for it. So why would we even consider to be open to discussing it?
- There is the perceived culture your colleagues will not support you and
- There is no medical solution for it and
- There is the risk of being seen to be ‘impaired’ and hauled before the medical board and having your license taken away from you.
This culture makes it very hard for doctors to talk about how they are feeling and thus hard for them to be open to considering how they are feeling, and this means that they will not even be willing to be honest about how they are feeling: this means that it can be too late to help that person, and to help the patients that will be potentially be impacted when it gets too bad.
If we are not aware of or allowed to be aware of and honest about the way that we are feeling, then we can never heal anything. We will keep repeating the same patterns and behaviours that are hurting us in the same place.
Our doctors are hurting. Half of the profession is burnt out and something needs to change.
We need a culture of care and trust in medicine for all people, both doctors and patients.
We need the profession to be a safe space for honest dialogue about what is going on.
We need a culture that is willing to support them all, to be understanding and not treat doctors as ‘impaired’ but rather offer understanding and support. If those foundations are not there, we are unable to offer the true support to those in the profession who need it, and we are putting even greater strain on them.
Often when we look at things we can consider that things are overwhelming and that it is hard to change the culture of ‘the system’, and we feel that we have to wait for ‘the culture’ to change before we can start to give ourselves permission to do things a different way.
We are the culture of medicine.
Cultures are formed from the collective actions of people. ie the people in medicine and how they act and live, forms the collective culture of medicine.
People form cultures and the actions of each person collectively adds up to a culture.
Each person is very powerful in the effect they have within a culture.
We don’t need to wait for the ‘system’ of medicine and health care to change for us to make a difference in the lives of ourselves and others.
We are that change through the choices that we make ourselves in the way that we live on a daily basis.
We can bring this culture of care and trust to medicine by living it ourselves, and caring for ourselves.
This care begins with knowing that we are people and not ‘doctors’, and that we are human beings with feelings and sensitivities that deserve to be honoured, just like our patients.
We as individuals can start to care for ourselves, and look after ourselves and through that bring that caring approach to others.
Through that trust, care and communication, we will be able to foster an environment where doctors are able to be honest about what they are feeling and experiencing. Through being aware of what we are feeling and speaking about the way that we are really feeling we start to become truly empowered. It is through this awareness and self empowerment that we can address that which needs truly addressing in order to support our service in the profession, without the expense of our own health.
At the moment, too many are silent and through the collective cultural silence unaware of their own poor health.
In the silence, the medical profession is suffering, and with their suffering and ill health, so too are we all affected.
The health of the health care system depends on the health and care of the health care professionals. This is a matter that affects us all.
Lets get talking about burnout in the medical profession.
Stay tuned for my article on care in the medical profession….
The end. Dr Maxine Szramka