I had an off week a little while ago.
Nothing terrible, mind you. No catastrophes. But things felt a little more tedious. I had to schlepp around a little more than usual And a few clinical judgment calls I made turned out wrong. Patients who I had thought would get better got worse instead, and my management played a part in that.
I can go back and look at both judgment calls and see the reasoning behind the decisions I’d made. In fact, after things didn’t go the way I would have hoped with one of those patients, I had the chance to explain my rationale to her parents, who were able to understand why I made the call I did. I could point to X and Y, which led me to make decision Z. And again, nothing catastrophic happened.
But still the wrong outcome. And two wrong calls in one week made for an off week indeed.
What troubles me more than simply having been wrong was that I remember being annoyed when I walked into one of the patients’ exam room. It would be the very definition of imprudence to go into detail about why I was annoyed. Suffice it to say that some pre-existing detail of the patient’s management had irritated me, and I carried that irritation into the appointment. Did it negatively impact my decision-making? As I said, I can look at the details of the visit and justify my decision on the merits. I could quite easily have come to the same conclusion in the most perfect of moods.
But in this case, I’m not sure if my mood didn’t play a part in my clinical decision-making, reasonable as it may have been. I’m not sure. I’m not sure.
All of this sprang to mind when I read this essay about doctor burn-out.
Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. The researchers then compared the doctors’ responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender, age, number of hours worked and amount of education, the doctors were still more likely to suffer from burnout.
The doctors’ burnout appeared to have little to do with hours worked or even the ability to balance personal life with work. Instead, the only factor predictive of a higher risk was practicing a specialty that offered front-line access to care. More than half of the doctors in family medicine, emergency medicine and general internal medicine experienced some form of burnout.
It behooves me at this point to make clear that I don’t actually think I’m burned out. I think I was having an off few days, and have had plenty of good days since. I love my job as much as I can imagine loving any within the medical profession (I’m still willing to consider a career in Oscar-season color commentary… call me, E!), and enjoy my colleagues and patients a lot. I get up most days glad to go to work, which wasn’t true with any of my previous jobs from residency forward. I’m happy to be doing what I do.
But I sure can see how it would be easy to get burned out, and how burnout would lead to compromised patient care. If I can remember being merely annoyed during a clinical encounter and wonder if that made a difference in the choices I made, surely feeling disconnected on a consistent basis could negatively impact clinical decision-making over time. And patient care is far too important an endeavor to be treated with indifference or resentment.
I think there are a number of factors that can lead to burnout. One of them is something I’ve already alluded to in this post. Everyone has off days in their job, I’d imagine. Not to get too highfalutin’ about medicine, but in the case of doctors a bad day or wrong judgment call can mean someone gets sick or worse. In both cases I mention above, I made decisions that seemed sound at the time, and even now easy to explain if I were made to do so. But simply making the wrong call led to a couple of patients getting worse instead of better. I’m relatively young in my career, but I can certainly understand how a couple of decades of reasonable but wrong judgment calls could wear on a doctor.
Furthermore, there is still an ethos within the medical profession that tells doctors that their vocations should subsume all other aspects of their lives. That I think this attitude is for the birds does not mean it isn’t still quite pervasive. Not only do I think it is for the birds because it isn’t good for doctors, but it’s also not good for patients. The time I spend with people I love, with my friends and family, leaves me happier and more ready to attend to my work when I am there. The things I do for recreation (running, reading, being a part of this online community) give me some distance and respite from the depredations of a stressful career, and when I do have an off week allow me to bounce back and have a better one next time.
As that “doctor as god” mentality is rightly consigned to the rubbish heap of time, I hope a few things can occur that will be better for physician and patient alike. Indeed, I think they are already beginning to happen. I hope that doctors and patients can find better ways of communicating with each other, so when reasonable but wrong clinical decisions are made it doesn’t immediately become adversarial and litigious. (This doesn’t apply to situations where incompetence or negligence are factors in the mistakes, which are a different ball of wax altogether.) And I sincerely hope that newer generations of physicians are happily abandoning the notion that all other aspects of their lives must be subordinated to their careers.
As I said, I had an off week not so long ago. But my patients are fine, and so am I. Hell, I might actually be a little tiny bit wiser for having made a couple of wrong clinical decisions. I’m still delighted to do what I do. But I hope I know how to take care of myself well enough to keep a bad week from becoming a typical one. My patients deserve more, and so do I.