Doctor Burnout: Are We Missing The Elephant in the Exam Room?
A few years out of residency training, I was already feeling the early symptoms of burnout: a loss of motivation in my day-to-day work, and sometimes a feeling of being trapped. Part of this was due to the fast-paced demands of outpatient care. In primary care, I felt overwhelmed by administrative duties, insurance guidelines, and cramming in too many patients into a single day. More so, I felt at a loss for treatment options. In my hospital-based training, acute exacerbations of chronic diseases felt readily treatable with drugs and procedures. But in outpatient medicine, where I was trying to meet patients and their chronic conditions in their day-to-day lives, I felt like the tools in my doctor's bag were few and far between. Anti-inflammatories, antidepressants, and acid-suppressing heartburn medications could only stave symptoms off for a period of time. Patients would be back. Sooner. Sicker. And more frustrated. This pattern fueled within me a frustration toward my own patients--the very people I'd gone into medicine to serve.
One strategy I took, which was also fueled by my own personal health challenges, was to get trained in integrative and functional medicine. Integrative means approaching the body holistically, as dynamic systems rather than isolated organs. Functional refers to the optimal functioning of the body, which involves going down to the root causes of inflammation, the common denominator for chronic conditions. So I added to my doctor's bag a wealth of tools: therapeutic diets, vitamins and minerals and other supplements, movement strategies, mind-body-spirit practices, grief work, and hormone balancing. Personally, I took restorative retreats, modified my schedule for greater work-family balance, eliminated my commute, and set a real intention to "practice pleasure," as I called it. I learned the ukulele, hiked and camped with my family, watched funny movies, and returned to reading novels.
Still, I felt the symptoms of burnout at work simmering within me. I saw the signs in my integrative and functional medicine colleagues, too. Because that's just it--burnout is a symptom. It's not the root of the issue. There was something larger, something more hidden, that wasn't being addressed by me personally. And it certainly wasn't being addressed by the medical culture as a whole.
At the root of burnout is detachment and disconnection. I don't believe we can begin to heal detachment without confronting the elephant in the exam room: grief. With the nature of our work, we're encountering patients in their deepest fears, in their most vulnerable states, and we seem to be taught 2 options: carry it, or detach. If we carry too much of their grief, we risk getting sick ourselves. If we detach in an effort to protect ourselves, we can cope, we can function. The trouble is that we can't heal something or someone we're detached from. What's more, when we detach from others, we also detach from our own humanity. We become robotic.
So how might we address burnout beyond symptom management? We can learn from the ancient medicine men and women who came before us--to embrace grief as a fundamental part of being human, and to respond to grief in a healthy, affirming way. In my own experience, I've learned two pathways. One is release. I attended grief retreats where we did writing practices and poem readings to awaken the soul, to evoke experiences of loss, and then we participated in rituals to help us release any grief that was stored within our bodies. Many indigenous cultures around the world have grief ceremonies as regular "detoxes." Might we as doctors have more space for empathy if we could learn to release better? A second path is transformation. I took up Wisdom Healing Qigong, a moving meditation that integrates consciousness with core-strengthening exercises, and learned that I could more readily receive the suffering of others and, through repetitive sweeping movements of the arms and direct visualizations, I could transform in my mind their suffering into an experience of compassion.
By doing the hard work of grieving and transforming, I've let go of the biggest unstated pressure I've carried as a doctor: that it was somehow up to me, lil' ole me, to alleviate the suffering of the world. And by letting that go, I've experienced greater spaciousness for reconnection to myself and others. I've nipped burnout in the bud.
CYNTHIA LI, MD graduated from The University of Texas Southwestern Medical Center, and has practiced internal medicine in settings as diverse as Kaiser Permanente Medical Center, San Francisco General Hospital, St. Anthony Medical Clinic for the homeless, and Doctors Without Borders in rural China. Her own health challenges led her to functional medicine, a paradigm that addresses the root causes of chronic conditions. She currently serves on the faculty of the Healer's Art Program at the University of California San Francisco School of Medicine, and has a private practice. She lives in Berkeley, CA with her husband and their two daughters.
Brave New Medicine: A Doctor’s Unconventional Path to Healing Her Autoimmune Illness is available September 1, 2019 in paperback at Amazon and other retailers.