The problem of martyrdom in medicine
Here’s how: It’s not because burned out doctors do a bad job in caring for patients. I scoured the medical literature and I found while there were an awful lot of presumptions that burned-out doctors would do a worse job at caring for patients, there was really no data to show this to be the case. Other than one small study showing decreased patient satisfaction scores and delayed post-discharge recovery time,[i] and several studies showing an increased perception of medical errors by burned-out physicians,[ii] no studies have demonstrated true evidence of serious adverse effects on patient care. In fact, one study actually showed no correlation between patient care and physician burnout.[iii]
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Here’s my theory on why: It’s because physicians are so resilient, and so concerned about patient wellbeing that we will abuse ourselves—our body, our mind and our relationships—before we allow patients to be affected by our own emotional or physical stress. Unfortunately, by the time that doctors get to this point, our level of burnout may be so severe that we take drastic measures.
And this is the main reason that patients suffer when doctors don’t care for themselves: Because burned-out doctors are doing something that hurts patients more than anything else. We are leaving the practice of medicine, either by leaving medicine entirely or more heart-wrenchingly, by taking their own lives, with physician suicide claiming the lives of approximately 400 doctors—an entire medical school class—each year. [iv]
Here is the main reason that physician self-care is so important for patient care: Unsatisfied physicians are two to three times as likely to leave clinical practice.[v] And doctors today are deeply unsatisfied, with the 2016 Physicians Foundation Report showing that 49% of doctors today are “always or often” burned out, with nearly that same percentage planning to ”cut-back on hours, retire, take a non-clinical job, switch to concierge medicine or take other steps limiting patient access to their practices.”[vi]
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And while part of the reason for physician dissatisfaction has to do with the ever-growing administrative bureaucracy that we face, including the burden of computerization and check-boxes and patient satisfaction surveys, a whole heck of a lot of it has to do with the choices that we make every day: choosing to go to work when we’re sick with the flu, to miss date night to attend another mindless meeting at the hospital, to cover for a colleague instead of going away for the weekend.
It’s tough to say ‘no’ when we feel so darn needed by everyone else, but if we don’t learn to take control of our own needs, eventually there won’t be anything left to give. That’s when we burn out and quit. And when doctors leave practice, where does that leave our patients? No doctor, no patient care, poorer population health. Period.