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    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.

    Next: How to do the right thing for patients

    Rebekah Bernard MD
    Dr Bernard was a National Health Care Scholar and served at a Federally Qualified Health Center in Immokalee, Florida for six years ...

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    • cgmdrx@------.com
      What if one could prevent martyrdom in the first place? I've seen my share of struggling physicians over 40 years in medical practice and one has to ask, Why? The answer I have found to be the greatest tragedy in medicine over the last century. The bottom line is the total brainwashing of medical students, doctors, and academics into the belief that medical practice is not a business, in any sense of the word. Yet we as physicians all know medical practice is a business. We also know that businesses don't survive without understanding the principles of successful business and implementing them from the start. Why then do all medical schools and nearly all physicians, even though they all know this fact, then completely ignore it? There's a reason. If a physician has never been told, or taught, that it's a good idea to learn business essentials, the foundation of any business and it's ultimate success, it leaves them with a choice. Either they choose to believe a business education will definitely help them, or they accept what their environment provides them, no control over their careers and potential. The problem is that when they start private medical practice they are predestined to fail both business-wise and consequently financial-wise. When doctors finally recognize the reason for their failure, as thousands of doctors today are suffering from, they continue their way to martyrdom... at least that's in their thoughts. They are completely ignorant about how to reverse the process. They don't know how to earn money in a business, to maintain a good practice, to expand their incomes and become much better qualified doctors provided by the increased income. Until then, physicians remain prisoners of business ignorance, and continue to be forced to suffer the consequences of decreasing incomes, no control of their careers, and even refuse to get a business education because they can't afford it. Does this make sense to you? You don't know what you don't know, nor what I know to be true. and they consequently are left to believe the myth of medical education tradition---doctors don't need it---
    • Anonymous
      So true. I made it a point to teach myself the business of medicine because without it one is oblivious to what is going on in the office, the institution, organized medicine, and the swamps in our local, state, and federal governments. This I believe is a major reason why medicine is in the mess it is in regarding the Obamacare disaster and every other third party intervention into the practice of medicine I've seen since the mid-70s. As Pogo once famously said, "We have met the enemy and he is us."
    • nanhwmd@------.com
      Dr. Bernard reminds me of a PETA activist(mostly female) who abhors hunting and devotes her precious time to banning hunting by Americans(mostly men) who love hunting. Like the PETA activists and modern feminists, she has been groomed by the State to virtue-label others, rather than speak to them, and to not recognize the fact that men's brains are different than women's. For a pediatric urologist to prefer helping children to eating lunch is not "martyrdom," (using Bernard's false definition of martyrdom) but it is his pursuit of happiness and financial success, the reason this country was founded. If one takes the time to read the article, "Lunch is for Losers," and reflect on it, the author notes that he rarely saw his surgeon father and the father of a friend served as a surrogate. He loved that man, but failed to attend his funeral. This is normal male behavior. Most men's brains are designed to focus on work and provide for their wife and family. Women are rarely happy being away from their children, so working as many hours as men are required to advance in their careers often does make them unhappy and "burnt out." Women, especially pre-menopausal women, have a different metabolism than men of their age, and many cannot skip lunch. Feminist propagandists are employed by the State to groom young women to become emotional when men behave like men, and there is an entire industry that preys on these female "social justice warriors." The young men of America suffer greatly because of the "War on Men" that leaves them fatherless, uneducated, penniless, and broken. The main source of "burnout" in today's primary care physicians, however, began 100 years ago with the Flexner Report and the Progressives' war on the Hippocratic private physician. Our government-funded medical schools and residency programs taught us that the old Hippocratic American physician was a "quack" and did not practice "scientific medicine" in the way the lawyer Flexner said we should. This idea of the Progressives was not any more scientific than their idea that the White Race is superior and "inferior races" should have their reproduction limited by forced sterilization and birth control. Hundreds of millions of human beings suffered and died due to their Fake Science in the 20th century alone, and our government schools and globalist-owned media do not point this fact out about the failure of Progressive rule over We the People. Today's government health system that started with Medicare is the real cause of "burn out" and all of the other problems of the "healthcare system." Chaos systems theory will tell you than government bureaucrats should not be in charge of a human being's health. The government does not fund studies that will prove that it is lying and that its power apparatus should be dismantled, so no journal references are provided here. As I would like to start a private pediatric practice in Hesperia, I will go to Dr. Bernard's website for information. As I am a kind of natural martyr, that is witness to the Truth, I keep getting distracted from my goal by such articles as this that are filled with falsehoods, but somehow are published in magazines like Medical Economics.
    • Anonymous
      I spent 20 years in full time academic medicine practice, and another 15 years of direct patient primary care in various private/public settings. One term I learned in recent years from trainees is so called "work-life balance." I have also noted a concomitant deterioration in the quality of medical care I have received over time, to the point that I have had to intervene/protest multiple times when I or my loved ones have received what I consider to be substandard care. Most are due to the fact that doctors and nurses are paying more attention to computers than patients, especially superficial or near absent histories & physicals, mostly on fully clothed patients!! One thing I have always taught my young trainees is to forget about starting your career with "work-life balance." You need to eat, sleep and drink 24/7 the practice of medicine at least 10 years before you have the knowledge AND experience to be really good at it. My other parting advice to them is, "This ain't about YOU!!" I rest my case.

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