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Burnout

The lead article this week in the New England Journal of Medicine is entitled "Innovation in Primary Care--Staying One Step ahead of Burnout". Reading this brought up many issues for me as burnout describes my ongoing experience in internal medicine for the 16 years I was in practice. I ongoingly wrestled with this state during my time in this great profession. While I loved helping people and being their doctor, for unclear reasons to me after 7 months away from primary care, I could not maintain my energy, health and well-being in the midst of this practice. My employers were accomodating; I was permitted to try different innovations (some mentioned in this article including caring for people in groups). At the end, they even allowed me to work half-time which initially did give me enough balance in my life to continue my work. However, I still maintained a large patient population (close to the full-time "ideal" according to this article. While I did have more time, I always struggled to stay strong in this career. Why?? What is this phenomenon of burnout? Why could I not stay in this profession which defined me and gave me so much meaning and purpose and allowed me to help so many?

Looking back now 8 months removed from this journey, here is what I see. I love being a doctor. I miss it like a person misses food and water when they are taken away. I have not yet figured out how to be a doctor in a way that allows me to stay healthy, strong and balanced. I realize that I need the structure and support of an institution behind me to be a primary care physician -- I am not cut out to be a private practice doctor. I just do not have the business sense and entrepreneurial spirit to run a medical office on my own. I am meant to be a doctor not a business person. With that said and finally truly understood by me, why was I not able to "stay ahead of burnout" in the system?

I never was able to figure out how to protect myself from the pain and suffering experienced by my clients. In my efforts to empathize with their experience, I took on their pain; not their actual symptoms but their depleted states. I could never learn (and I did try) to stop this process. While I believe that a key to health and happiness is the elimination of isolation and separation from others, it was this very quest that took me down. The depletion experienced by my clients became my depletion. I counseled them on how to fill their tanks and build their energy but I lost the ability to rebuild my own depleted stores. Yes, acupuncture, massage, rest, talking about one's feelings, sun, pleasure, good food all help; but a leak in the tank prevents full rejuvenation. So what is this "leak" and how can it be sealed shut forever? My partners seemed to be able to protect themselves better and be able to keep themselves rejuvenated while I wrestled with depletion on an ongoing basis. In my youth, I always had energy, vitality and gusto, but I lost these great states and surprisingly I have not found them again with my time away.

So my burned out state may have less to do with my work as a primary care doctor than with my own style of managing my energy. In other words, my "style" may just not be able to handle the rigor of this interactive lifestyle. So how to be different? How to maintain energy and power?

Comments

Unknown said…
As a physician delegates lab work to the lab techs, taking blood pressure and vitals to his/her nurse, etc. other aspects of running a successful private practice (or any business for that matter) get delegated to those who have particular strengths/talents. You have heard "go with your strengths." Mark, delegate. You LOVE medicine. You LOVE helping people. You have the trusted network that can find the right people to run your business while you do the part that you love aka your strength. Don't look at this time as burn out, this is the time to look inside, identify your passion and run with it. We will talk on Monday and make a plan.

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