Dear fellow doctor,

Do you remember when you first wanted to be a doctor? What inspired you? Maybe it was a family members illness, an older doctor who treated you so well, a scientific brain combined with an altruistic heart; a curiosity, and a love for research into all things biological?

Whatever it was, you chose this noble path. You were probably an A student in elementary school; a valedictorian in high school; a master test taker and an ace in biological sciences in college or medical school.

In medical school, you learned vast amounts of material that would one day serve you in this most noble profession of treating and taking care of your fellow human beings.

Residency:

One day, you graduated. The residency pathway loomed ahead, but you grabbed the bull by the horns. Depending on where you did your residency, it may have felt like the worst hazing of your life. There were long days, and even longer nights. You made friends with fellow residents as you bonded over your shared trauma. You may have, like I did take multiple depression screenings, showed up as severely depressed, laughed it off and continued with the day’s work. After all, those patients were not going to round on themselves, and you did not want to come across as being incapable of coping.

You were taught to put the patient first, what did it matter if it was 7 PM and you had had neither breakfast nor lunch? Not only were you not told to take care of yourself, the unspoken word was that self-care did not matter in the grand scheme of patient care. You were told that being a doctor was calling, sacrifice, and there was no better vocation that you could have chosen to dedicate your life to.

You finally graduated as an Attending Physician, in your chosen specialty or subspecialty. You would get to catch up on life. You would get a job of your choosing, get married, have children, and start earning a high income.

And now?

Dear fellow doctor, here you are now. Is life all that you dreamed it would be? Are you happy? Do you have time for the relationships that you hold so dear? Do you have time to contemplate and attend to your spiritual needs? Are you mentally and emotionally whole? Do you have time to attend to the needs of your own physical health?

These days, with a physician shortage in the USA, doctors are under increased pressure to see more patients, under the ever-increasing weight of the non-medical bureaucracy. Healthcare is an industry in the US and as such, the bottom line is first and foremost in the minds of physician employers. During residency, physicians in training are not prepared for the business that medicine has become. As such, most physicians are conflicted. We know that it takes more than 15 minutes evaluate a sick patient, however we are forced to make do, as most physician schedules are double and even triple booked within the same time slot.

This is not good for patients, and not good for doctors. Physicians are spending more time at work, as electronic medical records have taken over, making the whole process of evaluating a patient even more cumbersome. No patient wants a doctor interacting with a computer screen more than the doctor is interacting with them.

Dear fellow doctor, while this is going on, how are you? Do you feel guilty every time you have to eat a meal or go to the bathroom? Have you worked so hard that you have fallen sick and ended up having to be hospitalized? Have you ever sat outside of your work place before going in and just cried? Are your patients doing great, while your health, goes to pieces?

We have some of the highest suicide rates in the world!

Saving the lives of others should not cost you your own. Medicine is still noble profession, one that only the cream of the crop gets to practice. However, at the end of the day it is a job; and should not be allowed to consume your whole life. You were a human being before you became a doctor. When you are on your deathbed, you will not ask to see your boss, your patients, or your bank balance. All you will ask about is if the things that you did with your life truly mattered to you and to those that you cared most about. 

Burnout is a legitimate condition of chronic stress characterized by emotional exhaustion, depersonalization (compassion fatigue, and cynicism); and a lack of sense of personal accomplishment.

If you are in, or headed to that dark dreaded place called burnout, here is what you can do to start.

  1. Realize that it is not your fault: Years of indoctrination have made us believe that we have to shed bits of our humanity to be good doctors. It leads to the belief that if we are not stoic and unemotional, it means that we are weak. Nothing could be farther from the truth.
  2. Refuse to live a life of guilt: When we feel that burnout is our fault, we feel guilty for not being “more resilient “. This guilt leads to a form of self-silencing, and pretense that everything is ok, even when we are mentally frazzled almost to the point of hopelessness. Do not feel guilty if your mental state is not where you wanted to be.
  3. Seek help and support: A lot of times, as doctors even in our families, we are loath to admit that everything is not the paradise that our family members think we live in. If you are burnt out, or teetering on the edge of burnout, it is time to involve your trusted family members and friends and let them know what you are going through.
  4. Prioritize your health: This includes your mental health, physical health, emotional health, and spiritual health. Get your health check-ups, eat right, exercise regularly, and talk to your life coach and/or therapist. Doctors are patients too!
  5. Dialogue: Now more than ever, there is an awareness that physician burnout is an epidemic. It has been recognized as a diagnosis by the WHO. If you are an employed physician, start to open up discussions with your employers, bosses, managers, and whoever is in your chain of command. Research has shown that burnout is contributed to by organizational factors, as well as personal factors. Make a note of the organizational factors, prepare yourself, and make a case for yourself with various suggestions that will benefit you, the patient, and the organization. This is the tricky part, as not all organizations will welcome suggestions by physicians.
  6. Prioritize your wellbeing, over a desire not to be seen to rock the boat. This means that in cases where there is an impasse or stalemate, and you have tried you may need to make a decision to change jobs, for the sake of your overall life well-being.
  7. Do other things outside of medicine: Being a doctor, you need a fun outlet, a hobby, or a side gig to take your mind off work.

Dear fellow doctor, there is light at the end of the tunnel.

You are not alone!

Love,

Your fellow doctor and partner in progress,

Shola Ezeokoli.

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