Physician Burnout: Confession of a Former Workaholic

Several days ago, I went with many women physician friends to Montgomery County Medical Society meeting.  Part of the meeting included a panel discussion of physician wellness.  Physician burnout is not a new topic but has taken on a serious toll, with about 400 physician suicides each year.  Women physicians have a four times higher risk of suicide than others.  Physicians, according to the National Occupational Mortality Surveillance Data, have the highest suicide rate of all professions, followed by dentists and veterinarians.  Employees in the finance sectors were number sixth on this worrisome data list.

Many risk factors were proposed for the burned out professionals.  Long hours of work, complexity of their work, lack of social support, personality traits of the “overachievers” in society were among the risks.  Healthcare providers are more intense, self critical, perfectionists.  They tend to neglect their health while taking care of others.

I once had a patient whose husband was among the most important physicians in his division at NIH.  He had back pain which progressively got worse.  He didn’t follow his wife’s advice to see a physician until one day when he could no longer get up from bed.  An emergency workup revealed end stage spinal cancer and he died a few weeks later.  My patient, a homemaker who never paid attention to her family financial matters, was devastated with the drastic changes in her life.  There was no life insurance or good investments of their savings made over the years by her workaholic husband.  She had to sell her home in Potomac and she moved to another state to get emotional support from her family and have a more affordable life.

I can identify with my patient’s physician husband.  During the panel discussion at the medical society meeting, a speaker asked how many of us in the audience had had our yearly health checkup.  Only a few, in the room packed with more than a hundred physicians, raised their hand.  It was not a surprise to me.  I was among the majority who did not raise my hand.  I have not had time to see a primary care physician.  Work has been so busy over the years that I have followed my own cholesterol and glucose levels every few years.  I am long overdue for an eye exam, not having had a follow-up exam since my Lasik surgery more than ten years ago.  I mention my need for an eye exam on and off to my friend and ophthalmologist Dr. Holly Gross when I see her at bootcamp or yoga gatherings, who even offers to do my eye exam during the weekend.  I will soon take her offer…sometime soon. 

Many physician friends and professional patients agreed with me that we understood how and why Mrs. Hillary Clinton handled her pneumonia by plowing on with her work day.  That’s exactly what many physicians would have done, dragging themselves into the office with a severe cold while telling patients we were having “allergy symptoms.”  We might have put patients at risk for catching our cold but we can’t think of ourselves as being sick or weak.  We don’t have time to get sick; physicians are not supposed to be sick.  Who would have seen the patients on the schedule that day?

I think I know why my physician friends or other professionals live this inadequate life.  We care so much about our patients and others in our life that we lack self compassion.   We take our job as a moral responsibility to care for others in need.  We are the last to get help and we do not seek help.  A day has only 24 hours and, as we spend most of our waking hours caring for those “in need,“ we have no time left for ourselves.  How do we efficiently care for our children, maintain the order for our daily family life while taking care of thousand of patients yearly?  By skipping meals, not drinking too much water to avoid rest room breaks, exercising before dawn or after dark, reading a book a chapter a week if we even have time to do so.

A month ago, I start taking every Friday off and working an extra hour on days I am in the office.  I had felt overwhelmed by the multiple daily tasks at work.  I had too many passwords, too many IDs between the hospital and my office, not counting the passwords to my cell phone and home computer.  Like other physicians in my office, I was far behind in timely handling of my “PAQ,” the abbreviation for office labs and documents I have to sign off every day on my work computer. We have to sign off our daily notes on patients’ visits, reports of mammograms, pap smears, blood work, bone density scans, sonograms and numerous consult reports from specialists such as high risk obstetricians, internists, oncologists, urologists, breast and other surgeons… Every click on my office laptop would eliminate one item, but a new one would pop up.  My company, at the end of the week, alerts each physician how many lab items we still have to review, correlating this to how many more clicks we have to do for the week to keep them under a certain number so that our paycheck would not be held back. It’s an adult version of “Pac Man” game, to get your “enemy” number down so you would not be consumed in the process, or your game is over.  My office even got me a new laptop to improve the speed of my clicking, so the next lab item would appear in less than a second after each click.  Every second counts in our office life, as we live like a mindfulness expert.  

In addition to office work, I have on-call nights, where I am up most of the night answering emergency phone calls or tending to a laboring patient or those in the hospital with complicated medical problems during pregnancy.  In our practice, after night call, we continue to work the next day until at least five o’clock in the evening, either seeing patients in the office or taking care of those in the hospital.  The evening arrives with many mandated meetings from our work organizations such as hospitals, or malpractice carriers to reduce the very expensive malpractice insurance we have to pay yearly to practice medicine.  Many of us physicians, including me, also participate in hospital or department committees to improve patients’ care.  Certain time is set aside for all physicians to do their maintenance board certification activity, which means we have to read numerous medical articles sent every few months by our specialty college and take a written exam every few years administered by our board.  Other professions do not have to face this intense monitoring process, but physicians are not supposed to make mistakes at work.  

I’ve learned so far from my Fridays off that I should have taken a day off weekly decades ago.    Each physician or professional in a high risk career should take a day off weekly, even if it means having to extend an hour or two in her schedule when at work.  The government allows many employees to do so, working four ten-hour days week in return for taking every or every other Friday off.  I now have time to do the mundane things that many others get to do, such as going to the grocery stores during the day, picking the tomatoes from our vegetable garden before they fall on the ground, reading the newspaper articles in full detail instead of scanning their headlines, answering business or personal emails while my mind is still awake, relaxed and focused.  There’s a lightness somewhere in my chest and shoulders.  I can breath better now.  The day off, however, seems to go so quickly, as I treasure it like a starving person given a few bites of food.  

I also learn how “disposable” I am as a physician, a vital recognition for all “at risk” professionals to heal themselves.  My patients have not missed me on Fridays.  The office is still running well without me.  Babies are still delivered healthy as there are other obstetricians in my office waiting by their mothers’ bedside for their arrival.

How did that happen?  I thought I was so important to the survival of my office.  I do not feel insulted, however, that my staff doesn’t miss me on Fridays. I feel enlightened indeed, to recognize that my patients can survive without me.  I am not their savior.  While at work, I will continue to put in my best to care for them.  However, I have to care for myself too.  After all, if I don’t do well mentally, I would not be a good doctor.  The number of patients I see each week has not gone down drastically even with the Fridays off, as I extend office hours on other days.  I still have many “PAQ” to continue my Electronic Medical Record “Pac Man” game.  I still have to click numerous times, with my fingers having the best workout compared to the rest of my body each day, except for my legs as I constantly stand to save time in walking from one exam room to the other.  Sitting in between patients would take more time.  

However, there is that lightness that I feel now.  Maybe it’s just a psychological change in my work; but my psychology is the ultimate wellness route to my physical health.  After a month or two of enjoying my Fridays off, I plan to make some medical appointments to get myself seen by some of my physician friends.  I have saved my insurance company too much money over the years by not seeing a gynecologist, an internist, a gastroenterologist or an ophthalmologist.  I need to see my friend Dr. Holly Gross in her white coat and not just her yoga outfits, now that the world of illness is no longer on my shoulders constantly.