Truly happy, yet non-brain dead...
Does such a critter exist?
One often gets the impression that physicians who are not deeply troubled by the current state of medicine are either in deep denial or are in collusion with bad care and general meanness. Lack of dissatisfaction often strikes me as polyannish.
Nonetheless, I think it's important to note that one can be reasonably happy as a physician. One can be happy or unhappy in most lines of work, in fact.
And yes, I have met happy doctors who are both nice and competent. It exists!
Is this specialty dependent? I've heard by now from physicians from practically every specialty and have yet to find one that is burnout-proof, largely due to administrative hassles and general disrespect rather than the practice of medicine itself. ER docs and FPs/IMs are obviously burnt out, but (surprisingly to me) so are plastic surgeons.
Is it character dependent? To a certain extent, yes. Some people are better at brushing aside trivialities, some take them to heart more, as they probably do most non-trivial things. The more you lean towards the latter, the more likely you are to be on the receiving end of unpleasantness in the healthcare industrial complex, as bullies sense your weakness and target you, thus creating a vicious cycle. The more oblivious you are, the more untouchable you become.
You can do some work here towards acknowledging who you are and accepting yourself. You could do a better job of avoiding hostile work places - but you must be purposeful about this, not just go 'wherever', only to be shocked over and over. And you might think more seriously about independent practice, as a kindness to yourself.
Is it dependent on specific circumstances?
Your life as you know it is made up of many factors big and small. One smallish but relatively unchangeable factor is your commute. You might live in a place you love and have a pleasant ten minute commute through tree lined streets. In your Tesla. The beach is five minutes in the other direction and you can go for a jog there most months of the year.
Or, you might be stuck in a place you despise and sit for hours every day in the "rush hour traffic" watching smoke stacks spew their pollutants over the concrete. The beach is several thousand miles away and so is the nearest mountain or tree. Plus, you're spending those hours in your non-Tesla car. Double or triple whammy.
The thing is, if you have some vague notion that things will change for the better, it might surprise you to realise that the beach will always be several thousand miles away. No trees will sprout in your path. This is the way it will stay.
It sounds absurd to say all that, but we have a tendency to live in a state of daydreaming. This includes some magical thinking about sudden improvements in traffic and the appearance of beaches, trees and mountains. If living near any of the above is important to you, you need to MOVE. The mountains won't come to you. Trees won't sprout magically along your commute. You need to go to them. You need to make this happen.
As far as the business of medicine goes, you might be a dull, mediocre doctor, possibly an uncaring one, yet what you offer is what people want, so: success. You might be the best doctor and human being in the entire known universe yet fail to sell your wares. Wrong time, wrong place, and the guy down the street takes insurance and gives out z-packs, opiates - and more!
Don't beat yourself up for not doing well, but see if you can find someone you consider both good and successful, not mediocre or z-packy, and see what aspects of their practice you can adopt. Willingness to take all referrals, and quickly? Maybe you should, maybe you shouldn't, but it's something to consider. Or maybe you should limit your practice to a specific niche? That might be what you really want to do. What's right for you? What will work in your market?
Bright cheery waiting room? Check. Little fountain spa thingies and real plants? Check. Quick responses by e-mail? Check if you're DPC. A wellness program for patients? Check, if you're into it.
Cash practice - some say it's easy. Don't believe them. They're not telling you the whole story. Some say its impossible. It might be impossible in certain geographic areas, but in general it's a lot more doable then the system would have you believe.
Much of your day to day happiness, and much of your success in your work life, boils down to small, concrete circumstances. If you analyze all these factors you can find some you can change. Other things, you might find a way to make peace with.
You can't have it all, but you can probably have more control than you currently have over your life. First, you need to be honest about your preferences and your abilities. You need to be honest with yourself about why you're stuck in a bad workplace. You need to not be deterred by those who say failure is assured, nor be shamed by those who claim insta-success.
Lastly, you really need to reserve yourself a Tesla*.
COI disclosure: None. *I have no affiliation with Tesla or any of its subsidiaries**, and am not paid by them.
**I'm not sure what 'subsidiaries' means but it's an important-sounding word so I stuck it there.
Present day, Utah:
Present day, Oregon:
The future of it all:
About that healthcare-industrial complex:
The present is all we have. The end is inevitable.
Shouldn't you spend more time doing what you love?
Say you're a physician with burnout. You're stressed, you're depressed, you're angry at the way your profession has gone. You've decided to get an outside opinion about your life, as described on the page 'Life Coaching versus Therapy'. Who to turn to? Some people think that the word psychiatrist is scary and that going to see one means that something is seriously wrong with you. Not so!
There's an advantage to seeing a person with broad training and experience. Psychiatrists are in the somewhat unique position, by virtue of their medical training, to have seen people from all walks of life, from the indigent to very high functioning people. We've encountered the whole gamut of human difficulties - and no less importantly, abilities and strengths.
Think about surgeons and this point will be clearer. A surgeon will have operated on people young and old, on very healthy people with a relatively small problem, and on elderly, medically complex patients with complicated surgical problems. Would you refuse to have your simple appendectomy done by a surgeon because 'they deal with really sick people'? It's patently absurd, of course.
The old style psychoanalyst type of psychiatrist, adapted to today, is your 21st century hi-tech, small, local, organic, hand crafted, single batch anything. If Freud were alive today, and if he was a bit less frowny, a bit more chill, then his couch would be a chair, his pipe would be, well, gone, and he'd be Skyping with his patients about the deeper meaning of cat videos.
Here's another common argument among doctors. Sometimes I encounter doctors, usually with severe physician burnout themselves, who are dismissive of the notion that doctors with burnout should seek out help. They feel that therapy, or coaching, or wellness measures, are B.S. attempts by the system to create an impression of doing something while changing nothing. They're corporate imposed nonsense and a continuance of the oppression. As though if you meditate a little and are taken out to dinner once a year, you won't notice the other 364 days in that year, where you're treated like less than nothing.
That may very well be true if these measures are coming from the corporation. But this is not true at all if initiated by the individual doctor and done with a private non-affiliated therapist, preferably a psychiatrist.
Just because the world is a hostile place does not mean you're not suffering. And till we can remove all causes of suffering, including all the elements that make the medical workplace a hostile one, why suffer alone and in silence?
The goal of talking to someone is not to increase your 'compliance' or acquiescence to the boot. It's to help you deal with tough situations. It can be a safe place to vent your anger or frustration without damaging you. It can help you see situations in a calmer, more objective light. It can help you make better choices about how to deal with things. You might then choose to pretend outwardly that nothing is wrong. You might choose to wage an all out battle against the system. Most likely, you will have an easier time finding some internal peace than if you go at it alone, and you'll increase your chances of finding a course of external action to better your situation.
Talking all this over is a way to fortify yourself. Till the revolution cometh. Or till we go back to the Garden of Eden.
California superbloom, Carrizo Plain National Monument, Spring 2017
The majority of doctors are experiencing some degree of burnout. I'll touch very briefly on the causes here, since these are not the focus of this post. Causes include:
1) Factors inherent to the practice of medicine - the incredible stress of bearing responsibility for other people's lives.
2) The traditional medical culture, which is not a gentle one.
3) Internal causes stemming from each person's unique history and psychological make up.
4) Lastly in this brief (and not comprehensive) list, but in my opinion THE major cause of burnout, is the current atmosphere in the so-called 'healthcare industry' in which the traditional physician patient relationship has been assaulted, perhaps to the point of no return, and the internal sense of mission which led doctors to choose this profession has been quashed with the stomping boots of corporate culture at its very worst. Physicians are beaten down and micromanaged by business people. They spend most of their time as data entry clerks, while still bearing the full responsibility of a doctor. They're treated as replaceable cogs. They have lost their professional autonomy and their sense of purpose.
Burnout is therefore endemic in the physician population. In addition, doctors, like all people, can suffer from depression and other common conditions. Yet I often hear how doctors won't go to talk to someone. It seems that there are two major reasons.
ONE: "I am not weak"
One is a perception that seeking help is an admission of weakness. Doctors need to tough it up, don't they?
I find that absurd. Psychological stuff is not something that happens to 'others' or to weak people. It's normal. N-O-R-M-A-L. Unless you're a robot. You have a psyche and stuff happens in it. There's turbulence. This is life.
We all need to work on our psychological health (a term I prefer to 'mental health' or any other such terms), just as we work on our physical health, and in fact we do, all the time, all our lives. Much of this work is an ongoing process which you do on your own without even realizing it. The most common forms of this are mulling things over in your head, and talking to others, often in the form of venting. The former can get you out of bad spots, but can also leave you trapped in loops that go nowhere. The latter provides a release valve and a decrease in the intensity of emotions, but carries certain risks for doctors in hostile work environments.
Then there are all the other methods to relieve stress, some healthier than others - exercise, time outdoors, Netflix (seven seasons of Gilmore girls!) and so on.
When these are not enough, why not talk to someone outside your life who can help you sort things out? Since when has increased understanding (insight) lessened anyone? How is discussing something in private anything but dignified?
It can seem hard to let your guard down when all day long at work you're 'it'. This is one reason I think it better that doctors see psychiatrists or PhD psychologists and not random therapists, unless there is a specific issue, such as marital counseling, for which other professions might just be better suited. Consider that the doctor in the other chair is not your better, and you are not the lesser one. Two people, that's all.
TWO: "It will end my career"
I've heard this myth propagated among doctors: if they go see a therapist or psychiatrist their career will be over. This is for the most part fear mongering. Psychiatrists are not in the habit of calling up medical boards for a chit chat. Nor do they have impromptu discussions with your employers. If anything, many psychiatrists are so secretive (about the general population, not even about doctors) that other doctors complain they can't get any information from them. I do not know where doctors get this notion that talking to a psychiatrist will end your career. NO ONE WILL KNOW.
There are some rare exceptions. While serious mental illness is rare among doctors, there are certain conditions which can impair you at times to such an extent that you could be a danger to patients. The most common one is probably substance abuse. I do not treat addictions myself, that's perhaps a whole other ballgame. Who will know and who will out you about impairment, substance induced or other? Your workplace, or you yourself if you want to be pre-emptive and fair towards patients. It would be exceedingly rare for a psychiatrist to need to make that call! I have never needed to, not ever, and I suspect the same is true for most psychiatrists.
If you're stressed, burnt out, depressed, etc., you're the bread and butter of the psychotherapeutic psychiatrist's practice and if you're a physician with burnout you're probably at the high end of functioning in their office. To think that you would be reported for this to anyone is ridiculous. It's kinda crazy, actually!
What about those license renewal forms? I do recall hearing once about some state, I don't remember which one, that asked if you've ever been in treatment. With possibly that one exception, license renewal forms ask if you're IMPAIRED. There is no reason for the overwhelming majority of doctors to ever answer yes. There are some extreme conditions that would affect your judgment to the point where you're a danger to patients. This is RARE. This does not apply to run of the mill depressed, stressed, burnt out doctors. This is highly unlikely to be YOU.
It is important not to get tangled up in workplace hostilities, because they can use flimsy mental health excuses as a weapon, and once targeted, you can't win. So unless you truly are impaired, and they are in the right to protect patients from you, then talking to someone will help you avert this disaster. You will strengthen your capacity to smile and nod and exit the bad situation gracefully.
In other words, not only does seeking help for burnout not end your career, it will help you avoid situations where someone else ends it for you.
For the utmost privacy, I would advise doctors to see a cash only psychiatrist, and one who's psychotherapeutically inclined (an admittedly shrinking population). <--- Note bad pun there.
In medicine you do often times need to be an oak, but tend to yourself before you crack and you'll live to see many more seasons.