It’s Not Burnout Revised

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By: Briana Rueda, DO

Physician burnout is a term that is thrown around all too often now in the world of medicine.  In fact, I can’t seem to open an email or medical journal without being bombarded by articles on physician burnout.  To be completely honest, I disagree with using the term “burnout.”  To me, the term “burnout” insinuates a sense of blame on the physician.  Instead of blaming the physician for straining to work 74 hours a week, staying up all night finishing charts, missing Sunday dinner with their family, and then taking calls over Christmas, why not just call it what it really is… completely unnecessary expectations!  And unfortunately, this thing they call burnout, I’ve experienced it.

In the 1970s, Dr. Herbert Freudenberger, a well-known and respected psychologist, was the first person to study and coin the term “burnout.”  He called it a “state of mental and physical exhaustion caused by one’s professional life.” Although I’m sure he interviewed a great number of physicians and had a deep appreciation for their sacrifices, as a psychologist, his training to be a psychologist probably did not include the same trauma of physician training.  He probably never had to stay awake for 30 hours, physically running to a string of high-stress emergencies with a pager repeatedly beeping in his ear.  If he had, I doubt he would have titled the constellation of manifestations “burnout.”  In fact, he would have realized that it is not a diagnosis at all. It is merely a normal reaction to what is clearly an abnormal situation for any human to experience.

To my dismay, I learned that there is actually an ICD 10 code for burnout.  Yep.  That’s right.  It’s actually a diagnosis!  If you haven’t found it yet, it’s Z73.0, under the umbrella diagnosis, “Problems related to life management difficulty.”

Just sitting here writing this blog, I can think of dozens of riskier careers than medicine: police officer, military, stunt actor, crab fisherman, construction worker, 7-11 cashier on the south side of Chicago…etc.  Yet medicine is now THE deadliest profession in the United States.  Each year, roughly 400 (Yes, FOUR HUNDRED!) physicians die by suicide in the United States.  This is two to three times more than the general population.  And unfortunately, a great number of these suicides are completed by those in training: medical students and residents.

Pamela Wible, MD, an amazing physician and physician/medical student anti-suicide activist, started a crisis hotline years ago for physicians with suicide ideation to call.  She also keeps a registry of physicians who have died by suicide, and as of last month, she had a massive 949 doctors on her registry.  I contacted Dr. Wible to learn more about her campaign and was provided the link to a new documentary film about the medical student/physician suicide epidemic. I HIGHLY recommend taking a few moments to view the very powerful trailer:

http://www.donoharmfilm.com/about

As much as the term burnout bothers me, I am genuinely grateful for the increased awareness the term has brought for the medical profession’s unnecessary expectations. Many healthcare institutions are now actively implementing robust wellness programs to help foster healthier work environments, enhance downtime relaxation, and bolster enjoyment for their providers.

During my intern year, I was the first resident spotlighted on the GME Wellness Newsletter.  I felt extremely honored to be a face for the University of Utah’s exemplary GME Wellness Program.  At the University of Utah, we are fortunate to have a graduate medical education system that is undeniably concerned about the physical, mental, and spiritual wellness of its residents. Our GME has designed a very comprehensive program, with everything from yoga and massage, to free counseling and crisis intervention.

As much as I pride myself in being a poster child for wellness, last month I had a particularly challenging schedule and experienced some emotional trials that were beyond my coping capabilities.  In addition to calling in reinforcements from family and friends, I contacted the GME Wellness Program, and I can honestly say I’m so thankful that I reached out. As a resident, I could not be more pleased with how supportive the Wellness Program has been.  Besides taking advantage of their complementary resources, I was fortunate to also experience an additional grant the Department of Family and Preventative Medicine received through the GME Wellness Program.  On my last 28 hours shift, the GME Wellness department surprised me with a much-needed gift bag of healthy treats.  During an incredibly long shift, it felt good to know my program was thinking of me and appreciated all my hard work.  Now I’m no longer just a face for the Wellness Program, but an ambassador who can relate with first-hand experience.  Given the positive experience I have had, I would encourage all residents to feel comfortable reaching out and contacting the GME Wellness Program for extra support and resources during those tougher months in training.

As mentally draining and physically exhausting as practicing medicine can be, I would hesitate to label any provider as “burned out.”  I believe physicians are actually some of the most compassionate, dedicated, and resilient professionals in the world.  Just about every physician I know pours their entire heart and soul into caring for patients and they do it all while sleep-deprived, malnourished, with limited resources, and hand-cuffed to insurance company policies. The problem is not the physicians, but rather, it is a healthcare system that expects providers to perform superhuman tasks while running on fumes.  I’m hopeful that the recent emphasis on physician wellness will help the system move from simply attaching a ridiculous diagnosis to the manifestations of what are clearly unnecessary expectations and will lead to real improvements in physician work environments, fostering longevity to the greatest career in the world medicine.

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Briana Rueda, DO, is a current resident in the Family Medicine Residency Program at the University of Utah. Her medical areas of interest include integrative and functional medicine, women’s health, and psychiatry.

 


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