Solving physician burnout requires so much more than self-care

By | December 30, 2018

So many people are suggesting that if only doctors practice self-care we could deflect burnout before it overtakes us. Yes, physicians are probably the worst professionals for taking care of ourselves. We work long hours,  answer calls at all hours of the night, take little vacation, work in stressful situations, and often face hostility in the workplace. But this is not the reason we are burning out at high rates; we have thrived under these same conditions since medical school.

Honestly, I don’t think I had more than three hours of sleep a night during medical school. And in residency, I once went three straight nights of call, ER rotation, family medicine clinic, repeat with zero hours of sleep. Yes, it was stressful and exhausting, but that’s all that it was: stressful and exhausting. Telling me to sleep better is not going to cure my, and I suspect most other physicians’, burnout, because we have spent most of our years of study and subsequent careers existing on limited, interrupted sleep.

Many people suggest yoga and meditation to overcome the flames of burnout. While it may work for some, I am not particularly well-balanced enough to do yoga (once took two people down trying to balance on one leg in some awkward pose) and my mind never stops long enough to meditate. Sure, getting some form of exercise can improve our mental outlook.

But it is not going to help my patient who has been fighting her insurance company for three years now to get a hip replacement to ease her progressive pain so she can go back to work. It’s not going to ease my frustration of having to switch my patient from Advair to Flovent because the insurance company won’t pay otherwise: they are not even the same class of medication! Nor is it going to help me not bring homework with me because I now have to click off a multitude of checkboxes in the EHR or the government will say I’m not doing my work and financially penalize me. Yes, doctors should exercise because it is healthy but that isn’t going to fix the problems causing our burnout.

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Others suggest eating healthy as a means to alleviate this growing problem. Again, reducing carbs is not going to help my patient get the MRI they need. Reducing fat is not going to pay for my patient’s surgery after the insurance company refused to pay the bill after deeming it “not medically necessary” after the surgery was already done. What do I tell my patient when they come to me crying that they don’t know how they are going to afford to pay the astronomically absurd bill? Go vegan? Doctors should eat healthy because everyone should. But, it is not going to fix physician burnout.

Is practicing self-care going to ease my burnout? Not unless it can fix any of those things that are creating it. I am not burning out from lack of exercise, eating non-nutritious food, or working long hours in a stressful environment. I am burning out because I took an oath to give my patients the best care, to do no harm. Yet, all too often obstacles are placed in the road that prevents me from doing that.  Please stop telling me to eat more veggies and meditate to avoid burnout! What I need is for someone to tell me how to convince the insurance company to let my patients have a few more weeks of physical therapy or to cover that CT scan for my patient with abdominal pain. If you can do that, you’ve just solved the burnout crisis for most physicians.

Linda Girgis is a family physician who blogs at Dr. Linda.

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