Burnout Culture and Disconnected Medicine
By Dr Nathalie Martinek
Reports to date show that health and caring professionals across every specialty experience high rates of work-related burnout, compassion fatigue, vicarious trauma, loss of joy and loss by suicide. This has ripple effects on professional, personal and patient satisfaction, patient safety, quality of care and the ability to achieve meaningful outcomes for all involved.
In other words, practicing as a physician, surgeon, nurse and other health professional may be hazardous to your health.
There’s a collective buzz across the medical world about combating burnout culture and creating a kinder and more compassionate healthcare system. Among the buzz are opinion pieces blaming and shaming a variety of sources balanced by those who write wonderful pieces about how they thrived after burnout and the importance of self-care, rest and compassion in medicine.
The blamed and shamed include: commercialisation of medicine, defensive medicine, reduced consultation time, increased complexity in patient care and more subtle issues such as unhealthy/absent personal boundaries, treatment noncompliance, vicarious trauma, sleep deprivation, reduced social and family time, prejudice, abusive behaviour and witnessing illness and recovery, or death of patients or colleagues, lack of compassion and kindness, and the list goes on.
Healthcare organisations and professional bodies are efficient at expressing their concern and support for improved work conditions with greater mental health focus. These public declarations are often followed by professional development training headlines punctuated by words like resilience and leadership, mandated by reactive management far removed from the realities of the frontline. These efforts fall short as they aim to address perceived deficits in strength, genetics, mental health and character of physicians rather than addressing harmful, entrenched workplace cultural norms against the backdrop of an emotionally charged healthcare system.
Before anyone can address these issues we need to ask ourselves:
How did we get here?
This is not just a question for medical students, educators, physicians and surgeons, medical leadership, healthcare administration, and the healthcare workforce. We are ALL responsible for our current healthcare system. How did the collective WE get here?
If we take a snapshot of where we are now and start to look upstream, we will see that the burnout problem doesn’t start once physicians, surgeons and other healthcare professionals are settled into their workplaces.
Looking at training we will see that students are exposed to subtle and explicit opportunities and behavioural modelling that promote depersonalisation and can reduce empathy from first year medical school. Is it not curious that the first experiences that future doctors have with patients is with a cadaver? A non-living being that can’t advocate for their needs, share their hopes, dreams and concerns and make decisions. It’s realistic to imagine that exposing mostly sheltered young adults to a dead body would be traumatising or emotionally distressing. What impact does this first encounter have on the ability to form healthy, empowered, compassionate therapeutic connections with future patients?
Despite the hidden curriculum of depersonalisation in medical training, this isn’t the source of the burnout problem.
The problem also doesn’t start with conditioning children and young adults by their parents, society, culture, education system and other influences to believe that being a physician is the noblest profession because humanity needs heroes who can swoop in and save people from the inevitabilities of life, such as suffering and death.
The source of the burnout problem isn’t human suffering.
The source of the burnout problem is OUR problem with human suffering.
We as a society have become masterful at pathologising the human experience and negative emotions. This mastery has shaped medical training, education and specialisation, public perception of illness, flawed research theories and unconsciously biased study results to create what is now an illness system. This cocktail of ingredients has been used to guide practices that unintentionally create distance between doctor and patient that mirror the distance between us, our bodies and experiences, so that we can all play out our respective roles of hero and helpless victim.
Disconnected medicine becomes entrenched as physicians-in-training learn to pick apart the human body, reducing human experience to anatomy and physiology, illnesses, diagnostic terminology, symptoms and prognoses. This training has produced incredible approaches to studying and repairing our bits and pieces. But the curriculum forgot to include training on HOW to help a patient rebuild themselves and their identity to also include their strengths, pleasures, desires, resources, supportive connections and potential to transcend the limitations of their diagnostic label.
We can’t be surprised then that an entire system has been established that reinforces the notion that patients are helpless and need to be fixed, therefore physicians are not allowed to have similar issues and health concerns as their patients. Or they have to be kept separate, secret or simply buried. Burnout is not a surprise – it’s a natural result of practicing the art of disconnected medicine.
What would healthcare look like if there were more real discussions among health professionals about the mistakes, disasters, near misses and the ‘what just happened here‘ moments in practice? Could these current sources of shame be used as priceless group learning, reconnection and self-kindness building opportunities rather than shoving them under the rug of perceived weakness or incompetence?
Could practicing the art of connected medicine be assisted through learning how to implement emotional wellness and professional self-care practices that naturalise human experiences so we can face distress and suffering as easily as we embrace happiness and joy?
What if more trainees were exposed to physicians and healthcare workers at every level of experience who break and recreate the rules to allow kindness, compassion, empathy and intuitive caring to counteract the effects of disconnected medicine’s protocols?
Imagine training and education programs that teach physicians how to access patients’ and their own healing capacity through being totally present, seeing person over symptoms and demonstrating kindness, curiosity, interest and empathy when encountering another human in their time of need or suffering. That everyone’s capacity to heal is influenced by a sense of belonging in the world; spiritual connections, religious or secular values, purpose and vision, connection to land, community, peer support, social acceptance creativity and self-expression, connection to heritage and the things that nourish us in life, including foods for the body, mind and spirit.
We know what it feels like to be on the receiving end of kindness and genuine concern for our wellbeing. What if physicians and patients strived to share acts of kindness for each other, to provide a much-needed lift in what can feel like an unkind system? Kindness can take the sting out of pain and suffering, even if it’s temporary, because the act alone reminds us that we are seen, we matter and we are connected to someone.
Connection is medicine. Kindness is its dispensary. Strive for connection and everyone benefits.
By: Dr. Nathalie Martinek, PhD
Professional Self-Care Educator, Facilitator, Mentor
Mentoring physicians and healthcare workers
Independent researcher and upcoming author