The problem of martyrdom in medicine

I recently read the award-winning physician essay in Medical Economics entitled “Lunch is for Losers,” about the sacrifice that physicians make for patient care. As I read this doctor’s reflections of keeping crackers and candy bars in his lab coat pockets because he didn’t have time to eat during his med school days, it reminded me of the GYN attending I had in my residency who loved to cheerfully tell bleary-eyed interns: “You can sleep when you’re dead.”

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But you know what? Lunch isn’t for losers. Sleep isn’t only for the dead. 

News flash: Doctors, like everyone else, are human. It’s time that we not only acknowledge that to ourselves, but to the world. We are not supermen. We are people, individually flawed, doing our best every single day to help others. 

The problem is that we’ve made a ton of sacrifice to get where we are, we’re used to delaying gratification, and at some point in our medical training, we start to develop a delusional sense of indispensability and martyrdom. You know, like lunch is for losers and sleeping is for the dead.

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And since physicians tend to be highly motivated, intelligent and resilient, we get away with burning the candle at both ends for a very long time. Unfortunately, at some point, we burn so brightly that we burn ourselves out. And when doctors burn out, patients lose.

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Here’s how: It’s not because burned out doctors do a bad job in caring for patients. I scoured the medical literature and I found while there were an awful lot of presumptions that burned-out doctors would do a worse job at caring for patients, there was really no data to show this to be the case. Other than one small study showing decreased patient satisfaction scores and delayed post-discharge recovery time,[i]  and several studies showing an increased perception of medical errors by burned-out physicians,[ii]  no studies have demonstrated true evidence of serious adverse effects on patient care. In fact, one study actually showed no correlation between patient care and physician burnout.[iii]

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Here’s my theory on why: It’s because physicians are so resilient, and so concerned about patient wellbeing that we will abuse ourselves-our body, our mind and our relationships-before we allow patients to be affected by our own emotional or physical stress. Unfortunately, by the time that doctors get to this point, our level of burnout may be so severe that we take drastic measures.

And this is the main reason that patients suffer when doctors don’t care for themselves: Because burned-out doctors are doing something that hurts patients more than anything else. We are leaving the practice of medicine, either by leaving medicine entirely or more heart-wrenchingly, by taking their own lives, with physician suicide claiming the lives of approximately 400 doctors-an entire medical school class-each year. [iv]

Here is the main reason that physician self-care is so important for patient care: Unsatisfied physicians are two to three times as likely to leave clinical practice.[v] And doctors today are deeply unsatisfied, with the 2016 Physicians Foundation Report showing that 49% of doctors today are “always or often” burned out, with nearly that same percentage planning to ”cut-back on hours, retire, take a non-clinical job, switch to concierge medicine or take other steps limiting patient access to their practices.”[vi]

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And while part of the reason for physician dissatisfaction has to do with the ever-growing administrative bureaucracy that we face, including the burden of computerization and check-boxes and patient satisfaction surveys, a whole heck of a lot of it has to do with the choices that we make every day:  choosing to go to work when we’re sick with the flu, to miss date night to attend another mindless meeting at the hospital, to cover for a colleague instead of going away for the weekend.

It’s tough to say ‘no’ when we feel so darn needed by everyone else, but if we don’t learn to take control of our own needs, eventually there won’t be anything left to give. That’s when we burn out and quit.  And when doctors leave practice, where does that leave our patients? No doctor, no patient care, poorer population health. Period.

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So if we want to do the right thing for our patients, we have to prioritize our own needs in order to continue to be able to practice medicine over the long haul. The time has come to accept that it is not healthy for us to martyr ourselves on the altar of medicine. We must not use our job as an excuse to avoid nurturing our relationships, or as a security blanket to prevent us from trying things that are new and potentially scary or as a way of feeding our ego. 

We also have to give ourselves permission to be human, to be imperfect, and to make mistakes which are inevitable despite our best efforts. Yes, we do require sleep-at least seven to eight hours nightly, and our demand for sleep actually increases with age. And just like we tell our patients, we have to eat regularly, preferably not just crackers and candy bars, and our body yearns for exercise, fresh air and nature! 

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And when we have stress in our lives (and just being a doctor and listening to our patients is stressful enough), we need to get the same type of help that we recommend to our patients-a good psychologist that can help us develop insights into our thoughts and behaviors-like why we often feel the need to be workaholics, or how we can get past our perfectionist tendencies, or to simply give us tips to use psychology to be better doctors to our patients.

Taking care of ourselves isn’t selfish. It is good. It is necessary and it is vital for our very survival, just like eating and sleeping. It’s putting on your oxygen mask before helping those around you. 

So go ahead and eat lunch. I mean a real, sit-down lunch in the cafeteria or at a restaurant, or at a park bench outside, not out of your lab coat pocket or at your computer. And get some sleep. You need it.  Because your patients need you.

Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession.  She can be reached at her self-titled site, Rebekah Bernard, MD.

[i] Health Care Management Review:January/March 2008 - Volume 33 - Issue 1 - pp 29-39 doi: 10.1097/01.HMR.0000304493.87898.72

[ii]Burnout and medical errors among American surgeons Annals of Surgery, 251 (2010), pp. 995–1000

[iii]Working conditions in primary care: Physician reactions and care quality Annals of Internal Medicine, 151 (2009), pp. 28–36

[iv] http://emedicine.medscape.com/article/806779-overview

[v] Medical Care:March 2006 - Volume 44 - Issue 3 - pp 234-242 doi: 10.1097/01.mlr.0000199848.17133.9b

[vi] http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf