Why it's getting more and more demanding to be a physician.
|It all starts when you’re too young to understand. They promise you a brilliant future with lots of money, success, exotic holidays, usually a big car (big cars have always that element of glamour, there’s probably a specific subject taught in kindergarten about successful men with big cars and successful women with men with big cars). And you are full of hopes and enthusiasm and dive head first in your new life. Little by little, you learn to love competition. The rush of adrenaline keeps you up at night, and you start bragging with the others about those 36-hour uninterrupted shift. Meals and sleep are for the weak, true heroes can do without them! Workplace is the only family, at the expenses of your actual family and friends, but you don’t care that much because after all they don’t understand. And then, you notice how many of your seniors and older colleagues suddenly seem to act weird. Some look defeated, others look… empty. By then however, it’s usually too late to go back.
Sounds like the plot to a crime drama involving brainwashing, financial fraud, and drug dealing, right? Wrong. I’m talking about doctors. Welcome to the Healthcare System.
I’ll never forget one of my professors. An old-fashioned gentleman, offering patients that perfect mélange of solid reliability and warm, fluffy emotional support. Always perfectly professional even in the most difficult conversations, when the news is so bad the “non-traumatising terminology, and without excluding elements of hope” is only an abstract theory. One day while I was attending the outpatient clinic, when the last patient of the day closed the door behind him, he got to the window and lit up a cigarette.
“Maybe if I’d smoke two at a time all this would come to an end sooner”.
I turned around and looked at him. Suddenly he was looking much, much older. He was an oncologist, and I’m pretty well sure he knew exactly what he was talking about.
Recently some articles about depression and burnout syndrome have started to appear in the media. Surveys published by medical information website Medscape have been carried out in the UK, the US, and through several European countries, to investigate this “new” phenomenon. As with many illnesses, nothing of this is really new, it’s just that we are starting to acknowledge its existence. The results show that between one third and one half of all the surveyed reported suffering from burnout syndrome, depression, or both. Between one in four and one in five doctors say distress is enough to make them consider a change in their profession. To be fair, there are also many other doctors who are indeed very happy of their profession and of their life, and correctly the survey takes it into consideration, but this is only partially reassuring. As the American Medical Student Association reports, medical students are three times more likely to commit suicide than the rest of the general population in their age range.
All of this can appear far and difficult to understand from the ordinary perspective. Well-established, time-honoured urban legends taught us that doctors are rich and enjoying a luxurious lifestyle, that doctors are confident to the point of playing God, that they are selfish and insensitive and so on. The media are not innocent when it comes to myths. Screen doctors are always depicted as the tireless hero saving the day or as the mad villain trying to take over the world by spreading some lethal infection. Either way they have some sort of superpower, for the bad or for the good; being average is not an option. The same articles I read about burnout and depression in doctors have the aftertaste of an apology: burnout and depression are important because they reduce physicians’ efficiency at work and undermine the quality of patient care.
Now, of course patients have the right to receive the best quality care, it would be criminal to affirm otherwise, but on the other hand there are reasons to worry about work-related distress other than a lack in efficiency. Enough with “the sacred mission of the doctor” and all the other excuses that are constantly used to shield exploitation and abuses: doctors and other professionals of healthcare are not beasts of burden to put down when no longer productive. No other work environment sees working more than 12 hours in one take as normal, night shifts with no recovery period as normal, spending all weekends and holidays at work as normal. Being a doctor myself I’ve been there, I’ve been working 76 hours a week and been told “welcome to the real world”, I saw my colleagues challenge each other upon who would get more nervous breakdowns before the end of the month. A good friend of mine who is working in the US is having it even worse: 80 hours a week, basically she feels grateful when she has time and energy to wash a pair of knickers.
The situation is evolving, slowly, but unfortunately not always in the right direction. Many medical organisations are starting to take this issue into consideration, but still more often than not the burden of finding a solution lies on the overloaded physicians. “You must get your breaks” they say, as if it were your fault for stubbornly refusing to stop or just not trying hard enough. “If you feel overwhelmed you should try meditation” they add, like meditation or mindfulness or yoga were magic spells that could fix everything with a little visualisation and a couple conscious breaths. And even if that actually worked, that wouldn’t be the answer. Meditation and yoga are powerful tools for the wellbeing of body and mind, yet I’m not ok to use them to become more resilient at work: resilience, another magic word everybody celebrates, is just a tool to expect more from workers and guilt-trip them when they can’t or won’t comply. In other words, I won’t put all my efforts into learning how to tolerate a 12 hour shift, so next time I will be asked to work 16, thank you.
Being a doctor can be rewarding. Extremely rewarding. As one of my teachers used to say, “There is some artisanal satisfaction in giving the appropriate antibiotic and seeing after some hours the fever coming down, or in looking at radiograms showing the surgical repair you just performed has been successful”. Some doctors choose to commit their whole life to their profession, I had the honour to meet some of them and will always think very highly of them; it’s a life choice. Other people may choose, for example, to become an astronaut and spend months in space; war correspondents put their life at risk in order to report first-hand news about conflicts, and so on. However, being forced to give up everything, family, friends, personal interests, sometimes even health and sanity, has more of a detention. Meditation can help accept things as they are, when they cannot be changed; suggesting its application in contexts where a change is not only possible but necessary has the sole purpose of preserving the status quo. Healthcare professionals don’t need 5 minutes of Tibetan bells before falling asleep, and surely don’t need being pressured into fitting unrealistic expectations; they need a decent work-life balance, a healthy work environment, and reasonable wages.