A New Year's hope for physicians battling burnout

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A new year is upon us, so it is time for the obligatory New Year resolutions. However, since I am terrible at keeping resolutions, here is at least one thing I hope to work on for 2018: I want to grieve better.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Jack Tsai, MD, a family physician at The Children's Clinic in Long Beach, California. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Dr. Tsai

It is a bit of a downer, I know, but with every year of medical experience under my belt (which is also literally growing), I find it increasingly difficult to connect emotionally with my patient, especially those who are not doing well. This is ironic since physicians are supposed to be healers, and crucial to building that therapeutic relationship is the provider’s ability to empathize and have compassion.

Instead of an increasing capacity to care for my patients, though, I have noticed that each year of medical training and practice brings more cynicism, burnout and emotional detachment. While so many factors contribute to physician burnout, I suspect a big problem is not taking the time to remember, celebrate and grieve the patients I have lost.

Six years into primary care practice now, I have built up a steady panel of continuity patients, and sadly I have had a number of them pass away. Some deaths were expected due to multiple co-morbidities, others appeared just fine at their visit the week prior. When I think back on my experience of those deaths, I see how with each notification I am able to more quickly move on and back to my everyday of patient care, phone calls and lab reviews. What is alarming being that I cannot remember some of their names, even ones whom I have cared for over years and had developed a relationship with.

As a primary care physician in an underserved community, I have learned to be quite efficient. On an average day, I can get through a whole schedule of patients, follow up on abnormal labs and studies, return phone calls, and close out all my charts without having to bring any work home. Sometimes I can even sneak in a power nap during my lunch break. But that efficiency has come at the cost of cutting out the time needed to get to know patients on a personal level beyond their medical diagnoses.

Next: To my patients who have passed away

Now, granted, we as providers need a degree of emotional distance. There is a reason providers ought not to treat their own family members, and it takes a measured aloofness to be able to do certain tasks like cut into a person’s body. Providing medical care is exhausting work, and it is not possible (nor wise) to give your all to everyone.

Some walls do need to come up, but if we are not careful, we may find that those barriers we erect will not come down on demand when we hang our white coats and turn off our beepers (hopefully those can be turned off). That distance may protect me from suffering myself if my patients do not do well, but it also blunts my ability to experience all of life’s emotions outside the office and prevents me from being fully present to those most important in my life.

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The statistics for physician burnout is staggering. I hate to become a statistic, and I thought perhaps if I just powered through and do not let myself get too emotionally invested in my patient, I will be fine. But perhaps the opposite is true, that when we open ourselves up and connect with our patients in the good and especially the bad, we will find the joy again and be reminded of why we entered this field in the first place. This year, I want to give myself permission to pause and to grieve. It might mean I may not get to my next patient on time, but I think that patient (and ultimately my family and friends) will be better off for it.

I do not like to talk much, but writing has been a means of pausing and processing. With a toddler and newborn in my life, I have gotten out of the habit of journaling but hope to make time for in 2018. I went back and found this entry that I had written about the death of one of my first regular patients. I was glad that I still remember his name. But so that I do not forget his person, I share this with you.

To My Patient Who Passed Away

I found out yesterday that you passed away.

I’ve had patients pass away before, but since I’m just starting out, I haven’t had much of a relationship with many.

I got to see you almost monthly for the past two years because of your many medical problems, so I think we got to know each other a bit.

Next: "Thank you for reminding me why I became a doctor"

I’m sorry for getting mad at you at your last appointment. I wish our last time together could have been more pleasant.

I have to admit I got frustrated often taking care of you. You would just stop taking your medications, wouldn’t go to the specialty appointments we lined up for you, and wouldn’t go to the ER when your blood pressure was sky high.

But you would always come to see me.

Even though our appointments would always take more than the 15 minutes I’m allotted, I’m glad we took the time. And God always worked the schedule out anyway.

Thank you for always having your 10+ medications lined up on the exam table for me to check.

Thank you for sharing with me your story, you’ve had a really hard life.

Thank you for reminding me why I became a doctor.

You told me no one would care if you died.

You were wrong.

Since you were homeless, not sure if you will have a memorial service. Here’s to your memory.

Jack Tsai, MD, is a family physician at The Children’s Clinic, “Serving Children and Their Families,” a Federally Qualified Health Center in Long Beach, California. Dr. Tsai completed his residency at the Harbor-UCLA Family Medicine program, and is committed to the care of vulnerable populations, particularly those experiencing homelessness. He is the author of Worth the Cost? Becoming a Doctor Without Forfeiting Your Soul, published in 2013.