The Call of Duty

This morning, Dylan was being extra sweet. He woke me up at the usual 6AM, crawling into bed, except instead of insisting we get up, he let me and wife sleep an extra 30 minutes. When we finally did get up, Dylan went straight to his room and got dressed for school, he ate his entire breakfast without a fuss, and he brushed his teeth without me having to tell him.

“Do you have to go to work today?” he asked. Unfortunately, duty calls. “What’s duty?” he asked. I snickered. My four year old son was asking me what is “duty” and the first thing that came to my mind was poop.

When I arrived at work, I met Elaine. She was a 35 year old female, coming in to ask for time off. She was generally healthy, but she had been feeling overwhelmed at the job. She states that her co-workers were racist and were constantly giving her a hard time. She worked for an airline, and when she wasn’t dealing with her nasty co-workers, she was dealing with rude passengers that were looking for an upgrade or trying to get away with an extra five pounds in their luggage. “I tell them it’s written on the online contract,” she said. She began crying, mumbling she felt she was on the verge of a breakdown.

We’ve all been there. I’ve had it to where all I wanted to do was stay home and call out for the rest of the month. From the EMR acting squirrely to the improper coding that the biller is chewing my ear about. From the nagging patient with sore throat that refuses to believe it’s viral to the failed prior authorization for Cipro (frigging Cipro!). We all have things about work that we can’t stand. It gets easy to forget why you get into the field you choose to end up in. When the rubber hits the road, what you thought you would be doing for the rest of your life ends up being something different than you expected. This will sometimes lead to burnout.

While “burnout” is not a medical diagnosis, symptoms of it can mimic depression. The work related stress can lead to physical and emotional exhaustion which can sometimes lead to substance abuse, fatigue, physical susceptibility to illness, irritability and sadness. The risk factors for burnout are numerous, but the most commonly reported ones are lack of work life balance, lack of control, and a dysfunctional workplace.

The obvious next question is what do we do about it? It’s like telling Elaine to just change jobs. It’s not that simple. We all have to make a living somehow and if we have families that rely on our paychecks, that only complicates the picture. I can sit here and tell you to meditate, try to relax, take a vacation, find a good support system to help manage the stress, but the thing is that it doesn’t typically fix the problem, but rather only places a band-aid on a bleeding wound. When the stress returns, it’s like picking at the scab, that will only make the wound open again.

In truth, the problem sometimes lies with the employer. Why do you think everyone wants to work for Google? Google, from what I hear, has some amazing benefits including free childcare, an onsite masseuse, and a ridiculous amount of PTO. If it’s an employer problem, perhaps talking with a supervisor can help address the problems with doing the job. Even still, though, I’m sure there are some Google employees that burnout. So perhaps, the problem is bigger than our job and lies with our society. We live in a capitalism, and so our bottom line is what drives our employer’s motivations. If you can’t do the job given the constraints provided, somebody else will.

The problem is much bigger than a simple case of “job burnout.” And unfortunately, the solution isn’t really that simple. For physicians, I can tell you that it can be more than just burnout. Some have likened physician burnout to PTSD or post traumatic stress disorder, and moral injury, where a perceived moral transgression creates an emotional shame. While I won’t go so far as to say that the comparisons are accurate, I think that there are cases to be made on both sides of the burnout versus moral injury argument. When you have doctors that are working multiple shifts to make the most possible money, that’s on them. When doctors are scheduling 5 surgeries in a day, that’s on them. When doctors are coming to rely on telemedicine to get a quick buck without even touching a patient, that’s on them. However, when I want to give a patient a promising new drug that is denied coverage because of insurance, that’s on society. When I have to see twice as many patients in a day just to make the same money I made three years ago, that’s on society. When I have patients coming in complaining about their health because Google told them that they’re sick, that’s on society. And finally, when I spend more time making sure my EMR note is polished enough for proper billing rather than spending the time looking my patients in the eye, that’s on society.

It’s a privilege to be a physician and that’s something that I have always believed. We are granted access and become part of the lives of our patients at some of the most horrible and joyful moments they will ever experience. I have always considered myself lucky, which is why whenever I feel the sentiment of burning out, I try to remind myself of this fact.

For everyone else, what I’ll say is that if the issues with your employment can’t change and that you can’t escape the stress that the job provides by coping techniques, then it’s either time for help from a medication or it’s time to quit. That’s what Elaine ended up doing and she hasn’t been this happy in a long time. Remember that the expression “when duty calls” is referring to your commitment to your chosen profession, not to the crap you have to deal with when the job beckons.

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