Chicago, Illinois, USA
|Sarasota Sunset, courtesy of author. 2005.|
I was assigned to work at Cook County Hospital for my emergency room (ER) clerkship in my third year of medical school. “Whoa, that place is crazy . . . you will see a lot a people there,” I was told by a friend who worked there. Actually, I was looking forward to training there. My mother brought me to Cook County as a child to be treated in the pediatric emergency room on various occasions. I sat in the waiting room for hours at a time, bored and sick. But now I was a medical student on the other side of that equation, learning to evaluate and treat people as they came to the emergency room.
My first ER shift was a blur. After brief introductions to the attendings, residents, nurses, clerks, and other students, I was told, “Go see that patient in bay 3 with the resident.” As I continued in the clerkship, I got to know some of the staff better than others. There was one attending physician who had previously worked in emergency rooms in New York City before coming to Chicago. He was an excellent teacher, incredibly patient and compassionate.
During one of our ER shifts together, a teenage girl presented in status asthmaticus. She had waxing and waning levels of consciousness as she struggled to breathe. I watched as the physicians and nurses intubated her to force air into her lungs. I worked with one of the residents to get an arterial blood gas (ABG) to assess her oxygenation status. We successfully obtained the ABG but she coded and after multiple attempts to resuscitate her, she died in the emergency room. The attending physician spoke with the girl’s family who tearfully and reluctantly accepted the news that their daughter, sister, and loved one was gone. His grace and ability to empathize with this family during this time amazed me.
After consoling the family, he told me, “Let’s go grab some lunch.” As we walked over to the cafeteria, he confided, “That was hard. Sometimes I would like to do something else. Practicing medicine is hard and I would like to just go somewhere and plant trees.” I was surprised by the candor of this revelation. As we ate lunch together he explained how medicine had changed through his training and career. He loved medicine and lived his life to help, serve, and save others. In the process of this service, bits and pieces of himself were constantly being shared with others. Over time, it had become harder and harder to replenish and rejuvenate himself.
As I sat there listening and learning, I wanted more than anything for his desire to be a physician to be fully restored. He had saved countless lives and touched so many people as a healer, teacher, and mentor—but now he was in need of someone to touch his life as well. I recall my feeble attempt at a response, trying to validate what he felt and to somehow encourage him to continue to do what he had done for so long, sharing his skills and life with others. “Thank you for your service and sacrifice and for dedicating your life to save others,” I thought silently. But in that moment, I could only seem to nod my head and agree with what he said.
We finished lunch and walked back to the emergency room and I saw him in a different light. I hoped that someone would be able to help him to get beyond what he was feeling. I did not realize then how common his sentiment was among physicians of all specialties and practices. Physician burnout has become a familiar consequence of increasing expectations from patients, increased demands for productivity, and a litigious culture that forces physicians to practice medicine defensively. These increasing pressures, coupled with decreasing reimbursements, increasing costs to practice medicine, and arduous demands for documentation, lead many to look for an escape route.
“Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment.”1 Medical students, physicians in training, and practicing physicians are at risk. The prevalence of physician burnout now exceeds 50%.2 There has been a proliferation of seminars and programs geared toward alleviating burnout, including stress management programs and conferences geared toward alternative careers in medicine, as more and more physicians become disillusioned with the practice and culture of medicine in the United States. “Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period.”1 Many of these programs focus on increasing resilience and wellness among participants, but do not address problematic changes in the modern practice of medicine.3
“Do no harm” states the Hippocratic oath. But what about the harm that seems to be inflicted on physicians themselves in the practice of medicine? Can we as physicians continue to move forward in good faith, believing that the system that we are a part of will heal and sustain us as we heal and sustain others? Can we continue as others attempt to dictate how we evaluate and treat those we serve? We somehow must proceed, as the lives of those we have been entrusted to care for depend on us. But there must be a balance. Physicians will continue to serve and save lives, but must not be harmed themselves in the process.
- Romani, M and Ashkar, K.; Burnout Among Physicians. The Libyan Journal of Medicine. 2014 Feb 17;9:23556.
- Rothenberger, DA; Physician Burnout and Well-Being: A Systematic Review and Framework for Action, Diseases of the Colon and Rectum. 2017 Jun;60(6):567-576.
- Squiers JJ, Lobdell KW, Fann JI and DiMaio JM; Physician Burnout: Are We Treating the Symptoms Instead of the Disease? The Annals of Thoracic Surgery.
RONALD REMBERT JR, MD, is a family physician with over ten years of experience practicing medicine with a focus on treating the underserved with acute and chronic illnesses. He worked as an assistant professor in the department of family medicine and was co-chair of the Community Advisory Review Council reviewing community medicine research projects at University of Chicago. He is a physician advisor and clinical liaison to hospitals around the country with R1RCM. Dr. Rembert received his medical degree from the Chicago Medical School at Rosalind Franklin University. He completed residency at Rush and at Advocate Illinois Masonic Medical Centers.