Burnout: What happens when prevention fails?

When I was in medical school, I went to a lunchtime talk by one of the physicians in our community about the importance of physician wellness. At the time she was on her way to becoming a prominent leader and advocate for physician wellness across Canada. As a first-year medical student, I was shocked to listen to her so frankly share her own experience with falling over the edge, her struggles with coping and addiction and of feeling defeated and worthless for what she had become. She told us about the time she took to heal herself and everything she learned about how our medical system is almost designed to see physicians fail in this critical area of life. The intimate details of her story were not covered up or glossed over. The things she did, the way she fell . . . it was something you’d never expect to happen to a doctor. But it did. And despite the efforts we make towards physician wellbeing, it continues to happen, probably more than we think. Physicians are humans too—we’ve heard it over and over. Moreso since the onset of the pandemic. The statement is almost always stated to invoke the attitude that physicians, like non-physicians, are humans and deserve to be treated as such.It’s easy to forget, though, that physicians are also not exempt from the same folly and pitfalls of everyone else as well. We make judgments when the people around us fail, we get scared when something hits too close to home and we can easily forget that the difference between those of us who succeed and those of us who fail is often only a matter of mere circumstance. It seems like when physicians are struggling, the easiest thing to do is hide from the reality. Read: Dr. Ginevra Mills: Saving this timeWhen I think back to that lunchtime session, I often ask myself: What did that physician do to get back up? Try as I might, I can’t seem to remember what she said about the road to recovery and rediscovery. There was little emphasis on how she was supported by her colleagues, by the larger community of physicians or even the resources that were available to truly help her back up. Perhaps that was an insignificant part of her story, compared to the point of her talk. She was there to tell us, young new recruits in medicine, how to prevent getting to a place like she did. A warning, really, that if we didn’t start prioritizing our wellbeing early in our medical career, we could end up like she did. Prevention is the best treatment for a problem, as we like to believe. The reality is that prevention doesn’t always work. There are too many places for it to fail. The field of medicine is notorious for encouraging working beyond our means: our motto from early on being, “fake it till you make it” (to the extreme). We become experts at ignoring our own signs and symptoms, or we feel that our situation isn’t one that allows for change, or our chosen specialty or practice is so demanding that self-care becomes synonymous with self-destruction. Sometimes it’s as simple as knowing that taking care of ourselves means taking away from our patients, or even leaving behind a mess that only contributes to the problem for the other people around us.When I look back through jaded lenses, it seems that the message of this inspiring physician to her first-year medical students was really: “Don’t let burnout happen to you, because the way back out is harder than you think.” It’s as if the real reason she didn’t talk about the far side of burnout is because it’s all rather dark. Beyond that brink is unknown territory, where survival is not guaranteed. Where the people who land there have fallen from grace and left behind, unsupported to find their own way back. It’s as though “that place,” is the “thing that shall not be named” within our profession.In medicine, we have a long way to go to reduce the stigma around the dark side of physician wellbeing. It’s a disgrace to realize that being a physician doesn’t protect us from the devastating effects of chronic stress and years of sacrificing self-care. It’s difficult to accept that the cure to the slow burnout of our profession is not just the onus of the individual but also involves the collaborative care of each other and of our larger community of colleagues. As long as we keep quiet, secretive and in denial of our collective role in the problem, prevention will never equal a cure.Dr. Ginevra Mills is a reproductive endocrinologist and infertility specialist based in Victoria.

Burnout: What happens when prevention fails?

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