It’s easy to live with success. However, in the context of medicine, success can be dangerous because it makes us complacent and less self-critical.
It’s extremely important, yet incredibly difficult, to admit to our mistakes and try to learn from them. As a young doctor, you can’t risk being completely honest with yourself because a certain degree of blind self-confidence is necessary in order to keep doing your job and learning.
We hone our skills by making mistakes. However, they’re extremely hard to swallow. In fact, you develop something referred to in psychology as “cognitive dissonance” where you recognize two contradictory thoughts, and applied to decision-making the term is demonstrated when part of you knows that your choice was probably a mistake and part of you denies it.
There’s also an obligation to tell your colleagues about your errors so that they don’t make them. Consequently, there’s pain in being a physician and it’s even more painful if you’re a nice doctor.
Therefore, the art of medicine is finding a balance between compassion and creating distance in your relationships with patients. You have to be detached and scientific, yet caring and compassionate, but the more you care the more it hurts when things go wrong.
With practice, you get used to these challenges, but you still suffer and you still feel bad about it, especially when patients die. Somehow life goes on though.
If you don’t take on the difficult cases you won’t become a better physician. Eventually, you learn to live in a permanent state of slight anxiety.
Most doctors are young and healthy and don’t really understand what it’s like to be a sick patient in hospital. It’s often only when physicians become patients that they say, “I never realized what it was like.” Perhaps hospitals would be nicer places if more doctors had personal experiences with health and many of us should probably listen to our patients more.
We’re all frightened about losing our health and physicians know what can go wrong. With experience you become more philosophical and as you age you also become wiser. In fact, there’s a common saying in medicine, “It takes three months to learn how to do an operation, three years to learn when to do it and 30 years to learn when not to do it.”
Is burnout a negative outcome on its own? Or, is it a surrogate outcome? Do we care about burnout because of how it affects patient outcomes and patient satisfaction? Or, is it something to worry about on its own because of the distress it causes practitioners?
Perhaps the answer lies in a combination of all of these questions.
Although I learned a great deal in medical school, burnout, resilience and their interaction with empathy wasn’t something I think I learned enough about.
In the theoretical understanding of burnout, there’s a clear link with how we understand empathy. However, there isn’t a lot of literature discussing the connection between them.
We know that burnout is associated with attrition—people burnout and they leave medical practice. It’s also associated with medical errors, or at least perceived medical errors—people who score highly on burnout ratings also report themselves as having made more medical errors. Moreover, burnout is highly associated with the patient’s sense of their interaction with the doctor. Or, in other words, their satisfaction with the process.
As a medical student, I remember thinking, ‘That looks scary. I hope I’m able to do it and still be active and healthy.’
Perhaps it isn’t perfect, but the three-factor model of burnout has been a helpful tool in clinical practice. It considers emotional exhaustion, depersonalization/cynicism (you start treating other people functionally (e.g. as objects as opposed to complicated human beings)) and a lost sense of personal effort (you start feeling like your work isn’t making the difference you wanted it to).
Empathy isn’t necessarily something that drains you emotionally. Nevertheless, it requires emotional resources. It demands that a certain amount of energy be present in order to do it well.
When people in the medical profession are rushed, or thinking of someone in terms of a disease process rather than a person who is experiencing distress, those concerns serve as barriers to empathy.
It’s the pressures of the work environment and often the lack of time that clinicians actually have. In medical school, it’s also the sheer volume of information. It gets easier once you master the medical science of the treatment and management of the patient.
However, at a time when you’re literally just trying to remember, ‘What does hypernatremia mean?’ ‘What causes that?’ it’s not easy to attend fully to the person in the room with you.
Then, once you start treating patients, how do you know if you’re being empathetic enough, or too empathetic?