Everyone can relate to this. It’s Monday morning and the alarm rings. You hit the snooze. I usually have to hit it 2 times or set several alarms. It’s time to get ready for work. Most of us dread it, I think. There are thousands of memes on social media exploiting this theme. But for some of us, the idea of going to “that job” again is loathsome. That is how it became for me. I’m an OB/GYN physician. For those of you that don’t know, I spent my days and nights delivering babies and taking care of all things that ail women. I particularly dealt with the aftermath of childbirth in the form of urinary incontinence and something called pelvic prolapse. After a baby is born, and as a woman ages, things tend to drop out of the hole, so to speak. I spent 65% of my time repairing that problem. I really liked my job. It was important to me to help these women regain a certain quality of life. My problem was that I did not have enough time in the day to do it the way I thought that it needed to be done. I also did not have enough partners in my practice to cover all the bases, especially if someone was on vacation or something. You can only be in one place at a time.
They say I got burned out. What does that mean? A fire burns out when it runs out of wood or air. A candle burns out for the same reason. How does a person burn out. This is becoming a hot topic in medicine. We physicians are supposed to be invulnerable. We can take it. That’s how we’re made. I used to think that staying up all night was something to be worn like a medal. As I’ve aged, I’ve come to realize how bad it is for the body and mind to be deprived of regular sleep. For a long time, burn out was considered a psychological problem of the doctor. There must be some flaw in that person or he/she could take it. For centuries, women were thought to not be tough enough to do the job. We now know that this is not true.
So what can make a highly intelligent and motivated individual “burn out?” Well, let us look at the fire, or fuel. In humans, this fire is often called passion. What fuels passion? The things that fuel passion are different for each of us. Some are driven by the need to do good and help people. For some, it is the lure of the money. And others, it is the need to be somebody that other people can respect. For me, it was a mixture. I initially went into medicine for the prestige it would bring me. I then discovered that I really did want to take care of people. Then I saw my first baby being born and was awestruck. Boom, I will do OB/GYN. The money just came along with the work. What we are not taught in school is how to manage a medical practice and take care of ourselves at the same time.
After twenty-four years of caring for women and delivering babies, I was exhausted. Along the way, my health began to suffer. I ruptured a few discs in my back and had back surgery. My body got slower. The night call got more burdensome. The pain in my back never left, and in fact got worse every time I delivered a baby. Then, I got to the point were I thought, on several occasions, that I could not get the baby delivered. I just could not get my body into the right position to do it, due to my back. It scared the crap out of me.
Suddenly I found myself not sleeping well. If I screwed up a delivery, or a surgery, and hurt someone, how could I live with myself? The easy answer, I would not be able to live with myself. I became so tired that I started to miss things. Try as I might, I just could not keep enough fuel in my tank to do my job. I confided in my partner that I feared that I might be a danger to my patients. Well, when you say that in certain circles, you get asked to take time off and go get your head evaluated. I felt like I’d been hit with a baseball bat.
Now it’s been 7 months, I’ve had the second back surgery and a whole lot of counseling. I’ve come to realize that “burn out” is not a problem with an individual in isolation. It is quite often a response that an individual makes in the face of overwhelming stress. In fact, the World Health Organization (WHO) has redefined their interpretation of burn out as an employment related syndrome. The bottom line is that the individual is the candle wick and the was is the fuel that keeps the wick lit,
The wax is whatever you need to do your job to the best that you can do it. It’s the right equipment for your job, or the right people with whom you work, or the amount of rest and time away from the job. If your work environment does not supply the fuel well, you will lose energy. Eventually, you will lose all fuel and become ineffective. At this point, you can literally die. The trick is to discover that you are in trouble before that happens.
In my situation, I was in a partnership with one other physician and a midwife. We were a rural practice owned by the hospital. We originally had four doctors and two midwives. We suddenly found ourselves two doctors and one midwife down. Each of the remaining doctors, my partner and me, was on call twelve to fifteen days per month. We each performed gynecologic surgery at least one full day a week. We could easily have to add surgery or deliveries at any given time. And we saw fifteen to twenty-five patients in the office per day. We needed another doctor, at least, to help the load. We worked this way for over a year and our business grew 67%.
Then I started to run out of fuel. I found that I could not keep up with the work demand. I talked to the CEO of the hospital about getting us help. What I really needed was less time on call so I could rest. He did not want to spend excessive money on a doctor to give us a break. We interviewed several doctors to fill the spot, but they never seemed to take the job, for some reason. I finally broke. My needed fuel was sleep and I could not get enough. Thankfully, I figured it out before I really hurt someone. Many of my colleagues don’t figure it out and they inadvertently commit malpractice. Some turn to drugs or alcohol. Some commit suicide. I’d like to help this problem somehow. This blog will be my musings on the business and practice of medicine, and specifically OB/GYN. I hope to encourage discussion on the many crossover issues related to work fatigue in other industries. The transportation industry has addressed these types of stressors. It’s time for medicine to do so as well.
TheRoastedNutt 