Adapted from a keynote address given to the graduating medical class at the University of Toronto.
When I was asked to give the keynote to graduates of the class of ’14, it was an honor that nevertheless filled me with terror and a bit of wistfulness.
My sense of fear in giving advice to these amazing young doctors comes from not being sure I belong in the same company. They are whip smart, talented, and ambitious beyond anything I could muster. The competition for a place in med school is past daunting; out of 3,000 wannabes, just 250 make the cut. The thought crossed my mind that if I was starting out today, I’m not at all sure I’d make the class.
The wistfulness comes from wondering whether I would want to be a member of the class of ’14 if I had the opportunity. These are trying times for young doctors.
An editorial in the most recent edition of the Canadian Medical Association Journal puts the rate of burnout among residents as high as 50% — with symptoms such as emotional and physical exhaustion, a detached attitude, and a belief that they can no longer work effectively with patients.
The path to burnout in these young doctors is often set years before the first symptoms appear.
The medical profession attracts bright people with personality traits like perfectionism and a martyr complex. The academic demands of being a doctor are quite high. And as these students become residents, the work demands are even higher.
Just take a trip through the hospital. The patients we treat are older, sicker and more complex. Today’s residents must grasp more and do more each day than ever before. Technology fixes some problems and creates others.
To that, add sleepless nights. We all know that sleep deprivation can’t be good for a resident’s diagnostic acumen. A recent front-page story in the Globe and Mail documented the mixed results reducing those hours have on the well-being of residents and of their patients.
When it comes to taking care of the emotional well-being of residents (and each other), we’re downright stingy.
Once students and residents have completed their last oral and written examinations, they may never receive any other feedback about their competence, let alone that that they do good work.
With nearly three decades under my belt, I can say with complete confidence that it’s possible to go years without hearing anyone in authority say you’re doing well.
As well, we don’t do a good job helping the resident or practicing physician work through and learn from the medical mistakes that are inevitable given the complexity of medicine today. Blame for failing to diagnose a heart attack — a discredited approach in other high-stakes enterprises such as commercial aviation — is still the default approach to error in medicine.
All that, plus a series of firsts that test a young doctor’s ability to keep in balance emotionally. The exhilaration of a first solo birth or a first save is beyond description. Then again, there’s the fallout of emotionally charged events such as the first unanticipated death and the first time you have to ask a substitute decision-maker to agree to a do-not-attempt-resuscitation order.
Some firsts make us glad we became physicians; others make us question our choice. These young doctors will see things and may be asked to do things that put their personal moral code to the test. The experts call that moral distress, and it’s considered yet another risk factor for depression and burnout — both of which lead to more errors — and the beginnings of a vicious cycle.
The human cost of burnout is almost unfathomable. Health professionals with burnout make more mistakes and their patients are at greater risk of being injured as a result of their errors. There’s also a good chance the patient who is going through a traumatic event like the loss of a loved won’t get emotional support because the burned out doctor doesn’t have any to provide.
Even more troubling are the rates of depression that some of us feel. The number one cause of death among physicians age 35 and younger is suicide.
One may wonder how a profession as ethically grounded as doctoring has so much trouble taking care of its own. I think it’s time we recognized that, collectively, we bear responsibility for the current state of affairs.
More accurately, the medical culture that fosters us is the problem. It’s a culture that implies you should strive to be perfect even though you’re human — one that encourages you to run from your feelings even though you can’t hide from them.
There is no MRI that can peer into the doctor’s emotional core. There’s no clot-busting drug that can unblock the way there. But inward we must look, for the sake of those who just joined our ranks — and ours.
Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R. He blogs at White Coat, Black Art. This article originally appeared in the Globe and Mail.
