We are often our own worst critics.

Whenever doctors feel down, or burned out in our roles as health care providers and healers, we look inward. We wonder what is wrong with us. What could we do differently? We wonder why other doctors don’t have this problem.

The truth is, we do. We all do.

And yes, sometimes the problem is within us.

But other times, the problem is outside of us. Sometimes, it’s not our failure.

It’s medicine’s failure.

And that’s when it gets rough.

Let’s look at it objectively for a minute. We’ve done our duty. Studied like mad to get into med school or nursing school or vet school. Worked crazy hours through our training, while striving to maintain our spirits, our stamina, and our motivation. Missed countless family gatherings, weddings, funerals, and baby’s first steps. Kept up the momentum after training and given each of our patients the love we would hope our beloved grandmother would receive.

Then what?

Then medicine smacks us — not a little, but a lot.

Medicine fails us when we are told that we must recertify our board exams every 5 or 7 or 10 years. The tests are grueling, expensive, and typically do not have anything to do with what we are currently doing medicine-wise to help others. It feels like a slap in the face to spend thousands of dollars and hours to maintain our status quo.

Medicine fails us when we are told we must change the way we present data. We’re required to spend more time, money, and effort to use electronic medical records. And then, we must change the coding system so that paper-pushers, who do not take patient calls, do not care for patients, and who do not know the difference between cancer-treating procedures and cosmetic ones, will have an easier time denying payment for our services.

Medicine fails us when we are told to ensure our patients are “satisfied.” Are they satisfied after we explain the reason their infection is not healing is because their diabetes is out of control due to poor eating habits? Are they satisfied after we explain that the reason they are not getting better is because they stopped taking the medication we prescribed? Are they satisfied after we tell them—again—to quit smoking so they can breathe better?

And medicine fails us when mistakes are made.

• Mistakes made by colleagues in the OR, the office, or the boardroom.
• Mistakes due to cutbacks that allow our surgical instruments to be improperly sterilized, putting our patients at risk.
• Mistakes due to certification processes that push colleagues to use robotics for procedures so they can accumulate enough hours to meet the certification criteria, even though they are not skilled in the first place.
• Mistakes made by nurses in medication delivery because they are so short-staffed that they must do everything, for everyone, all the time.

It’s medicine’s mistakes that make me weep and wonder about our future. Not merely the future of medicine, but the future of our world.

When medicine fails us so deeply, so undeniably, so irrevocably, I struggle to remain the glass-half-full person you’ve come to know. And I not only burnout, I bottom out.

It’s times like this that I don’t have all the answers. I don’t even have some of the answers.

And maybe that’s okay. Maybe it helps me better understand the frustration and sadness in the emails and phone calls from my colleagues.

Maybe it helps remind me that we’re all just human beings, trying to make a difference, one patient, one colleague, one day at a time.

Starla Fitch is an ophthalmologist, speaker and personal coach.  She blogs at Love Medicine Again and is the author of Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine. She can also be reached on Twitter @StarlaFitchMD.