In a previous piece, I described the killer B’s of burnout in medicine, namely, bleakness, boredom, and bureaucracy. Both times I went through burnout, the cycle started with boredom. I found medicine so full of the mundane most days, after about five years in practice, I grew restless. There’s only so much time after your office is done, the kitchen is clean, and the kids are in bed to socialize or pursue other interests. I’m someone that needs to enjoy what he does to keep doing it, and medicine just wasn’t “it.”

So I decided to shift gears in my career, starting part-time work in public health and pursuing a master’s degree. While it reignited my enthusiasm for a time, it was a misguided decision. In effect, I responded to stagnation in my career by working myself to the bone. While it was completely in keeping with the culture of over-achievement in medicine, it left me with no “slack” in my life … no time for building a social life, connecting with friends, or just taking an evening on the couch to veg. All it took was a minor sports injury, and the fuse to the bomb was lit.

About two years into the master’s, juggling two jobs, my wife noticed that I angered all too easily. The chronic pain definitely contributed, but this was a different phase of my burnout syndrome. Things I could ordinarily laugh off — hospital privacy policies, College of Physicians correspondence about sex — put me reflexively in a foul mood. I lost my temper with patients, firing some of them on the spot, in what I can only in hindsight call a tantrum on my part. To borrow from the original name for the blog, this wasn’t patient care but impatient care.

As time wore on, my physical health deteriorated. The injury kept me from exercising, but I was still dropping weight to a point I hadn’t been since high school. My blood pressure was climbing as well, spiking into the 180s without my knowledge. More than that, though, my emotional health was in a shambles. The only thing that brought me to work each day was my duty and obligation to my patients. I ceased to have any identity outside of “chronically pissed-off slave to medicine.” It didn’t matter what patient was in front of me 90 percent of the time, because all they were getting from me was a facade, a persona saying whatever needed to be said to get them out the door.

So I did the only thing I could: I closed up shop and rested. I saw my doctor (there’s a novel idea), had my injuries dealt with, and thought about getting back in the proverbial saddle. Still, I couldn’t face the prospect of being back at the pace of regular practice. I was damaged goods.

I landed a spot at a local community health center (CHC). I’m a huge proponent of the CHC model, with team-based care that’s 100 percent necessary given the population. The CHC patients had many needs, and many of them struggle with mental health and addictions; this was not medicine for the faint of heart. The CHC gave me the time I needed to work with them constructively, but I had no idea how long I’d last.

I made it about three years before boredom started to settle in, and I ended up leaving public health for reasons that aren’t relevant here. I grumbled on another six months, bored but satisfied, when the other Killer B’s came a-hunting with a vengeance. The paperwork and government meddling were starting to drain the enjoyment out of the job, and the neediest patients’ problems were starting to drain the life out of me. Even an amazing holiday barely refilled my tank, and I was tired and bitching within days of being back at work.

So the cycle of burnout came back. I started snapping at people around me, started groaning about patients that created only minor nuisances. I was sullen and withdrawn coming home at the end of the day, reaching for a drink instead of a kiss from my wife and kids. I saw no value in what I was doing, and grew furious with the proverbial faceless bureaucrats that decided I couldn’t even try to provide proper care. One tantrum later, I gave my notice.

It’s been almost a year since I’ve seen a live patient. I once thought I’d be able to go back, even made plans for temporary gigs or permanent part-time work. But I don’t enjoy medicine, and never did for very long, and even a six figure income isn’t worth 30 more years of cyclical unhappiness.

More importantly, burnout has left its mark. I am irretrievably cynical about the future of the profession; though, in fairness, the government shoulders a sizable chunk of the blame there. That part of my pride and my identity attributable to medicine is essentially gone from my life. And I suspect I’ll never be free of my guilt over leaving practice – twice now. No matter what I might have gone through, it’s always the patients that lose out in the end, and I took responsibility for, and formed attachments to, some of the most frail and traumatized people in my community. That regret is a humbling but truly awful feeling to live with.

So to anybody reading or hearing this: if any part of this sounds like you, or a colleague, or a loved one, get yourself or that person help. Not a meditation retreat, or a yoga class, or a chakra adjustment, or a pat on the back and a pep talk, but meaningful, professional help. Yes, all that stuff can work, even turn lives around, but no one method works for everybody. If you choose a “path to wellness” that’s not right for you or the person you care about, there’s a risk of increasing the sense of hopelessness, and making matters far, far worse. The good news is that the help is out there, just a click or a phone call away. Seek it out. You’ll be far better off for doing so.

Franklin Warsh is a family physician who blogs at Impatient Care and can be reached on Twitter @drwarsh.

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