Medicine is currently struggling with the problem of physician burnout and the specter of diminishing wellness. Despite concerted efforts, burnout continues to expand. In light of this, being vigilant for limitations in the current framing of the issue is prudent.
Words express the conceptualizations of our world and frame ideas. Such framing is meant to be revealing. However, frames and the words that construct them may also be constraining. One approach to exploring physician burnout is to evaluate its current framing through a consideration of its prevailing lexicon. Doing so may expand the frame of the discussion and lead to better solutions.
Burnout: fatigue, frustration, or apathy resulting from prolonged stress or intense activity
Origin: “burn” from gwher – “to heat, warm” + “out” from ud- “up, up away.”
Burnout is then to have something fiery and hot go away. Consider the metaphor. Something fiery and hot in the medical psyche has gone away. What in the human psyche is fiery and hot? What put it out? Where has it gone away to?
Wellness: the quality or state of being healthy
Origin: “well” from wel – “to turn, roll” i.e., roiling or bubbling water. “Health” from kailo- “whole.”
Wellness is then to have a bubbling up of wholeness. Regarding etiology, given that physician burnout is an occupational mental illness, how has the medical mind been made unwhole? What part of the human mind is missing from medicine? Where did it go?
Mindfulness: the state or quality of being mindful or aware of something
Origin: “mind” from men- “think, remember” + “full” from ple- “to be full.”
If we are to posit mindfulness as a solution to the problem of burnout, what has the medical mind been emptied of? What has been forgotten? To be fulfilled, what awareness are we to fill the medical mind with?
Work-life balance: effort directed to produce or accomplish something in equilibrium with the sum of experiences and actions that constitute a person’s existence
Origin: “work” from werg- “to work” + “life” from lip- “to remain, persevere, live” + “balance” from bilanx “scale.”
If to be well in medicine we must balance the scales of our work and life, what then are we saying? That medical work does not constitute life? That we die at work and persevere away from it? Do not the deeds of our professional efforts constitute the actions and experiences of our existence?
Resilience: the power to return to the original form, the ability to recover readily from illness and adversity
Origin: from re- “back” + salire “to jump, leap.”
To be resilient then is to leap back to the place one was displaced from through adversity. However, what if the place one came from is unhealthy? What if the adversity derived from that place? Given that medicine is broadly creating illness in its physicians, is not leaping back precisely the wrong thing to do?
Finding meaning in medicine: to locate by search the end, purpose, or significance of the art or science of preserving health
Origin: “find” from pent- “to go, pass, bridge” + “meaning” from meino- “opinion, intent” + “medicine” from med- “to advise, consider.”
If to be well in medicine we must find its meaning, where did it go? How was it lost? What bridge must we pass over to find the intent of our work again and be well considered in it?
Finding joy in medicine: to locate by search the emotion of great delight or happiness in the art or science of preserving health
Origin: “find” from pent- “to go, pass, bridge” + “joy” from gau- “rejoice.”
If finding joy in medicine makes us well, where was it lost? If being emotional in medicine is a therapy to enable professionals to rejoice, what about all the myriad clinical emotions found in medicine like horror, relief, frustration, anger, pride, and shame?
These questions of lexical framing are profound. How is medicine to answer them to find a way forward? Consider a reframing.
What has burned out in the medical psyche is the fire and heat of human emotion of human passions. Modern medicine has become hyper-intellectualized through excess objectivity. It cooly evaluates patients under the reductionist paradigm of biological machines. The excess rationality inherent in this hyper-intellectualization has sired industrialized medicine and elaborated numerically efficient medical conveyors designed to mass produce generic health in standardized patients. These health factories treat practitioners as interchangeable cogs a machine that subject them (and patients) to unhealthy, cold, rigid, mechanical environments.
Hyper-intellectualization has made the medical mind unwhole by suppressing clinical emotion below the liminal border between the conscious and unconscious professional mind.
The medical mind has been emptied of its passions. Thus to be fulfilled, medicine must fill the medical mind with an awareness of clinical emotionality.
The work-life balance formulation expresses a cultural assignment of intellect to the public sphere and emotion to the private sphere. This is inhuman. Medicine is inundated with emotion by nature its work. The mentally healthy balance that must be struck by medicine is an intellectual/emotional balance professionally struck in the face of the whole of human life.
Resilience can’t take us forward. What’s needed is a “prosilience,” a leaping forward to a better place (pro – “forward”). Medicine can’t go back to the mental desolation wrought by indiscriminate suppression of clinical emotion. It must create a professional discourse in the knowledge and guidance that human emotions provide the professional mind.
The end, the purpose, and the significance of medicine are found in expressed human compassion. For medicine to be well considered, it must consciously bridge the clinical mind to the passions and compassion that give its work meaning.
Yet, there in that new and as of yet undiscovered country, clinicians will find not just joy but all the emotions that arise through the work of healing. Medicine must develop a sophisticated professional discourse in clinical emotionality if it is to be well.
John Clark is a family physician.
Image credit: Shutterstock.com
