By Diana Duong and Dr. Sharon Vorona
Between the late nights and the challenging nature of medicine, the life of a doctor can sometimes be a lonely one. But as it turns out, the medical community is quite strong and tight-knit. Online platforms—like Twitter and, of course, this one—help physicians voice their doubts, vulnerabilities, frustrations, or just find comfort and connection through sharing what’s on their mind.
This weekly feature is meant to bring you closer to the medical community, or at least know what your peers are talking about. Here, we gathered a few of the most buzzy Tweets on #MedTwitter. This week, it’s all about burnout.
Burnout starts early—before students are even fully qualified
Dr. Vineet Chopra, an associate professor at the University of Michigan, commented how “sobering” it was for him as an educator to see how early burnout begins. A presentation at this year’s Society of Hospital Medicine conference revealed that symptoms of burnout hit medical students in their second year of medical school—a feeling that eventually “crescendos” during residency.
It’s the accumulation of thousands of difficulties that distract from the goal
Holly Humphrey helping us understand burn out better. This description is both accurate and disturbing. Thank you for calling it to my attention. pic.twitter.com/cIZ7smM1oO— Richard Byyny (@rbyyny) February 2, 2019
Dr. Richard Byyny, a Colorado academic emergency physician, shared a slide from a presentation given by University of Chicago dean of Medical Education Dr. Holly Humphrey on burnout. Yes, the hours of paperwork, the countless clicks on an EMR to perform the simplest of tasks, and the alerts that are so overwhelming they get ignored are all part of it. (We wrote more about that stupid stuff here.) But burnout is more than the frustration of everyday obstacles—it’s the lost sense of direction that comes with facing those challenges.
It’s not burnout, it’s moral injury
“These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.”https://t.co/v0E0pcNdM9— Wendy Dean (@WDeanMD) February 3, 2019
In other words, burnout is a “state of moral distress.” Many students choose medicine out of compassion and a desire to help people. But the thousands of obstacles they face every day—from astronomical debt and lack of mental health resources, to the impersonal environment and competitive nature—can eventually drive them further and further from the purpose with which they entered medicine.
Instead of promoting the real art of medicine, it produces students who are exhausted, cynical, and decreasingly productive.
In a Stat News article, Drs. Wendy Dean and Simon G. Talbot write:
“Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.
Doctors share their coping strategies
Let’s start a thread with lots of useful coping strategies that can be used on a busy shift at work.— The Bipolar Doc (@doc_bipolar) March 25, 2019
If I get overwhelmed I can find it hard to see a way out.
I try to focus on one task at a time & take notice of the here and now.
What are yours?#medtwitter #MH4Docs
In terms of coping with daily burnout, a U.K. physician who goes by @doc_bipolar called for suggestions on how to manage during busy shifts. The majority of physicians say they’ll find a quiet place—whether it’s a stairwell, an empty room, or just stepping outside—to take a minute to breathe deeply and clear their minds.
I pull out my gratitude list and take a few deep breaths while I look it over.— Adam B. Hill, M.D. (@Adamhill1212) March 26, 2019
Dr. Marcus Greatheart, a Vancouver-based family physician, suggested washrooms as a convenient quiet place:
In Residency, a new grad Staff told me me to find a single person bathroom to hide in when feeling anxious in the ER. Meditate, play a game or check social media for a few minutes. Folks will assume you have diarrhea so they won’t ask you why you’re in there so often.— Marcus Greatheart MD (@DrMarcusG) March 26, 2019
Other physicians say they’ll re-evaluate their to-do lists to tackle urgent tasks one at a time, and leave anything else until the following day.
The case doctors are talking about this week
“The blunt name of Hawaii Pacific Health’s program is exactly why it worked: No one wants to streamline collaborative workflows, but everyone wants to point out stupidities. In addition to actually fixing problems, the GROSS (Get Rid of Stupid Stuff) system opened lines of communication and empowered staff.” See what they reported.
Consult for a pulmonary nodule three weeks after the patient was admitted for headache and ataxia. Had relocated from Arizona. Hobbies include flying gliders in the desert. The patient asked “Do you think what’s in my lungs is related to my headaches?” See the answer here.
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