What we now call ‘burnout’ is nothing new in medicine, nor are many of the structural problems that cause it. But motivating doctors to treat patients with humanity is as urgent as ever
Global and Mail Opinion by Nicholas Pimlott
Nicholas Pimlott is an academic family physician at Women’s College Hospital and the Department of Family and Community Medicine at the University of Toronto. He is also the scientific editor of Canadian Family Physician.
Last summer, I received a phone message from the wife of a patient. The message was shocking yet not shocking at the same time. Her husband, who had been my patient since I finished my residency in family medicine in 1993, had been found dead at the age of 58 on the living room floor.
An autopsy had been arranged, as is done in all such cases of unexpected death, but not yet completed. The coroner had told her that it was likely that he had died quickly, if not painlessly, from a heart attack. She had called to thank me for being his doctor for almost 30 years, and for my efforts over those many years to help him deal with his lifelong depression, his many accumulating health problems and his many attempts to quit smoking cigarettes.
It was the last of these problems that frustrated him the most. He was in thrall to his addiction and he deeply – viscerally – resented it. Together over the years we used every gambit in the physician’s repertoire – motivational interviewing, the nicotine patch and gum, various medications and, unusually for me, scare tactics – but nothing had ever really worked for long. He was one of the many patients during my years of practice whom I have failed to help overcome their problems, despite my best efforts. An unhappiness descended upon me for days afterward as I ruminated on the many ways that I might have done better.
For as long as I have been a physician, I have listened to my colleagues complain about their unhappiness and I felt that same unhappiness myself (just ask my family) – unhappiness that may come as a surprise to our patients and the public. How could the members of a profession with so much power, status and affluence be so chronically unhappy?
These days we call the pervasive unhappiness of doctors “burnout.” Burnout, just like unhappiness, is much more than disgruntlement. Yet burnout falls short, in most cases, of depression, since most of us experiencing it continue to work as we always have, but talk wistfully of early retirement or making a career change. Some few have done it, but many remain in practice and grumble on.
Over the past decade a growing body of research published in prestigious medical journals has documented in meticulous detail the association between physician burnout and the impact of electronic medical records in practice. EMRs have radically changed the nature of the work that doctors do, pulling us away from face-to-face care of our patients toward increasing clerical and administrative work. The evidence is overwhelming that the greatest impact has been on front-line primary care physicians such as family doctors and emergency room doctors.