OPINION
DOCTORS ' Lounge
A
topic
ONE ANTIDOTE FOR BURNOUT – Is it Possible ?
John Lloyd , MD
for frequent discussion in the medical profession ( s ) has been burnout . Webster defines burnout as :
1 ) The point at which a rockets ’ fuel is used up , and the rocket enters free flight or is jettisoned . or
2 ) Emotional exhaustion from mental stress .
Almost everyone has ideas regarding causes for burnout in the medical spheres of action , but few have any ideas regarding prevention or resolution of burnout . Until my retirement , I was involved in the practice of pulmonary and critical care medicine for 43 years . During those years , I watched numerous physicians , nurses , medical assistants and related professionals reach critical mass in terms of ‘ emotional exhaustion from mental stress .’ And , several times in my career I was at the brink , but I managed to pull back and avoid the tumble . How ?
On a busy Monday , many years ago ( at least 30 ), a call came to me from the emergency department informing me that one of my patients was being coded in the ER . I went to the scene , examined the patient and noted a pulsating mass in the patient ’ s abdomen . At my request , a vascular surgeon was called . He , with my “ non-surgical assistance ,” opened the patient ’ s abdomen . The surgeon cross-clamped the patient ’ s aorta . The patient was transported to the operating suite with open abdomen and assisted ventilation . The skilled vascular surgeon repaired the ruptured aneurysm , closed the abdomen , and the patient was sent to the
ICU on a ventilator with full medical and pharmacological support . The surgeon and I talked with the patient ’ s spouse regarding the patient ’ s dismal prognosis , suggesting that preparations be made for the worst possible outcome . When I went to the patient the next morning , the subject was awake , and he mouthed the words ( unlike on TV , he was unable to talk with an endotracheal tube in place ) “ what happened to me ?” He recovered and went home in due time .
This case was my eureka moment . My epiphany : physicians do not determine patient outcomes . Many times since that episode , I treated patients who had little or no chance for recovery who did recover and go home . The converse is also true . In my years of practice , I also saw and treated patients who should have done well but who had an unfortunate or even fatal outcome . As a consequence , I concluded with much reflection that physicians do not determine patient outcomes . If one takes credit for good patient outcomes , they must also take the blame for poor patient outcomes , which is a prescription for rapid burnout .
What does determine a patient ’ s outcome ? I do not know the answer and will probably never know . One could resort to a metaphysical answer ( and that is alright ), but in my opinion , a reasonable answer is “ I don ’ t know .” Until all answers are in , I will have to stand by “ I don ’ t know .” The physician ’ s role and the health care team ’ s role are to provide the best care possible , according to their knowledge and acquired experience , that will give the patient the best chance for recovery or the next best outcome . But , I maintain that the ultimate patient outcome is determined by something outside the realm of available knowledge .
Is there an antidote for burnout ? For me , the discovery that physicians do not determine ultimate patient outcomes allowed me to practice medicine for 43 years . Under this “ antidote umbrella ,” I was able to continue to provide patient care to the best of my ability and acquired experience . According to my understanding , the “ good ” physician makes the right choices that will give the patient the best chance for a good outcome . But , in my opinion , ultimate patient outcomes are beyond the doctor ’ s control . I learned to live with that assumed knowledge , and as a consequence , I was able to continue the practice of pulmonary and critical care medicine for more than 40 years without excessive “ emotional exhaustion from mental stress .” But , if the aforementioned prescription does not work , one can contemplate this bit of ancient wisdom .
“ Within the sum total of diseases is one which is widespread and from which men rarely escape … I refer to this … that every person thinks his mind more clever and more learned than it is .” – Moses Maimonides ( 1135-1204 )
The physician ’ s mandate is to provide the best professional care that is possible , but live with the apparent knowledge that outcomes are out of one ’ s control . Knowing that one is limited in what he can accomplish will go a long way in the effort to prevent burnout .
Dr . Lloyd is a retired pulmonologist .
36 LOUISVILLE MEDICINE