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
OPINION
DOCTORS' Lounge
ONE ANTIDOTE FOR BURNOUT –
Is it Possible?
A
John Lloyd, MD
topic 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 men-
tal 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 assis-
tants and related professionals reach criti-
cal 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 emer-
gency 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 assis-
tance,” opened the patient’s abdomen. The
surgeon cross-clamped the patient’s aorta.
The patient was transported to the operat-
ing 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
36
LOUISVILLE MEDICINE
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 pos-
sible 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 out-
come? 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 physi-
cian’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 deter-
mine 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 con-
sequence, 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 \) ]]\B\ۈ [\Z[[ܙH]\[[ܙHX\Y []\˸'H8$[\XZ[[ۋBY\
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