Barriers to wellness in medicine - 2. The Disconnected Doctor as patient zero
To find an example of people who are especially unwell, look no further than a group of doctors. Or worse, resident doctors.
Would you hire a broke financier as a wealth manager? Would Über employ a driver whose personal record is a smattering of daily accidents? No. Yet the people in charge of our society’s health are alarmingly unwell. When physicians become more than twice as likely to commit suicide as the general population, what we have is an epidemic with patient zero(s) at the helm.
Wellness is not just the absence of physical disease – it is the intersection of physical + mental + spiritual health. We have been inundated lately with articles calling attention to the epidemic of physician burnout. The common reasons listed include:
Stress of dealing with life and death of patients without proper space to process
Mind numbing time-suck that is our interaction with electronic health records
Threats of litigation, lack of autonomy
Work environments that can sometimes be hostile and toxic
Feeling like a cog in an ever-expanding corporate machine
All true. All relevant. All need to be changed.
But WHY do these things make doctors unhealthy? What is the common pathophysiology between these aspects that creates the barrier to wellness?
The answer lies in Disconnection.
If we think of wellness and happiness as the top of a mountain, then humans have been trying to climb it since the dawn of consciousness from all directions. The paths look different from each other, but the common tool to forge the way is to connect.
Religions provide connection to a congregation and an idea/deity
Social organization like the military or Girl Scouts provide a connection to a group and a mission
Spiritual schools of thought teach the practice of connecting to the self through meditation, yoga, etc.
Even solitude, as prescribed by non-theistic philosophies like stoicism and Taoism, is a path to tapping into a connection with the universe
Family. Friends. Relationships. You get the picture.
I could go on. It’s no accident that we have phrases like “being a part of something larger than myself.” Alan Watts, the famous British philosopher who brought eastern philosophy to the west, explained that the antidote to anxiety is realizing that the ego of “self” is an illusion, an attempt to horde security for the future, while happiness lies in presence and the realization that we were always whole and connected. The “I” doesn’t exist.
The identity of a Healer through the ages used to be a sacred calling that formed a crux of connection in the community. Unfortunately, being a modern physician is one of the most disconnected experiences in our era. Let’s take another look at the reasons for burnout in the context of disconnection:
From the self: Being a doctor is an ego-centric experience, and I don’t just mean ego in the sense of pridefulness, but the philosophical ego that is the seat of self-awareness. From the battle that is getting into medical school to the style of training that justifies bullying with supposed learning-enhancing aspects of fear, we have a cycle that reinforces traumatic and acute awareness of “I.” It isn’t enough to be smart and hardworking, one has to be tough to make it through this experience. That toughness, coupled with a lack of personal time for reflection and self-care, makes physicians intensely aware of their ego’s perception of performance and equally disconnected from their inner self.
From the patients: Unfortunately, this one is self-explanatory. Connection with a person takes time, openness, and a clean slate. In the time we can spare between being chained to the electronic health record and churning out paperwork, our time with patients is distorted by worries of being sued, lack of autonomy from insurance dictations, and the stress on the ego of having to be correct. Patients often say they don’t feel heard, and it’s true – a disconnected physician is not able to listen.
From each other: When was the last time you heard two residents from different specialties speak to each other? It can be a chilling experience. Instead of openly offering our expertise in the spirit of a connected team, the tired & disconnected physician is annoyed by the burden this question places on our to-do list. The ego feels superior in having knowledge over someone else because our training hordes the feeling of being right, forgetting that the point of having subspecialties is the benefit of collaboration. A disconnected physician is not a collaborator.
From the profession: We arrive at the place where we hear reports of astronomical dissatisfaction rates from physicians. We receive the “don’t go to medical school” advice. A disconnected physician can’t remember the passion that pushed him or her towards the profession of healing.
Just like a flame in an airtight chamber extinguishes without oxygen, a disconnected experience is not sustainable.
Our lack of wellness is not an accident – it’s a result of systematic steps that cut off the oxygen. A physician suicide is not any more tragic than a tinker/tailor/soldier/spy reaching the same desperation, but it is a more alarming sign of our broken cycle. We don’t know wellness, but our society and culture place us in a position of authority over it; our insurance companies would only pay for us, instead of for someone with expertise in multidimensional health, to deal with the issue. Our research funding pay for the creation of medicines, not change, because the former is profitable.
The way forward is clear, and it involves going backwards in some ways. Let’s invest in understanding the role of a healer and reconnect with that calling. To do this, we will have to commit to radical changes, tear down structures accepted as given, and go back to the drawing board. Only when we stand in an open space can the rebuilding begin.