I graduated from medical school 25yrs ago and recently left my family and maternity practice because of “burn out.” Since leaving my practice, I have been reflecting on some of the factors that led to my burnout.
When I was training, I was taught the importance of maintaining “professional distance.” I donned my white coat and worked very hard to contain the tears as I saw patients who had cancer, who had just lost a baby, who were leaving an abusive marriage or struggling with any number of medical or life events. As an empath, holding in my emotions was a very challenging endeavor. If I let a tear be shed, I would be pulled aside after the encounter and reminded of the importance of maintaining a “professional distance.” So, I continued to work hard at shutting myself off from my emotions and my humanity, as it seemed this was what was necessary to be a doctor.
For better or for worse, I was not able to shut off from my emotions or my desire to really be with people when they were suffering. Time after time, patients would open up to me about things they had never told anyone. I would often run behind and have a waiting room full of people to see, making clinic staff very upset at times. I tried various strategies to help me to be more efficient, but whenever I encountered someone who really needed me to spend the extra time, I felt called to be there for them – to journey with them through this challenging time. And I would run late, yet again.
Eventually, I moved from doing locums into having my own practice. With this change, I came to know my patients much more. I felt even more called to be there for them in their time of need. Sadly, in an environment of rising business costs and an outdated fee structure that, by and large, pays only for short, quick visits, I found it increasingly challenging to keep up. I continued to give people the time they needed – but did less and less of my charting and labs during the day, leaving them to do late into the night after my daughter went to bed.
Over time this became untenable, and last summer, I broke. Half-way through a clinic on August 11, 2020, I stopped caring what anyone was dealing with. I had given all that I had to give, and there was nothing left. Shortly after, I gave notice that I would be leaving my practice. I organized a lot of extra help and limped through the last eight months, finally leaving my practice this spring. Since leaving, I’ve felt a bit like a deflated balloon – trying to figure out what is “wrong” with me and why I just couldn’t cope.
Last night, I came across a stack of cards that patients had given me over the years. The cards were full of messages of thanks for taking the time, holding their hand, being with them through their most challenging moments. I was reminded why I went into medicine in the first place. There’s nothing wrong with me. As the many cards expressed, there was something very “right” with me. I showed up with my patients in our shared humanity, I took the time, I journeyed with them. The problem wasn’t that I wasn’t fast enough. The problem was that our system strongly discourages (and financially penalizes) us for taking the time, for caring, for showing up with another person and sharing in their pain.
In all honesty, I’m not sure what I’m going to do next. I do know it will involve embracing my empathy, my humanity and our shared human experience. Hopefully, the culture of medicine will eventually encourage us all to do this.
By Dr. Shana Johnston
Family Physician, Victoria