When a Patient Becomes Another ‘Task’: How Burnout Can Be Insidious

It is widely acknowledged that burnout is prevalent in the medical field and can occur as early as during medical school. However, what is not often emphasized is that the process of burning out is insidious and can go undetected. The following, an experience of the second author, a third-year medical student, effectively illustrates this point:

On a Friday afternoon on the psychiatry consultation-liaison rotation, my attending sent me to see a consult in the trauma bay: a middle-aged man who presented with a self-inflicted knife wound to his abdomen. When I asked what brought him in, he avoided eye contact and remained silent. Knowing that the day would not end until I attained more information, I asked multiple times in different ways to encourage him to open up. I peeked at my phone and saw that it was getting late, and my fellow students were getting impatient. I asked again, “What brought you to the hospital?” and he finally responded, “Do not talk to me in that way.” Moments later, he began to cry, a muffled cry at first and then a crescendo into a full-on wail. After a few minutes, the patient collected himself and said he had refused to speak because the staff did not seem to care about him. He thought no one would understand and doubted that anyone could help.

As I spoke to this patient in his state of vulnerability and helplessness, the team waiting upstairs and the plans I had for my Friday evening dissolved and were replaced by the patient’s voice. For the first time in a while, I felt as though I was not only hearing but also truly listening to the patient’s story. I was reminded of why I had decided to become a physician in the first place: to care for those who are hurting. It was as simple as that, and yet after just a few years of being buried in books and overwhelmed by the daily pressures of clinical clerkships, I had lost touch with the reason I started this journey. I had burnt out.

Burnout is a syndrome of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. It is apparent in this interaction that the medical student initially approached the patient without true empathy. She saw the patient as just another consult to finish up the day. As you read this article, take a second and reflect: how many times have you felt the above phenomena?

Lack of empathy could reflect the emotional exhaustion you might be experiencing. Seeing a patient not as a person but as a number or task is depersonalization. While not described in the incident above, the student also endorsed a diminished sense of personal accomplishment. Decreased professional satisfaction is a common sentiment experienced by medical students, residents, and faculty alike. In this scenario, like many of us, the student fulfilled all three criteria for burnout and yet failed to realize anything was wrong.

Another important lesson that can be learned through this experience is that while those who are burnt out may not recognize the burnout in themselves, the signs of burnout do not go unnoticed by their patients. In the scenario above, even though the patient was in desperate need of care, he initially refused his providers’ help because he sensed that their intentions were not genuine. Only when the student gave the patient her full attention did he reciprocate with the same. Often, we feel guilty about prioritizing our own wellness for fear of appearing lazy or undisciplined. However, burnout diminishes the quality of care we deliver; caring for ourselves is not only our right but also our duty as health care providers.

Preventing burnout in the medical field requires a multifaceted approach that includes organizational changes, introspection, education, and recognition of the impact of physician burnout on the quality of care. Organizations need to train clinicians on what burnout is and how to recognize it before it is too late. Regular opportunities for self-assessment and reflection may result in earlier detection and intervention. It is also of paramount importance to recognize that today’s culture of medicine does not encourage us to take care of ourselves without feeling guilty.

Empowering residents and especially medical students to prioritize their well-being will result in a culture change that leads to both more rewarding professional careers for physicians and higher quality care for patients. Self-aware residents and students will not be afraid to ask their future employers to provide the right environment that will enable them to serve as empathetic, humanistic, and effective physicians for the long haul. ■