Improving Physicians’ Well-Being Calls for Systemic Revolution

Stockholm syndrome is described as behavior that develops in captives in which they begin to gain sympathy for and act like their captors, despite ongoing abuse, and later, after the captives have been freed, they refuse to cooperate with law enforcement to prosecute their captors.

Today’s physicians are the captives. Our captors are regulatory agencies that define the care for which we will be paid, insurance companies that prescribe the care and treatment and outcomes for which we will be paid, patients without whose positive opinion we will not be paid, and the internet whose physician-rating posts influence whether patients will choose to come to us for their care.

Every physician who cares for patients today has the same complaints: too many patients scheduled, not enough time spent with patients, too much time spent documenting care in cumbersome systems and defending our decisions to nonclinicians in the insurance industry, too much administrative oversight—the list is long. The reasons we were inspired to become doctors—to care for patients, to use our scientific knowledge, to influence individuals and society to be healthier and to have some autonomy in our professional lives—have been crushed beneath the heels of economic imperatives. We did not set these conditions, but we are captive victims of them.

Is it any wonder we are burned out, exhausted, depressed, and even suicidal? I think not. We are being told that we need to take better care of ourselves, have some “me time,” find someone to talk to, make time for exercise and massages, and so on. While such advice has its place, it is a reflection of the Stockholm syndrome. The lives physicians find themselves leading are not the ones they expected when they optimistically chose this career and answered to its calling. Instead, what we need to do is speak out that the system is entirely broken. All of us, employers and employees alike, must fight this system and acknowledge its inability to defend us, not from despair per se, but from the cognitive dissonance that this is somehow all right. It is not. We must advocate for our freedom, say what is right, and renew our vows to our patients. What will make us happy and ensure our well-being is being able to satisfy our ego-ideal: to provide good care, based on our knowledge and experience, with our patients’ well-being first and foremost in mind.

Only a revolution in the health care system will achieve this, and this is what all physicians must seek: not accommodation, but revolution. ■