January 27, 2020
Physician Heal Thyself: A Case Study
By Michael D. Shaw
The expression “Physician, heal thyself” has its origins in an ancient Jewish proverb, “Physician, heal thy lameness,” taken from Genesis Rabbah (ch. xxiii. §4; D. 109). The principal meaning back then, as it is now, is “Before attempting to correct others, make sure that you aren’t guilty of the same faults.” This message is nuanced a bit in Luke 4:23, when Jesus is anticipating the question as to why he has not worked so many miracles in his own town. In this context, the proverb was being extended to include his immediate surroundings.
These days, an important form of physician self-healing involves the much-publicized issue of physician burnout—not to mention physician suicide. According to the Agency for Healthcare Research and Quality (AHRQ)…
“The health care environment—with its packed work days, demanding pace, time pressures, and emotional intensity—can put physicians and other clinicians at high risk for burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.” The agency also mentions that burnout might affect over 50 percent of doctors, and if these practitioners are thus impaired, quality of care and patient safety can be affected.
AHRQ cites five causes of physician burnout: Family responsibilities, time pressure, electronic health records, chaotic environment, and low control of pace. Let’s unpack a few of these.
Time pressure is a direct result of the current state of corporate medicine, whereby patients are commoditized to be a means to bill; and so many patients must be seen per day. Remind me again why professional athletes have far better ownership of their own skill sets than do physicians. Electronic health records were supposed to be the great panacea, but instead are almost universally hated. In fact, in their most successful deployment, they are used by medical scribes. As to chaotic environment and low control of pace, these just stem from the plague of corporate medicine.
For our case study, consider Debra Blaine, MD, whom we first mentioned in this article. Blaine was a practicing physician in Long Island, NY for 30 years, and became a victim of physician burnout. Her book Code Blue: The Other End of the Stethoscope was written out of frustration with the system and the realization that the lay public has no idea what is going on behind the scenes. Dr. Blaine told me that it became a kind of therapy for her.
As she puts it, “When my stomach was churning in knots, instead of developing an ulcer, I would just say to myself ‘I’m going to write about that’. I’d jot down a couple of notes and later transmute it into an unrecognizable encounter and put it in my book. I even had colleagues calling me and saying you won’t believe what happened today—you have to put this in your book!”
Her frustrations with corporate medicine were building for a long time, but the final straw involved a ridiculous incident with the unreasonable parents of a young patient, who complained to management. It took three weeks, but she was cleared of any wrongdoing. Ironically, she had already submitted her resignation. Full marks if you made the connection between the proliferation of insolent healthcare consumers, and the commoditization of healthcare.
Code Blue is a work of fiction, but much of it is based on her own experiences. While venting her grievances via this book and her blog are therapeutic, Dr. Blaine has also received great personal satisfaction from her work as a professional coach. She specializes in serving medical and other professionals who are struggling with the burnout of feeling overtired, disconnected, unmotivated, and under-appreciated in the impersonal, corporatized world.
Dr. Blaine’s description of her activities as a coach sounds a whole lot like practicing old-time medicine…
“I get to spend time talking to clients, getting to know them, and helping them discover their inner strengths. I can help them devise their own strategies, cheer them on, and together we can celebrate their victories, big and small. I can do those human things I used to really enjoy about being a doctor.”
Do you think healthcare would improve if most physicians actually enjoyed what they were doing?