Attending by Ronald Epstein

Author:Ronald Epstein
Language: eng
Format: epub
Publisher: Scribner

THE INNER ENVIRONMENT

But changing the health care system won’t solve it all. It is important to recognize that burnout has affected clinicians for centuries, and important causes of burnout reside within clinicians themselves. For the first time in memory, perhaps precipitated by the perfect storm of the heavy burden of suffering in the clinic and the increasing dysfunction of the health care system, some doctors are finally paying attention to their inner environment in a systematic way and finding ways to bring greater presence and resilience to the practice of medicine.

Imagine you’re choosing a doctor or that you’re hiring a physician to join a practice. What qualities would you want the doctor to have? When I ask this question of the general public or groups of clinicians—no matter what their profession or specialty—the answers are always the same. They want someone who is altruistic and hardworking, has excellent technical skills, is knowledgeable, has good judgment, is empathic and caring, and has equanimity in the face of tragedy and loss.

Yet, even these very desirable personality characteristics make doctors psychologically vulnerable.16 Those who are detail oriented can become compulsive, subjecting patients to too many tests and procedures “just to be sure” and waking at night because they think that they may have forgotten something.17 Altruistic, service-oriented doctors tend to overcommit and then get exhausted trying to follow through. Truly skilled doctors might believe that they can do it all—feeling omniscient, omnipotent, and unable to admit mistakes—a dangerous combination in medicine. Or they feel insecure. When physicians are asked if they ever feel like an impostor, a remarkable percentage (up to 43 percent) say yes.18 Of all personality factors, the most closely associated with burnout is rigidity. When unaware of his rigidity, a doctor might insist that his is the single best approach for each problem, and blame his frustration and ineffectiveness on other people (including patients) rather than looking inside himself.19 Even being empathic takes its toll when doctors don’t recognize their secondary trauma and negative emotions.20 Disturbingly, some clinicians wear stress and burnout as badges of honor, part of the macho culture of medicine that further compounds the anguish and isolation of distressed clinicians.21 Too often, self-awareness is lacking.

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