“WHAT do you do for a living?” the young man asked me.
“I’m an emergency physician. How about you?”
“I’m just a chef,” he replied.
“Pal, I can live a lifetime without medicine. I can only live a week without food.”
Sometimes a group of people you speak to love you. Other times, well — hate may be a bit strong, but they are far less enamoured with what you have to say. This is a tale of the latter, and to tell you the truth, I’m kind of proud of it.
Recently, an incredibly inspiring physician invited me to speak at a conference, the central theme being burnout in medicine. I really thought I had a handle on this since I had been practising emergency medicine for nearly 25 years and I did not feel burned out — which I learned is way above the average for ER physicians, who typically have a burnout rate of more than 50 per cent.
In fact, in our very large private physician group, the rate of burnout and attrition is, well, damn near close to zero. So why is that? What were we doing right? Certainly we are all very supportive of each other. We are all completely bogged down in electronic medical record keeping, seas of bureaucracy, fears of malpractice and other stressors including working far more hours than most other physicians in our specialty. What is it about us? I truly think it comes to four simple words that all of us have grown to embrace. Those words?
It’s just a job.
Let that sink in a bit because when I proposed that to this group of nurses, physicians and nurse practitioners, you would have thought I just stood up and proclaimed I was the antichrist. Even though I prefaced it during my talk by elaborating and saying that medicine is a deeply rewarding career choice, I insisted that it’s not our life. I tried to express that it’s simply a wonderful, marvellous and mystical avenue to allow us the opportunity to pursue meaningful work, make a good living, support our families and to do a job that allows us to see and do many magical things.
I also said that I felt it was not a prerequisite to always practice with compassion. Compassion means to suffer with others. I proposed that we do not need to suffer. Our role is to be there, provide comfort, alleviate suffering, listen and be engaged. We don’t HAVE to feel every bit of it viscerally but certainly there will be times where we truly connect and we will. But it’s also OK when we don’t. We don’t have to take every single emotion home, internalise it and make it part of our being. Which, in today’s society of rapid extrapolation, registered as:
“He must not listen to his patients.”
I tried to explain that I feel our emotions wax and wane day-to-day and minute-to-minute. It does not mean for one second that we are incapable of providing excellent care during those times and that this emotional separation does keep you sane and helps prevent burnout and allows you to focus on your job.
That wasn’t good enough for these attendees. In fact, one pretty much raised her hand, took the mic and said she was highly offended that I would say or even imply that medicine was just a job. She said she would not want to have a physician like me and there is no way that you can “fake” compassion. That’s when Starbucks entered my brain.
How often does a barista smile at you, thank you and tell you to have a good day? How often do you walk away feeling good that he or she was so welcoming and friendly? How often do you know what happened to them last night, what news they got this morning, how much money is in their bank account, what their marriage is like? Let me help you out with the answer … pretty much never. So do you think that patients are any different than you in those moments? You smile, listen, stroke their hands and offer words of comfort. Do you think the patient pauses and asks themselves about what happened to you last night, how marriage is, what is going on in your life? They just want to feel comforted.
One attendee warmly smirked at me earlier at dinner.
“I just don’t buy your assertion that it is just a job.” She motioned to the bartender. “Look, he just pours drinks and you say my job is no different than his?”
I tilted my glasses down and stared into her eyes.
“What if I told you that he works three jobs to support a disabled child at home and that this late-night job affords him the opportunity to buy her a few things that make her smile and feel special. Perhaps some toys he could otherwise not afford or a new dress perhaps. You think your job is so much better than his because you hold someone’s hand when they are sick instead of passing a beer?”
I like to think she bowed her a head a bit in shame perhaps, but I’m not so sure.
As the discussion went on that morning, a common theme emerged. Many of these people did not want suggestions on how to keep from being burned out. What they wanted was to be fawned over and congratulated on how compassionate they were, and how they had the hardest jobs in the world, and that no one could possibly understand the work or appreciate how hard their jobs were. I’m sorry, I said. “I just don’t buy it. You invited me; I’m not here to validate you. That has to come from within.”
You see, I think we are a bit elitist as to how we view ourselves in medicine at times. Sure, this is a very hard job, charged with emotion; it leads to crying, heartbreak and nightmares on occasion. But it is also filled with incredible rewards both spiritually and even financially.
One speaker, who was a physician and also a faculty member at Duke’s school of divinity, disagreed with my assertion and proposed that medicine was different, though. In a way, it was an embodiment of Christ’s principals of healing and was perhaps the first real charitable endeavour. I turned to him and said something to the effect.
“Yeah, that’s all fine and dandy but if it weren’t for the farmers, shepherds and fisherman during that time, the weak and infirm would just have been a source of protein.”
One attendee lamented about caring for a patient who was recovering from a procedure that went against her own personal values. She said she was distressed and angered by this; I believe what she hoped for was for me to embrace her distress, validate it, provide words of comfort and support and give advice on how to change. Even though, mind you, she said the patient was happy and very comforted by her care. I looked at her and responded.
“So what? That’s your job. You are supposed to provide care regardless of your values.”
She snapped at me.
“Yeah, but what about me?”
“What about you?” I replied. “It’s not about you. It’s about your patient. It’s about caring for your patient. That’s what you signed up for.”
This gave an opportunity for another speaker to chime in and take advantage of what he felt was oratory faux pas. “I believe this is more than a job. It’s a passion,” with reverent emphasis on the word “passion.” The crowd nodded in agreement, then turned and glared at me some more. I gave them one of those head tilting “whatever” looks.
“Listen, your passion should be your family, those around you that you love. You have to separate the two. There is not one of you that would not abandon your job for the sake of someone who you love and who needs you.” You see, I know this from experience, from deep within my gut.
Two Septembers ago, I got a call from a hospital in New York. My son who was in college at the time was just diagnosed with leukaemia. Fifteen minutes later, I jumped in a car and drove all night to New York, pretty much crying and pounding the steering wheel all along the way. I called one of my partners and said, “I am not coming to work. I have no idea how long I’ll be gone. If you need to hire someone to replace me, go right ahead.” I slept in a chair next to his bed for 42 days. Do you think for one second I regretted not going to work? I’d give up medicine and clean outhouses at Woodstock for all eternity if it meant I could help my child. People in medicine often say you can’t separate the two. I say bulls***. You just don’t know any better.
Listen, no matter how we like to hold up ourselves as the pillars of compassion, the keepers of the public wellbeing, we are just one profession out of countless others that keep our world moving. We are no more heroes than the social worker visiting homes in the projects, the farmer up at 4am to feed the cattle, the ironworker strapped to a beam on the 50th floor. We are no more a hero than the single mom working overnight as a custodian, trying to feed her kids. We are no more heroic than countless others who work in jobs they perhaps hate in order to care for and support the people they love.
Maybe I’m wrong in telling the group that medicine is just a job, but I am damn sure we in medicine are all wrong if we think our job is somehow more special and valuable than the bartender’s.
Dr Louis M. Profeta is an emergency physician practising in Indianapolis. He is the author of The Patient in Room Nine Says He’s God.