I have a colleague who has lost his nerve to continue practicing critical care medicine. It didn’t happen suddenly; it came on gradually over a year or so. It also didn’t follow from a single event or bad experience. It was just a creeping uneasiness that culminated in his unwillingness, after two decades, to go on doing this. I don’t share his discomfort, at least for now, but I understand it.
Critical care medicine as a specialty has a fairly high burn-out rate. Some of this comes from the hours we keep and some comes from the continual crisis mentality you find in many ICUs, but most of the reason comes from within us. Each of us has a finite capacity for tolerating stress, a fact known for many years. When that limit is reached, we are done and our bodies make us stop, even if we don’t want to. This is something worth remembering for everyone — not just ICU doctors, but everyone.
Have a look into the eyes of Abraham Lincoln in portraits taken at the beginning and at the end of the Civil War. His trial was a terrible one, far worse than any of us face. But if a man like him was so used up in four years, how can any of the rest of us avoid it unless we find ways of sharing our stress with others. It may be a blow to our medical egos, inflated as they often are, but it must be done.
Yes, not only are the pressures of work (Work that spills into personal time and consumes most of it) but also the fact that physicians feel DEVALUED in most employment situations- e.g. physician employed by larger entity such as a hospital or business-corporation. The loss of autonomy in day-to day decisions of aspects including how a physician practices medicine (style/art) is an important contributor to burnout and stress.
I feel that this is a recent phenomenon, an aspect that has not been looked into in depth.
Thanks for your comment. Yes, indeed. The fact of being accountable for things we do, but being largely unable to do much about the environment in which we do those things definitely adds to stress. Medical practice, it seems to me, works better on a craft model than on an industrial model. At least I like to think of myself as a craftsman.