I have a colleague who has lost his capacity to continue practicing pediatric 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. Even though I’ve been practicing pediatric critical care for thirty years, I don’t share his discomfort, at least for now, but I understand it. I can’t say much about other specialties because I’ve only done this one. So I don’t have much insight into the specific stresses other kinds of physicians face. I assume that these specifics matter to some extent.
There is a large body of research on occupational burnout in general and physicians in particular, one which I don’t pretend to know very well. You can find a good recent example here. That study, a survey of over 27,000 physicians, defined burnout as the presence of a loss of enthusiasm for work, feelings of cynicism about the work, and a low feeling of personal accomplishment. Those strike me as pretty broad categories, things that would include most of us from time to time. So I am not surprised that an average of 46% of physicians reported at least one of those symptoms. I would have thought it would have been higher. Still, compared with the general population, physicians were around 50% more likely to report these symptoms.
The physician group most likely to experience these feelings were emergency physicians, with primary care practitioners close behind. This particular study didn’t say anything about my specialty of pediatric critical care, or even critical care generally, but did note that general pediatricians were among the least likely to report such feelings.
It is my impression that critical care medicine as a specialty has a fairly high burn-out rate. By that I mean something more than the survey: I mean people who actually leave the practice of critical care. Some of this comes from the hours we keep and some comes from the continual crisis mentality you find in many ICUs, but I think mostly the reason comes from within us. Each of us has a finite capacity for tolerating stress, a fact known for many years. Old studies of combat fatigue from World War II even estimated precisely how large that capacity is, on average. When that limit is reached, we are done and our bodies make us stop, even if we may not want to. This is something worth remembering for everyone — not just ICU doctors, but everyone.
My own view is that this individual well of resistance to burnout varies a great deal from person to person. Perhaps this is innate, perhaps it is greatly modified by our past experiences. What I think, after many conversations with colleagues about it, is that nobody knows when they choose a career how deep is their well for tolerating this. I don’t know of any way of determining this, either, although perhaps psychologists have some tool or other for assessing it.
What I do know is that the effects on the individual can be very grave, especially if that person has no choice but to carry on as best he can. 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 if you feel it happening to you, it must be done if you want to continue on.