Thursday, March 18, 2010

THE EXHAUSTED PHYSICIAN


Snippets in the news suggest that the issue of resident physician exhaustion is on the rise again.

Imagine that as you awake from your coma in the ICU, the young physician who’s adjusting your IV drip is heading into a coma of his own. On the job twenty-four hours now, his brain consists of tired neurons connected by strands of caffeine. If it weren't for that tube in your mouth, you’d yell for help.

This question of resident overwork pops up like clockwork in our media every ten years, like a cicada cycle. “OMG,” we text one another, “have you heard about this?” We write letters to editors. We call for Congressional hearings. Outrage blooms in headlines. Then the issue burrows underground again for a decade. University committees that study the problem eventually recommend limited work hours.

And very little changes. When I put on my anthropologist hat to question this inertia, I identify a couple of suspicious factors. One involves the intent of young doctors themselves. A few years ago I attended a meeting at a midwestern medical school in which the faculty announced new rules to resident physicians. Shifts were to be limited to twelve hours. Overtime work would not be permitted. Residents were to take two consecutive days off every two weeks. This still sounded like a lot of work to my slacker ears, but several residents responded as though they were being laid off.

“This is a teaching hospital,” one complained. “How am I going to learn with such abbreviated hours?”

Another protested, “You’re telling us to go into our board exams against the residents at St. Elsewhere who’re getting a hundred hours of training a week.”

No one said, “Gosh, thanks. Maybe I’ll be able to lead a humane life now, and give my patients more mindful care.”

So part of the resident exhaustion syndrome stems from rat-race mentality. But part, I think, comes from our cultural view of healing as a metaphoric transfusion from the caregiver to the sick person. We tend to see healing as a zero-sum game: the patient’s improvement will be roughly equivalent to the healer’s depletion. This is especially visible in lay caregivers. It’s not uncommon for relatives of sick people to work themselves into sickness.

When I recommend that we begin healthcare reform not with its economics, but its most fundamental principles, this is one item worth discussion. Do we actually believe caregivers—including professionals—need to be drained by their work, or can we imagine a system in which all players feel better for their efforts?

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