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Doctors can only give so much

Published March 30, 2013 1:01 am

This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Medical training is a transforming experience for those who endure it. We enter hallowed halls as bright kids wanting to help people, and somehow, by the end, we exit as doctors who can't always see past our own busy schedules to be kind to our patients.

During one of my first clinical rotations, a resident shared a story about how he was called down to the emergency room to admit a patient. The patient was sick and very likely to die.

"If he died on my service I'd have to do so much more paperwork than if he died in the ER," the resident told a group of doctors, who laughed in recognition when he added, "I've never prayed so hard for someone to die."

When doctors in training forego sleep for long hours and endure physically and emotionally taxing days only to come home to spouses or children who are hurt by their long absences — or worse yet, to come home to no one at all — the struggle to just get up in the morning can drain their empathy.

They are surrounded by people dying, by people whose lives are derailed by illness, and this emotional burden weighs on them. When they look at the person before them asking for help, they can't see past their own struggles to help the patient. If the patient doesn't respond to treatment, if the symptoms don't make sense, we blame the patient.

It's not that our understanding of medicine is incomplete, or we have the wrong diagnosis. It is that the patient is anxious, or unreliable, or crazy, or malingering. If things don't make sense, it is not our fault — it is the patient's. Really, we've given all we've got, and there isn't much left to give.

The brilliant writer David Foster Wallace describes a comparable experience in his short story "The Depressed Person." The Depressed Person is suffering so much that she "waited patiently for an episode of retching" by a friend who was dying from terminal brain cancer to end. Then, finally, she could continue talking about her own suffering.

Depression can make people selfish. It is not because depressed people are bad, but because when someone is suffering so much that it is a struggle to get out of bed every morning, there is nothing left for anyone else. There is nothing left over to look at the person suffering across from you and listen to their complaints. You have your own complaints, and right then they seem so much bigger to you than the patient's that you can barely see past them to tie your shoes, let alone take care of anyone else.

This is what happens when physicians burn out.

One attempt at addressing the problem of physician burnout in some hospitals has been through Schwartz Rounds. These rounds are conferences that allow clinicians to come together and discuss challenging cases. The focus of these conferences is not on the difficulties of the diagnosis or treatment, but on the social and emotional challenges that we encounter taking care of patients: The difficulties of making life and death mistakes, of communicating with unreasonable family members or patients, of handling conflicts among team members and navigating a health care system that leaves too many people to struggle alone.

"We do these once a month," my friend said, "and there's not a dry eye in the house." We don't have Schwartz Rounds in my hospital, but I wonder whether my blog provides me an outlet for discussing some of the challenges of seeing people suffer.

Denitza Blagev is director of the Schmidt Chest Clinic at Intermountain Medical Center, an assistant professor at the University of Utah and blogs on medicine and healthcare at mybetterdoctor.com. The opinions expressed are her own and do not represent the institutions with which she is affiliated.