Thread by @danielleofri

#Burnout among #doctors & #nurses appears to be at epidemic proportions these days, with concomitant prescriptions for wellness and resilience. But in reality, most are not burned out: most love taking care of patients and want nothing more than to be able to do just that.

#Resilience? The medical folks I see are among the most resilient people in existence. That they manage to soldier on and not walk out en masse—that’s resilience!

#Wellness? That’s like a kindly offer of an ice pack from a mafioso after he’s kneecapped you with a baseball bat.

The corporatization of medicine has profoundly changed the tenor of medical practice. Somewhere along the line, the medical profession was ceded to the health care industry.

Many of us no longer recognize the profession we entered.

And no, I don’t pine for the days of the giants. No amount of polishing of rose-colored glasses would make me yearn for the good ol’ days of paternalism toward patients and the old boys’ club of medical leadership. We’re done and gone with that, and good riddance.

The despair I see is more than just burnout. It is a betrayal of trust, the trust we gave to our own profession.

We are not burned out—we are heartbroken.

This is not what we signed up for.

This is not where we placed our trust.

Everyone who has a role in health care should work directly with patients and experience how the system thwarts efforts to do the right thing.

Folks in the C-suites ought to do 2 mornings of clinic per month or a few weeks of ward time each year.

Administrators without medical or nursing degrees should staff the front desk and the call centers.

This would surely be an eye-opening experience (and we could all use the extra hands on deck).

If the healthcare industry is as patient-centered as it claims, then revenues ought to be prioritized toward giving doctors sufficient time with patients and fully staffing the nursing ranks.

When it comes to fundamentals of patient care, most everything else is secondary.

I’m heartened that applications to med school are at an all-time high. Medicine is still the most rewarding field, hands down. The covenant with the patient remains robust and indeed is the animating impulse for doctors and nurses.

The covenant with the profession, however, remains in guarded condition—thready pulse, raggedy breaths, BP 60 over palp. As any practicing physician could tell you, it’s time to address the “goals of care.”

(from Academic Medicine, Nov issue, pp 1646-8)

danielleofri.com/the-covenant/