Some people are tired and others are permanently drained. No matter the profession, if you have no energy, your abilities suffer. Medicine is a demanding field, no doubt, and we should expect our providers to be resolute and intelligent. Why should patients care about their doctor’s well-being? Doctors also happen to be human beings—they too can feel the vice-grip of burnout. A burned-out physician hurts your care and threatens any chance of having a great medical relationship. Patients need to recognize when their doctor isn’t fully present or just going through motions. In today’s episode, you’ll learn how to spot the signs of provider burnout.

There are so many sources about workplace exhaustion—everyone has an opinion about the subject, and rightly so. Of all this issue’s possible angles to comment on, the consequences to patients are the focus. Drained physicians are dangerous not only to themselves but also to patients carrying the consequences of that exhaustion. Patients need to know why providers get burned out and how that weariness is a personal and systemic problem. Doctors are people too—they make errors like the rest of mankind. That doesn’t mean patients have to stop holding physicians a higher standard. Rather, the patients able to identify burnout can either switch to another provider or make an effort to repair the sacred patient-doctor relationship for the better. These options present themselves only after having a clear idea of what occupational exhaustion is.

Burnout is both a nature and nurture phenomenon. Some people have an innate disposition for work to suck away their well-being. Others may be vigilant but their organization could bring unnecessary pressure to perform. The problem at hand isn’t hard to find. According to Medscape’s most recent annual burnout report, ~47% of physicians are burned out. The study’s main criteria defining burnout revolved around depersonalization and lack of fulfillment from work. ~60% of surveyed physicians noted that excessive bureaucratic demands of their respective workplaces were a cause of their exhaustion. Regarding internal characteristics, ~33% of doctors reported burnout having a direct connection with personality. Per the study’s parameters, common symptoms included more irritability, less patience, trouble with concentration, and full lack of empathy. A doctor unable to care for themselves won’t be able to care for you long-term. For simple medical problems, burnout may not be an issue, but when medical conditions get complex, the provider’s lack of energy becomes palpable. Burned-out physicians don’t last in one place for long. Excessive turnover stunts the continuity of any patient-doctor relationship. Even if the treatment is spot-on, the experience at the clinic could be awful.

Physician burnout itself was classified as a thing back in the 90’s. Providers generally agree that stress precedes burnout. Of course, a million things at the office can raise your blood pressure. Stress is a part of being a medical professional since, well, life is at stake with every decision. Researchers from the Stat Pearls medical education database list a host of burnout catalysts. Piling on more hours, spending more time entering medical data instead of seeing patients, a laser-like focus on productivity, and lack of support from peers to draw meaning from work are the factors standing out the most. The worst possible journey that can happen is stress creating burnout, with the compensation for that burnout leading to fatigue, depression, and even suicide. Patients can’t always see how eroded a physician becomes with time. However, patients do know when they’re treated badly. More diagnostic errors. Lack of engagement. Less safety checks. Even the most high-functioning burnt-out provider can’t avoid those mistakes forever. The greater challenge for both patients and doctors is the fact that burnout’s easy to misdiagnose. Someone could just be chronically tired. Any number of outside factors affect social versus clinical depression. Addiction or general anxiety could also be a predisposition that can’t be fixed without major intervention. Sometimes a doctor enjoys their job but has the personality of a stone statue. It’s easier to play whack-a-mole than identify your doctor’s burnout ahead of time.

Many have tried to explain workplace exhaustion, but one physician in particular built a helpful framework. Dike Drummond, a family medicine doctor who runs an empowerment organization called ‘The Happy MD,’ believes in three kinds of energy—physical, spiritual, and emotional. Burnout happens when there’s a deficit in those categories. Exhausted doctors can still forge on if they’re drained, just like how a government can operate in the red, but with a steep cost. Seeing patients for long hours without taking enough time to eat and sleep well is just the standard of medical training. Doctors also have to bear the weight of their patients’ many issues. Taking in hundreds of patients’ needs a day numbs physicians’ emotional capacity. At the spiritual level, physicians need to feel validated for choosing their profession, along the lines of “this is why I chose to practice medicine.” Not having enough of these moments breeds professional hopelessness. Physicians then begin to tell themselves “I’m not sure I can keep this up,” or “why should I bother doing more for my patients if my work doesn’t mean much to them?” Dr. Drummond argues that providers can recharge their batteries through building personal relationships outside of the clinic and taking pride in the best patient outcomes. I’ll link his work’s detailed follow-up on my page at rushinagalla.subtack.com.

This burnout concept is reflective to doctors themselves, but where do patients fit in? Patients can set up meaningful interactions by wanting to be involved in their care and by demonstrating appreciation to the doctor. I’m not staying you should write a thank-you note to every provider, but taking a short moment to thank your physician for their help in a small but focused way might just prevent their career from eroding their soul. Healing burnout at the individual level is wonderful, but persistent organizational dysfunction (e.g. a toxic or high-pressure workplace) blocks any progress. Systemic incentives die hard. Government organizations like the Agency for Healthcare Research and Quality argue for implementing flexible schedules and delegating work to mid-level staff to combat the pressures of medicine (e.g. time slots, data entry, general chaos). These are classic “sounds good, doesn’t work” policies. Most physicians and their employers make their income through volume more so than outcomes. Obviously, everyone steers clear of a bad clinic—healthcare still obeys some market laws. Imagine two primary care clinics with doctors accepting insurance plans with similar payouts. Clinic A has better staff and training (i.e. more doctors with expertise on specific conditions using less mid-level staff), but clinic B sees 50% more patients. Clinic B stays in business while A goes under. It’s that simple. If a medical office’s staff each need to see 100 patients a day and earn an average of ~$500-$1000 per insurance claim after contract deductions (assuming this is a traditional outpatient consultative practice), rational providers will see that many patients at whatever personal cost, including well-being. Our country’s insurance plans and the nature of American medical training need some reform (to say the least). I’ll spend more time on possible solutions in a future episode, but asking patients to fix those nationwide issues is too unreasonable outside of voting for someone with enough political will to handle the challenge.

It’s not all doom and gloom. Patients can still play a role in erasing burnout through collaborating with (rather than submitting to) their doctor, asking thoughtful questions, and demonstrating appreciation to the doctor for handling the demanding realities of medicine. Give your doctor assurance of their chosen profession being a positive and noble choice. Medicine is meant to be a craft, not an impersonal transaction performed in some beige-painted, windowless exam room. Thanks to telemedicine and new technologies, more providers are having somewhat of a blast to the past in practicing medicine outside of the clinic. House calls are (kind of) getting back into fashion. In the next pod, you’ll find out if home health is all the rage or just a gimmick. Subscribe and stay tuned to Friendly Neighborhood Patient to know what matters most to healthcare consumers. I’ll catch you at the next episode.

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