November 02, 2008

Medical Student Burnout and the Challenge to Patient Care

On this piece in the nytimes and the commentary that follows:

The majority of physicians practicing today have been able to adapt to the extraordinary process of medical training.

They’ve done so by virtue of extraordinary coping skills– through sublimation, denial, or simple concealment– and not without personal toll, be it family stress, mental illness, or substance abuse, which reaches terrifyingly high rates for many medical specialties. This is well described by the studies mentioned in this article and many other surveys of medical students, residents, physicians in practice and other medical providers. Likewise, there is a large body of evidence relating these conditions to medical errors, poor care, and patient dissatisfaction.

At a time when there is so much understanding and when there is a shortage of medical providers in many parts of this country, why do people at large and physicians themselves continue to believe that medical training must be miserable?

The answer cannot be that the misery is part of the best selection mechanism, because if this were so, then there would be many other professions with similar selection pressures. Similarly, the answer cannot be that good doctors cannot be trained without this hardship. Consider airline pilots who must perform at their best since a single error would affect the lives of hundreds of people. Are they subjected to training to fly aircraft while being sleep and food deprived and looked down upon by their more experienced coworkers?

Medicine and nursing are fundamentally different from other professions, but not with respect to the universal nature of adult learning, the effects of work hours and conditions, and individual performance under stress.

While I love caring for too many patients, because I love caring for each one of them, and working too many hours, because I love the work, I also want to feel well, to eat well, and to have a healthy family and home. Isn’t there a way to maximize the former and limit incursions on the latter?

Reform of medical training is long overdue.

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