Remembering My Burnout

This is an essay I wrote in 2023. I never published it at the time because it felt too personal and I feared it would be taken as criticism when my feelings in fact reflected a multifaceted situation where no one was to blame. I am now in a much better place but I can remember vividly this time in my life and much of what I wrestled with then, I wrestle with still. This is an interesting follow-up to my last essay where I make the case that in psychiatry, the relationship is everything. Here, I write more about the circumstances where it is still not enough.

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A major source of burnout for me was the internalization of the doctrine that I should be treating those who are the worst off, those with the most severe cases of illness and those who can not help themselves. That this was the physician's most noble calling shaped my early professional identity profoundly. Seeing the degree of burnout across the medical field, I can't help but wonder if its impact extends beyond me.

To focus our resources on the most ill idealistically makes sense. After all, it was Mahatma Gandhi who said, "The true measure of any society can be found in how it treats its most vulnerable members".

However, like all ideals, they clash when applied to the real world and in the last few years with COVID, this value, for me, has come crashing to the ground, engulfed in flames, taking my own mental health with it.

COVID has made me realize that I am a scarce resource and that how I apply myself needs careful consideration to be sustainable. I work in a system that can treat physicians as if our most valued asset is the number of prescriptions we write. I work in a system that tries to maximize the number of patients seen, with no measure of the quality of care being provided.

But this is mind-numbing, demoralizing work: to peddle medications like they should fix all mental health problems and to see many people, not surprisingly, return time and again not much better. I am not that kind of psychiatrist and like most, what fuels my passion, when applied inappropriately, is what taxes me most and has lead to my burn out in recent months.

I no longer believe my role is to treat the most severely ill. I no longer strive to treat the most number of people. I don't know if this would come as a surprise to many, but in psychiatry, those most unwell are often those who are unable to use the help that is provided to them. Often, these individuals have the least social supports and the least psychological strengths. This happens for so many reasons that a psychiatrist can do nothing about.

Well, isn't that your job Dr. Chan? As a psychiatrist who appreciates this full and nuanced picture of a person, isn't it your job to work with all of these factors and to make the patient better?

Sigh...I have run into this brick wall head first at full speed, too many times and from that experience I say no. That is not my job. I can not MAKE anyone do anything he/she can not or does not want to do. NO ONE in a therapeutic environment has the power to do this.

So to use my skills, my empathy, my energy, my time on the people who can not use it to improve themselves, this is the cause of my burnout. To work in a system that is so overwhelmed that it tells me that my specific skill set does not matter, apply it to everyone, it is better than nothing, is insulting.

To be better than nothing, what a professional aspiration.

As I previously wondered, does this run more rampant in our healthcare system beyond psychiatry alone? Pouring our resources and ourselves indiscriminately into those who can not be helped, or when there is little gained? To not know when to say enough is enough, to fear not being allowed to say this? It comes at a great expense to us all.

For those who can not be helped by medicine, it does not mean we as a society give up. I think it means physicians play a much smaller role and different supports and expertise come into play.

I will speak to what I know best. In mental health, community supports and programming that focus on improving quality of life, like access to gyms and social connectedness will have a far greater impact than any medical intervention.

Accessible programs that deal with trauma, nurture resilience, compassion and acceptance; programs that connect citizens to nature and creative outlets would do far more than any prescription.

When I apply my skills to the appropriate patient, not only is the care effective, but I find myself rejuvenated and keen to work harder. It becomes an antidote to burn out. Use my skills like a crude hammer where everyone is a nail, and I will join the exodus of health care professionals leaving acute care medicine, or psychiatry altogether.