One of the wonderful things about having a blog is stumbling upon other peoples writing. A few months ago I discovered another blogger writing about burnout and I was intrigued. Her name is ‘M’ and she writes at https://reflectionsofamillennialdoctor.com.  I love her writing, and after reading a few posts I  immediately reached out to her and asked if she would be willing to write a guest post.  She graciously agreed. Her story and background is very different than mine, but her struggles with burnout are familiar.

Enjoy!

THP

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“You’re all F****** idiots!!!  I’m going to report Dr. M to the state board and get her medical license revoked!  You’re just after our money, trying to make us come back to get re-examined again! You’ve just lost four patients, you F****** M************!!!

…

To repeat this message, press 7.”

 

I sighed, handing the phone back to my medical assistant.

 

“Well… I guess just try to document that in a phone encounter and censor it a bit.  We still need it for the patient’s chart. Also, don’t delete the message.”

 

Last week was just one of those weeks.  Again. Week after week after week.

 

I kept telling myself it would get better, that situations like this would resolve and I’d be back to some semblance of normalcy.  But, inevitably I’d have another situation pop up, like the next voicemail after the 5 minute cussing spree I just listened to, during which another patient was upset that I wouldn’t increase the dose of his narcotic AND give him a sleeping pill.

 

“I thought you were different and that you cared, but it’s pretty clear that you don’t!  You just lost this patient!”

 

I’m pretty sure if we could still hang up by slamming our cell phones down, both voicemails would have concluded in such a manner.

 

It’s time to face the music.

 

This is my new normal.

 

The hostile work environment, the intimidation, the “I can’t believe someone let you be a doctor” comments even as I’m providing appropriate, gold standard, evidence based medical care.  I had told myself I could put with these issues during residency because things would be infinitely better as an attending.

 

I was wrong.

 

One way or another, I need to get out.

 

 

Burnout

 

This term is everywhere nowadays.  When it’s an entire topic with multiple pages at Huffington Post, you know it’s gone mainstream.  The term “burnout” was actually coined in 1974 by psychologist Herbert Freudenberger in relation to job-associated stress.

 

As described in Psychology Today, burnout is a state of chronic stress that leads to:

• Physical and emotional exhaustion
• Cynicism and detachment
• Feelings of ineffectiveness and lack of accomplishment

 

People like me are at high risk for burnout.

• Type A personality?   ✓
• Perfectionist?✓
• Healthcare professional?  ✓
• Too stubborn to admit you’re struggling/ask for help?  ✓

I was pretty much doomed from day one.

 

 

Day 1:

I was the first-born to immigrant Filipino parents who had moved to Canada in the 1980s, with hopes and dreams of building a better life for their family.  The day I was born, those dreams were placed squarely on my little lanugo covered shoulders (I was a ridiculously hairy baby).

 

My mother loves to tell the story of the first time my father and I met.

 

She watched as my father counted all 10 fingers and all 10 toes declaring, “Look at those long fingers!  She’s going to be a pianist!” He stroked my full head of black hair and whispered, “You’re also going to be a doctor.”

 

This was where my script started, and invariably this is something quite familiar to 2nd generation immigrant children.

 

Not one to disappoint, I set off on the fast track to scholastic achievement.  I learned to read at age 3, started kindergarten at age 4, skipped third grade making me even younger than the rest of my classmates, and ultimately I graduated high school as valedictorian at the ripe old age of 16.  Somewhere in there I trained in classical piano, got my certifications through the Royal Conservatory of Music in Canada and moved to the U.S.

 

My father’s dreams became incarnate the day I declared my major as pre-med in undergrad.  By that time, I had internalized his dreams as my dreams too. I was DAMN GOOD at school. There was never any academic struggle for me to learn anything.  If I said I’d learn it, I would.

 

Why wouldn’t I be a doctor?  I had the academic chops to make it.  I wanted to help people – I mean, what kind of jerk doesn’t want to help people?  My path just made sense.

 

 

Except When It Didn’t

 

During the last year of pre-med, I had a crisis – what if I didn’t want to go to med school?  I saw my friends moving on to real adult jobs and I had to look forward to 8 more years of schooling and training?

 

My doubts and I went back and forth until the decision was made for me – I was waitlisted for a year at the med school I was accepted to.  I jumped at the chance to get myself out of my script and out of my parents’ basement (because what parent allows their 16 year old to go live off in the dorms by themselves?).

 

I did a complete 180 and became a pharmaceutical sales rep.  In Flint, MI.

 

My parents’ grief was palpable.  I had cast off all their hopes and dreams in such a selfish gesture.  On top of that, I made them drop me off in one of the most dangerous cities in America where I presumably would learn how to adult by myself.  The icing on the cake would have been the lead crisis, but that was 8 years too late.

 

I completely set myself up for failure as it was a decision based off emotion, not logic, but I learned so many lessons that year.

 

• I am not a salesperson
• I detest corporate bullshit and business speak
• No one should live in Flint
• I needed to return to the academic safety net

 

So, I planned my exit strategy after a year of sales repping/collecting signatures and quit the Friday before med school started.

 

 

Resuming the Script

 

I was back on track to living out the Filipino-Canadian-American dream.  Go to med school, become doctor, go to residency, become actual doctor. That year lost wasn’t even really lost as I was still one of the youngest med students to matriculate at the age of 21.

 

However, during my medical training I was acutely aware of the life I had turned my back on.  The one in which you only work 40 hours a week. The one that you actually accumulate wealth instead of piling on more and more student debt.  The one that you could turn work off and not allow it to intrude on your personal time. The one where your life’s identity isn’t consumed by your profession.

 

Instead, I had exchanged it for a life and career where unless you were giving 110% of yourself, it wasn’t enough.  In med school and residency, you were always encouraged to take on more: more research and more studying in your free time.  I was encouraged to keep moving onto fellowship because academically I could do it. When I pushed back and made the decision to “just” stay in primary care, I received so many comments on how “unfortunate” it was.

 

“You’ll never be happy with just being a primary care doc,” they told me.  “You were meant to be more than a referral generator.”

 

I ignored them, however, and found myself looking forward to returning to the much easier life I had when I was 20.  Upon completing residency, I came out on the other side and to my dismay, discovered I didn’t like that there was nothing left to achieve.  I was bereft of an academic goal I could move forward to.

 

Yet, I still was conditioned to give 110%, and primary care was more than happy to take it from me.  For 2 years, I ran myself into the ground by increasing my hours at work to the average 50-60 hour physician work week, giving more of myself emotionally to my patients than was healthy, fighting with insurance companies and sometimes patients so I could practice the type of medicine I had envisioned myself practicing, and for whatever reason, refusing to take real vacations.

 

Interactions with patients started to suffer as I became more and more cynical.  My efficiency waned as I began to fall behind on all the documents and paperwork coming into my inbox – some documents 300+ pages long for new patients.  How discouraging it was to get in my inbox down to zero by 7 at night, just to have it pop back up to 20 the very next morning! I started to have weekly sessions with my office manager over patients who were upset with me for a whole laundry list of things:

 

• Making them come back for a yearly appointment and labs in order to get refills for their diabetes, blood pressure and cholesterol medications – how dare I!
• Not giving antibiotics for their cold or allergies
• Refusing to give more narcotics than what their pain contract was signed for
• A patient infuriated their insurance didn’t cover their vitamin D testing when I explicitly told them it wouldn’t be
• A mother incensed that I wouldn’t discuss details of her 18 year old daughter’s appointment with her

 

These were things I was never warned of when I started my journey into my medical career.  This wasn’t medicine. This was babysitting. And it was taking up the majority of my day and emotional energy.

 

My personal life suffered.  I didn’t want to engage with my husband when I got home – I had nothing left to give to him since I left it all at work.  I started trying to find excuses to avoid spending time with friends – after hearing people at work complain for 9 hours a day, there was no way I was going to spend my free time with people who had a remote possibility of also bringing up something bothersome to them.  I started to view friends and family as more leeches to make sure I said the the right thing to. My perspective on my life choices that brought me to this point left me even more regretful and embittered.

 

The focus on my hopes and dreams to become a physician was now redirected to paying off my student loans and building up my retirement nest fund as quickly as possible so I could get out of this soul-sucking profession.  The irony was so laughable, it was the only thing that made me smile during those days.

 

 

Approaching Critical Mass

 

As crazy as it sounds, the election in 2016 marked my tipping point.  The swirling cesspool that is political discourse in the media pushed me right over the edge.  It just confirmed what I knew in my heart all along: People are THE WORST.

 

What was the point in going out and trying to save the world when the world has proven itself unworthy of saving?

 

It spiraled out of control during a conversation between my sister, father and I in November 2016.

 

“What is WRONG with people??  When did it become alright to discard entire swathes of the population just because you don’t agree with their opinions?

 

Why did I spend an additional 8 years beyond undergrad to ‘help these people’?  They don’t even try to help themselves, plus they’re all jerks!

 

What was the point of incurring $250,000 in student loans and wasting my 20s under the fluorescent lights of a hospital?

 

What is the point in general?  We’re teaching our children to be bullies and assholes!  The future is lost!

 

We’re all just going to die in World War III from nuclear holocaust!”

 

In between the hysteria, tears and body wracking sobs, I heard my father hesitantly ask, “M… are you ok?”

 

 

I Was Not OK

 

I stepped outside of myself in that moment and realized just how crazy I sounded.  I didn’t recognize myself anymore.

 

Gone was the level-headed, emotionally contained, rational person I knew myself to be.

 

For all my hard work and efforts to push me along toward my “successful” career, I had neglected to take care of my personal self.  And now she was a blabbering mess despite living the American dream – the great career, a wonderful marriage, the 3 bedroom, 2 bath house with stainless steel appliances and hardwood floors – the life of plenty my parents had envisioned for me.

 

It’s been a year and a half since that epiphany, and a long climb up a sand dune to get myself back.  Some days I make progress, other days I careen down the side back to my starting point. It’s a long, awkward fall you can’t help but gawk at, and I’m documenting it all on the interwebs for everyone to see.

 

I’ve done all the things you’re supposed to do – eat well, exercise, practice mindfulness, volunteer, have a gratitude journal, start a blog (apparently that’s what you do).  Finally, I’ve given myself permission to cut back on work which has allowed me to do a lot of philosophizing.  I have considered whether or not this was actually depression vs burnout, but by cutting back on work and seeing myself bounce back with greater gains, it confirms work as the primary driver of my misery.

 

With much introspection, I have been grappling with uncovering my “why” – why did I start on this career path at all?  Was it just me following the script I was handed which also happened to be the path of least resistance? Or was it truly my calling?  Can your calling change over time? If I really didn’t get into this for the sole purpose of helping people, does that make me a jerk?

 

Hopefully one day I’ll be able to answer all these existential questions for myself.

 

First, baby steps.  Currently, I’m on a self-imposed 30 day challenge of restocking my joy fund on Instagram because even now, it is deplete.  My journey is an ongoing saga, but a story that must be told.  With sharing my story, I’ve heard from so many colleagues with familiar feelings of burnout albeit different journeys, and it has been so incredibly helpful and healing.

 

I just want to thank HP for inviting me to talk about my story of my ongoing burnout – his blog is really the first one to speak to me in the midst of my struggle, given me the courage to write and the one I have modeled my personal blog after.

 

Thank you.

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It’s my pleasure M. Thank you for taking the time to share with us.

Let’s show M some love in the comments below and check out her blog – it’s good stuff 🙂

THP