Note: This is a Guest Post by Dr. Edward T. Creagan, MD, FAAHPM, Mayo Clinic
Every physician essentially makes a Faustian Bargain. Faust wanted fame, fortune, and notoriety so he was willing to sell his soul to the devil. Physicians, in turn, are giving up decades of their lives for the challenge, prestige, and social acknowledgment of medicine, but the risks are enormous, and many do not recognize that going into the profession.
Now that I have the benefit of forty years and over 40,000 patient encounters, I can look at my colleagues medicine and bring a broader perspective to the discussion.
Spectacular advances in the diagnosis and management of disease have taken place over the last few decades. Certain patients are now cured from conditions that were fatal just a few years ago. Patients are living far longer than ever, and the role of artificial intelligence and computer-based programs promises even more spectacular advances.
However (and you knew this shoe would drop), never before has the medical profession been under such pressure. The rate of burnout is about 50 percent depending upon specialties (among my colleagues in oncology, burnout is rampant). Today I find that most physicians would not strongly recommend the profession to their children. And the electronic health record—that digital dragon—consumes hours of aimless clicking per day and less face time with patients.
There is no clear relief on the horizon.
We physicians may have spent twelve to fifteen years of our lives in rigorous training. We are the epitome of the driven performer. Why? Because we have to be. Would patients expect any less?
The Passion Paradox is a fascinating vaccine to help stem the tide of this pandemic of burnout in my profession. The authors eloquently point out that no one goes flat out 2/47, and the elite performer—whether in business, sports, or medicine—must recognize the risks of being on the high wire, set boundaries, and carefully evaluate the tradeoffs they make to pursue their vocation.
What price are we willing to pay to play on the big stage? That’s the crucial question. It’s not how good we are compared to someone else. In medicine, we measure how good we are compared to when we started. The epidemic of performance-enhancing drugs with myriad risks of even death is an example of the price that some athletes will pay to play on the big stage. The musical performer, as witnessed by the tragic lives of some rock stars, can go to extremes and actually play on the big stage—but at what price?
At some point our passion can consume us with disastrous results. We in medicine have one of the highest rates of suicide—at minimum, one healthcare provider a day kills himself or herself.
That price is too high to pay.
The Passion Paradox provides a flight plan, a GPS of the soul, an MRI of the personality, so any of us—whatever our chosen passion—can go the distance. This is not a cookie cutter recipe for each of life’s issues but an anchor to guide us during challenging times. As the authors convey so eloquently, we need to step back at some point in our lives and ask the critical question: Is the price worth it? What tradeoffs and sacrifices am I making? It might be ok to be “unbalanced,” but for how long? How can I do what I love and focus on what matters without driving myself into the ground?
Let me share an example. Some physicians are driven to be professors, others to be iconic transcendent performers in the operating room, or brilliant administrators in the boardroom. They sacrifice their families and their health for this elusive goal. Others are more content to be the Marcus Welby or Dr. Kildare, the everyday doc with wonderful patient hands and vast empathy, which has its frustrations but also immense joys. Yes, even in the field of cancer, where most of my patients do not survive. I have been at the bedside on hospice service more hours, days, years than I can convey. I have, in many ways, dedicated my life to death. With hope, passion, and compassion.
That joy, even in the face of death, is what starts and ends long days. It keeps me mentoring future generations of physicians in this work and it sparks my stories and fuels my memories. But, at the same time, I realize I’m constantly walking a fine-line between just enough and too much. It’s that very realization and self-awareness—that, as The Passion Paradox explains, must be an ongoing practice—that keeps me going so that my passion is a gift and not a curse.
Edward T. Creagan is an emeritus professor of medical oncology and hospice and palliative care at Mayo Clinic. Follow him on Twitter @EdwardCreagan (a daily tweet on stress/burnout) and at www.AskDoctorEd.com (weekly blog on patient empowerment). He is the author of the new book Farewell: Vital End-of-Life Questions with Candid Answers and a triple award-winning book How Not to Be My Patient: A Physician’s Secrets for Staying Healthy and Surviving Any Diagnosis. He is a valued speaker for both professional and consumer audiences.
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