Cynicism Up, Answers Down

I really don’t know how to truly define burnout. It seems complicated. Zdogg likes the term “moral injury”. Fine. Maybe it’s just when doctors truly start hating their job? I’m not sure. All I know is that it’s getting worse. A recent study on March 15, in JAMA Network Open, observed an increase in burnout from 2014 to 2017, from 40.6 to 45.6 percent. There was a correlation for the increased rate with an increase in exhaustion (from 52.9 to 57.7 percent) and in cynicism (from 44.8 to 51.1 percent). BINGO!!! Yes, that last term that hits home with me. CYNICISM. Like in being cynical. Let me give you an example from the article linked above:

“Remediation of burnout in health care necessitates centrally and locally designed initiatives,” the authors write. “Solutions to address physician burnout will entail shared commitment from physicians and organizations, as well as physician-, practice-, and institution-level initiatives.”

I have no idea what they said but I believe they are full of sh%t and there is not way it is going to fix anything. You see…..CYNICISM. Now I get it. And got it.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Cynicism Up, Answers Down

  1. Kurt
    March 20, 2019 at 2:05 pm

    Funny thing I was quite happy doing call, office and hospital work prior to 2007. Then EHR and all the new rules and blaming Doctors for patients lousy health behaviors, prior auths and all this other new sh!t and can’t wait to leave. Current environment makes it impossible to be a “classical” physician. Ditto that on all the uncompensateable paperwork we now have to do.
    DPC? Fine, nice work if you can get it. It won’t work everywhere. If you are not careful, you “will” go bankrupt. Pull it off and one can be quite happy.
    Specialize and have 5 lucrative job offers before leaving fellowship/residency and make a bunch more money for a lot less work than a “classical” FP. (Now so much paperwork, no time for production.)

  2. Pat
    March 19, 2019 at 9:05 pm

    “Travis: I played all the games of What if. I counted the ladies I have known. I replayed the hard shots — given and taken. Remembered grief, remembered pleasure. I thought of all the choices made, the doors I’ve slammed shut, the seasons which have closed down on me, games called on account of pain. All that shit, Meyer. You know. A man’s head goes round and round about about. Filth and glory. The whole schmear. …

    Meyer: You question the validity of the mission. Thus you question the validity of the missionary. A loss of faith. That is corrosive. At that point you question existence itself, the meaning of it. A common human condition. Those with no imagination never really feel despair. Congratulations!”

    – from “The Empty Copper Sea” by John D. MacDonald

    Better than any explanation I could’ve come up with.

  3. JRDO
    March 19, 2019 at 11:17 am

    If I were to take to heart every article I read that tells me how unhappy I am, I may actually begin to believe it. There is a lot in our society that focuses only on the negative shit. Sometimes it helps to take a more complete inventory.

    I can easily come up with a list of things in our healthcare industry that I think should change. From a day to day perspective it would be getting rid of prior authorizations along with making healthcare more affordable for my patients by cutting the egregious profits within Big Pharma, health insurers and healthcare administration. For me, the issue of “burn out” isn’t so much financial or work load- it’s that I don’t have the control I want. Speaking from a PCP point of view- the patient care and clerical bullshit is constantly dictated to us by third parties and that is the most frustrating aspect of my day.

    But, I am an ambulist internist who owns my own clinic and I enjoy going to work with my hand-picked staff and taking care of friendly patients. My wife is an ER doc @ a local university. We didn’t come from money and so we’ve worked hard and managed our money well for decades. We are now able to enjoy being financially well-off and the vocational respect that physician still have. Yes we are tired at the end of the work day, but so were all the physicians that came before us. Overall I’m a happy doc and a happy guy.

    Disclaimer: I’m currently on vacation and am sitting on a beach in Florida with a gin and tonic which may be altering my attitude (my wife says it’s for the better).

    • PW
      March 19, 2019 at 1:08 pm

      If you’re not happy right this minute, you got a problem.

  4. Bill Ameen, MD
    March 19, 2019 at 10:48 am

    The so-called war on “burnout” (or as German rocketry experts called it a century ago, “Brennschluss”) has created a cottage industry for, as you’ve so aptly put it before, Dr. Doug, the very organizations that helped create it. The only doctors not at risk of burnout are the people who write articles about it for the AMA…

  5. PW
    March 19, 2019 at 9:16 am

    There is no question that what doctors are experiencing is moral injury. There is no question that this will continue and worsen UNLESS major changes are made in the system.

    • RSW
      March 19, 2019 at 11:40 am

      There is no question that those who run the system do not care.

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