Stop Physician BurnOut: There is no House of God
June 25, 2020
There is a classic medical traininig American book called the “House of God” by an author who wrote under the pseudonym Samuel Shem. Published in 1978, it is a fictionalized rendition of a group of interns as they go through their dehumanizing medical intern year. If you are considering medical school, I highly recommend it. You need to know the history of our profession. In some sad ways it is still very accurate. I forgot now how much that book struck me, and that likely much of the way I name things on this blog is influenced by that novel. That book is set at Beth Israel Deaconness Hospital, one of the teaching hospital systems within the Harvard system. I trained at another Harvard teaching hospital that I call Mans Greatest Hospital, and all of us who trained there still harbour that belief.
I completed pediatric training at Mans Greatest Hospital just as the residency work-hour restrictions were being implemented, and there was a cap on 80-hour work weeks. Now as an Assistant Boss and as a mother of a healthy tween daughter who also wants to be a pediatrician, I am somewhat horrified. But it has been almost 15 years since my residency training, and what I forget is that it takes time to unlearn the trauma of a misogynistic rascist and bullying medical residency program.
Please don’t misintepret my sentiment. At that time, the categorical pediatric residency program at Mans Greatest Hospital was probably one of the most inclusive, nurturing and clincally stellar programs. I am forever grateful I have spent my formidable professional years there. Mr. Plastic Picker and I were on parallel tracks within the white marble walls of Mans Greatest Hospital. We learned our craft there. We slept countless nights in the airless call rooms. Ate many meals with a cadre of fellow young physicians in the basement cafeteria at the 9 oclock meal, mostly greasy sweet potatoe fries and grilled cheeses. Transversed with our patients the well worn paths between the NICU and PICU, PICU to inpatient floor, inpatient floor to radiology reading room, and sometimes outside to sit and watch the rest of the world walk by – and thinking they were all thinking of us and wanted to be us. And weren’t we lucky to live our lives within these marbled white walls. I had both of our children at Man’s Greatest Hospital. I believed that those years there were the happiest in my life.
But were they? I will never forget the story of one of the nicest and most talented surgical residents during my time there. All the other residents in our bustling hospital knew collectively that he was one of the technically most skilled and emotionally compassionate trainnees in our class. I believe he was a senior surgical resident at some point when I was a pediatric resident. All the pediatric categorical interns in our program rotated on the pediatric surgical service. I remember the story went that Sean had gone psychotic one night in the surgical ICU. He had been overworked by his training program, back then they flagrantly flouted the 80-hour work week rule. One night as a junior resident covering the surgical ICU he became combative and psychotic. He literally started having visual and auditory hallucinations and began doing martial arts like moves, trying to fight off imaginary enemies. The story goes that one of the kinder surgical attendings was called, and took him home. The kind surgical attending made him go to sleep and covered his shift. Sean’s psychosis was resolved after some sleep. No actual internal medicine doctor was called. By the time I met Sean, he was back to being the kind and technically talented senior surgical resident. But I remember looking at him and wondering if he would suddenly karate-chop someone. It’s a funny story, but looking back at this through the lens of being a 40-something Assistant Boss and tween/teen mother and a pediatrician – I am horrified.
How do I reconcile the wonderful aspects of experiences and institution that created me with the underling currents of misogyny/rascism/bullying that pervaded all training program back then? All of us in middle management, physicians and nurses, were raised in that culture. For nurses, indeed, it is often worse. The common parlance is that nurses eat their young. As a young resident and even now as an Assistant Boss for MDs, I saw it and still see it.
In an essence to Stop Physician Burn Out, we have to recognize that there is no House of God. There is no Mans Greatest Hospital. I am Assistant Boss, but really it’s a temporary position that does not define who I am. Dr. Plastic Picker, mother of a tween, mother of a teen, wife of Mr. Plastic Picker, Daughter of an Accountant, Wannabe Financial Blogger and Trying Vegan – these are the titles I’m rather be remembered.
A nurse that I used to work with had asked for a letter of recommendation yesterday for a graduate program. I had thought it would take me a while to write the letter, but I was surprised that when I sat down and composed it last night – I finished it quickly. I read it to Mr. Plastic Picker and he agreed it was well written and a good reflection of my positive sentiments about this nurse. I’m not sure why I decided to blog about physician burn out and training programs this morning? I think it’s because through the course of picking #216 plastic bags and now having written 220 blog posts, I realized that my brain works really well now. More than anytime since graduating from college, my thought processes are clear. My writing is succint and well worded. My emotions are well modulated. I think I could take the SAT right now and get into Crimson College again.
And I have been working on my skillset of being a better Assistant Boss to the Pediatric Department. I did not have the emotional space to devote to mentoring others with an open heart even a year ago. I was in that moment experiencing a bullying culture myself by various people, which was very painful. They themselves were raised in a medical culture that was bullying. Dr. Plastic Picker is strong though and I fought back and won. But even that professional tusseling is painful for all sides and does not need to happen. A year later, I am better. I have learned how to master the other tasks of being Assistant Boss, but mentoring and leadership building is important too. And I realize now I needed to reflect on that culture that raised me, and reimagine the world I want.
I helped a young colleague the other day. Indeed, I’ve helped many of our young colleagues. I am trying to to give them the professional space to grow as leaders. Part of the reason why is that I don’t want to be Assistant Boss for ever. I may become Chief Boss or I may just go back to doing clinical work full time. But I need to create a pool of future candidates for Assistant Boss. And it’s not because being Assistant Boss is all that important, because remember there is no House of God, there is no Mans Greatest Hospital. It’s because knowing that they can become Assistant Boss gives young physicians a sense of agency, a sense of freedom.
And it’s that freedom that will stop physician burn out. I am so free these days. My mind, my writing and my life just flows. Because honestly I don’t give a flying F*@$# what anyone thinks. I’m Dr. Plastic Picker and I determine my own fate.
***One of the weird benefits that happened after becoming Dr. Plastic Picker is that I stopped cursing at work. I only ever did this with the door closed with other medical colleagues. But it started in the 3rd year of medical school at Mans Greatest Hospital and ended with becoming Dr. Plastic Picker. Isn’t that weird. I guess I don’t
need to anymore. But if you ask Mr. Plastic Picker and Dr. Dear Friend they will attest to this.