For the Young Doctor About to Burn Out

Professional burnout is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.
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Tertius Lydgate from Middlemarch by George Eliot (The Jenson Society, NY)

Our health depends in part on health professionals, and there is mounting evidence that many young physicians are not thriving. A recent report in the journal Academic Medicine revealed that, compared to age-matched fellow college graduates, medical students report significantly higher rates of burnout.

Specifically, they are suffering from high rates of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. College students choose careers in medicine because they care, because people matter to them, and because they want to make a difference. What is happening to the nearly 80,000 U.S. medical students to produce such high rates of burnout?

It is tempting to invoke the usual suspects: too many hours of study, too little contact with patients, and overwhelming anxiety concerning grades and test scores. Such stressors are compounded by exploding rates of change in medical science and technology and the general cloud of socioeconomic uncertainty hanging over the profession of medicine.

Yet the real roots of the problem go far deeper, and it is only by plumbing their full depth that we can hope to formulate an accurate diagnosis and prescribe an effective therapy. On closer inspection, burnout turns out to be a symptom of a more fundamental disorder that calls for curative—not merely symptomatic—therapy.

Nothing is more needed than nourishment for the imagination. Medical educators, learners, and those who care about the future of medicine need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. Humanly speaking, are we enriching or impoverishing students? What alterations are we asking them, explicitly or implicitly, to make in the ways they act, think, and feel? In what ways are we bringing out the best elements in their character—courage, compassion, and wisdom—as opposed to merely exacerbating their worst impulses—envy, fear, and destructive competitiveness? 

To a minority of students who care very little about such matters, such questions are likely to seem of little moment. Such students see clearly what they want to achieve—to gain admission to medical school, to graduate, to obtain a residency training position, and to take up the practice of medicine—and they do not trouble themselves about the ways in which their education is reshaping their humanity. When such students show up in class, they simply want to know what will be on the exam, and no matter how intricate or abstruse the material might be, they learn it sufficiently well to pass—and in many cases, ace—the tests.

But there are other students for whom medical school is not simply a proving ground, a gauntlet to be run, or a ticket to a well-paying and secure career. When they see a patient treated poorly, encounter a fellow student who is struggling with confusion and discouragement, or deep in a maze of tests and grades find themselves beginning to lose sight of the goals that brought them into medicine in the first place, they do not merely knuckle down and redouble their efforts. Instead they take such matters into their hearts, muse over them, and find themselves questioning whether medicine is what they really want to do with their lives.

Where can we turn to understand what goes on in the minds and hearts of highly intelligent, genuinely compassionate young adults who find themselves in a state of moral distress about the path they have chosen in life? Who or what can help them find the words to describe what they are going through, to know that they are not alone, and to locate a light at the end of the tunnel that can give them the hope and courage necessary to carry on? To understand and help such students, we need to find and apply the best resources available. One of the best guides on the matter I have ever encountered also happens to be one of the greatest novels in the English language. 

The novel in question is Middlemarch. Written by Mary Ann Evans (1819-1880) who, in order to be taken seriously felt compelled to write under the pen name George Eliot, Middlemarch concerns the affairs of a fictitious British Midlands town of the same name. The title evokes not only a kind of provincial mediocrity but also a deep authorial concern with what happens to people training for the professions, echoing the opening of Dante’s Divine Comedy, “In the middle of life’s journey … ”

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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