The Daily Dose • Monday, March 21, 2022
Like Moths to the Flame: Rediscovering Purpose in Navigating Burnout
In recent years, the medical literature has exploded with articles on burnout. During an engaging campfire session entitled “Transverse Orientation: Reframing Burnout in Terms of Identity” on Sunday, March 20, at the IARS 2022 Annual Meeting, Cynthia Wang, MD, Johanna Schwarzenberger, MD, and Anahat Dhillon, MD, suggested reframing burnout as a fundamental loss of connection with our original purpose in entering medicine — providing patients with excellent and compassionate care. In an open-ended discussion, the panelists explored various ways to mitigate burnout at both institutional and individual levels.
Cynthia Wang, MD, Acting Chief of Anesthesiology at the VA Greater Los Angeles Medical Center, began the session by contextualizing historically the phenomenon of workplace burnout. She traced several articles in the general press as far back as the 1980s (Morrow 1981, Kaufman 1999, Savage 2019) to highlight the longstanding nature of the problem and the need to shift the conversation away from the responsibility of the individual to that of the system.
Later in the discussion, Dr. Wang referenced the book, The End of Burnout (2022), by Jonathan Malesic, to explain that workers in professions involving the highest ideals and purity of purpose are often at the greatest risk. She called for “transformational leadership” from more senior physicians and administrators in viewing their roles as opportunities to serve and to advocate for others — “to lift others up.” She called for more clinician involvement in administrative roles to promote a greater understanding of the challenges unique to anesthesiologists — physicians who work in a variety of hospital settings with a wide range of procedural specialties. She also urged those of us in academic medicine to take a step back from the constant striving for titles and accolades to reflect on who we were when we entered medicine. Why are we doing what we do? What brings us true fulfillment as individuals and as professionals?
Johanna Schwarzenberger, MD, Professor of Anesthesiology at the VA Greater Los Angeles Medical Center, shared aspects of her professional journey and highlighted several specific challenges of working within the “medical-industrial complex” of today. Referencing the book Let Me Heal: The Opportunity to Preserve Excellence in American Medicine (2014) by physician-historian Kenneth Ludmerer, MD, Dr. Schwarzenberger explained burnout as a cultural phenomenon that begins during residency training. Chronic exhaustion is often viewed as a “rite of passage,” and work-hour restrictions have not actually decreased workload (given higher bureaucratic and emotional demands). She suggested designing and conducting studies that measure the physiological effects of work-related stress on clinicians to provide concrete evidence of the need for systemic change. She also called for a more humane workplace culture that celebrates differences and provides safe spaces — both physical and emotional — for people to share struggles and concerns.
Dr. Schwarzenberger encouraged us ultimately to be “physicians to others and to ourselves” — to unite together to resist unhealthy pressures from profit-driven health systems. In addition, she expressed a desire for leaders to be role models who “organize the solidarity,” prioritizing the human needs and concerns of the people they represent over supporting the financial needs of their institutions. Finally, in defining burnout as occurring when there is a vast difference between “what you thought you were going to do and what you are actually doing,” Dr. Schwarzenberger reiterated Dr. Wang’s point that we should remember our original motives and identities for going into medicine in order to find more meaning in our work.
Anahat Dhillon, MD, Associate Professor of Critical Care and Anesthesiology at the Keck School of Medicine of USC, explained “transverse orientation” as the mechanism by which moths maintain a fixed angle to the moon to fly in a straight line. Just as moths naturally orient to moonlight but quite literally “burn out” when they fly too close to artificial light, we physicians can easily burn out when we lose our sense of identity and purpose. She shared the limitations of mitigating burnout by pursuing “work-life balance” and advocated instead for refocusing ourselves on our original mission. Like Dr. Wang and Dr. Schwarzenberger, Dr. Dhillon emphasized the importance of committing ourselves fully to the care of our patients — the reason why we became physicians in the first place. As we have advanced in our careers, countless demands — academic, financial, legal, and bureaucratic — have distracted us from this purpose.
Dr. Dhillon also called for a broader and deeper definition of what it means to be an academic physician—one that enriches rather than limits our relationships with our patients, each other, and our work. As an intensivist, Dr. Dhillon has witnessed plenty of burnout. Over time, she has found that more intense and focused care of her patients and colleagues, though it might run counter to the notion of “work-life balance,” has provided her with a greater professional fulfillment. Like her co-panelists, she criticized the “six-sigma lean model of medicine” as contributing to the epidemic of burnout and expressed a desire for health care systems to protect their physicians more.
The three panelists successfully used the metaphor of “transverse orientation” to call for a return to our original purpose and identity as physicians who are committed to our patients. Their discussion was timely, relevant, and engaging.