I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is exhausted and miserable and that the needs of our administration come first. And anyone who tries to say anything about it gets called lazy.
I hope the new generation of physicians will demand better treatment, but even this week I could sense how much young doctors just crave compassionate mentorship. They’re so grateful to be told simple things like: “It’s okay. I’ve been there too. I’ve stumbled in my career path ten thousand times. I know what it’s like to be lonely here, to feel like an imposter who can’t do things right. You don’t have to make up answers to insolvable problems. Patients just want you to be a human being, living and breathing with them, and respecting their voices.”
Medicine attracts perfectionists, and our training sharpens that quality into a dagger. The worst part—we become so diminished in our own self-worth that we no longer appreciate or even offer the healing that is the true legacy of doctoring.
I’m finishing my final year of psychiatry residency (thank god) and I’m just so tired. I used to think that things would improve after residency, but now I realize there’s no guarantee.
In my profession there’s an immense pressure to maintain “boundaries,” and they scoff at anything which is close to poorly defined. Many psychiatrists seem obsessed with proving that our field is “real” medicine, so they break patients into algorithms and charts, refer them to highly structured, easily quantifiable courses of psychotherapy that don’t allow deviation from “the treatment plan.” They measure illnesses with checkboxes and screeners rather than actually listening to any individual’s story.
But I doubt any medical specialty can actually heal patients this way, even for the most easily definable problems! How does a fool-proof algorithm for blood pressure control help if patients cannot get their prescriptions, or hate taking medicine, or can’t remember to take it, or quit due to side effects that they’re afraid to disclose, or any of the other millions of reasons that get in the way of good patient outcomes?! And those are things that you can never discuss in a ten-minute appointment.
Anyway, I’m glad that there are so many physicians who feel this same way, and even some who are brave enough to talk about it openly!!! How did we get so brainwashed that we actually believed that advocating for ourselves and for our patients meant we were lazy or inadequate? It’s so crazy. Nobody needed to oppress me by the time I graduated med school: I was the taskmaster and the criticizer.
When I talk about changing things, people says it’s not possible and we’re all doomed to misery and blah blah . . . Sometimes I say, “Well if that’s the case then I just won’t do it. I’ll pay off my loans and then go find something else.” My colleagues always look so shocked—as if they don’t have the same secret thoughts!!!
I’m about to have my last “performance review” with my abusive boss. My friends outside of medicine don’t believe me when I share the abuse I’ve experienced during my training. Lots of doctors try to pretend it’s normal, but it’s not. I go back and forth between trying to stand up for myself and thinking I should just put my head down and not cause myself any more problems. Most of the time I spend fantasizing about doing any other job—selling Tupperware, painting, working at a library—something normal, where nobody swears at me or treats me like I’m lazy after a 16-hour day. But really what I’d like to do is treat people with respect and provide therapy and run groups and teach mindfulness meditation. I just don’t know how to get from here to there.
I would write more but I have to fill out about 600 pointless electronic evaluations of my colleagues, in order for us to better wound each other anonymously. Yay!
This letter was received and edited for clarity by Pamela Wible, M.D., a family physician and pioneer in the ideal medical care movement. Dr. Wible helps medical students and physicians recover from abuse and trains doctors to open ideal medical clinics at her biannual physician retreats. Photo by GeVe.
Pamela, is there any way to connect residents together? As a resident myself, I have a lot of compassion and empathy for Janelle and it would be great to be able to reach out to her and fellow residents…. either connect to each other or to mentors in the field….
I will forward your comment to Janelle. It is a worthy goal and one I support 100%. Let’s do it.
Thank you for this I really needed to read this!
Couldn’t have written a better post. ?
yes. as a (recently new) nurse i can only agree and support a major shift in our system. other people are profiting from our lives and the lives we care for. yes indeed
Say it Sistah! And please be vocal. Silently suffering in isolation will only perpetuate the status quo. Zero tolerance for abuse and bullying of health care workers.
Let me tell you I LOVE the shift I made 8 years ago. Patients and doctors are on the same page and no more insurance crap !
YES. And nobody talks to the ACGME. The amount of unreported hours, credit for procedures that one had minimal participation in, other than as an observer, the lack of continuity in a continuity clinic, the widely and loosely interpreted standards of a residency program that are often even ridiculed by the attendings, the treatment of residents in unprofessional and non-collegial ways, the drive to silence residents from speaking up when things are not right–“you are here to survive, not to learn anything… you will do that after residency,” as per a chief, and the lack of support from peers, faculty, and the program, when an resident is struggling and needs guidance, is what it has been like for me. Focus on the negatives in performance reviews. Do not allow the resident to explain or respond to the feedback. Make the resident sign whatever the administration says, whether you object to it or not. And if the ACGME is visiting, talk in hushed voices, give your cell phones to the secretary, and don’t say anything or make any suggestions for improvement. Don’t draw attention to yourself. Don’t be honest about what you don’t know. Just nod, say “yes ma’am, no ma’am, yessir, nossir,” pantomime your attendings, and you will be resident of the month. Whatever you do, don’t ever QA. Don’t ever think for yourself. Don’t ever go out on a limb on behalf of your patient, because you will be cut down. And whatever you do, you are NOT ALLOWED to talk about your residency–not a word, especially not in cyberspace, not unless you are posting photographs of everyone smiling with cake at a residency function. That is NOT the way to raise quality compassionate physicians.
Thank you for speaking up on this “Doctor Know.” Isn’t is sad that are doctors are so abused that they can only weak out anonymously? What organization protects our doctors from this widespread abuse? And all this abuse trickles right down on to patients. This is an outrage and there should be zero tolerance for abuse on our healers.
Here is a video I filmed of a physician (identity concealed for fear of repercussions) who is speaking out on her abuse:
Keep the faith. Live your dreams fearlessly. Be the doctor you always imagined.
Pamela, as you know from our communications, I’m the mother of a 23 year old daughter who killed herself at the beginning of her 3rd year of medical school 4-11-13. The only reason she gave in her note is that she was so very sad. I can think of 100 reasons she could be sad AFTER she died because she never showed any sadness. I can’t imagine how sad she would have been if she had gotten through med school then on to residency and into practice. No one will ever know.
But in saying all that, I wanted to mention the comment by the nurse above. I’ve been a registered nurse for 20 years now (though I have not been able to work since my daughter’s death). My nursing education was not that bad at all, even though the instructors were like drill sergeants. What WAS horrible was discovering that nursing in theory was much better that nursing in real life. Nothing prepared me for taking care of 10 or so patients, passing meds on time while in the middle of admitting and discharging patients, sending them off to surgery, then getting them back on the floor and all that is involved in that. Being cursed at by family members that it took too long to get their loved one their pain meds when all the while you are breaking your neck to do it as fast as you can, reading lab results and calling the doctor to report them, an occasionalal code in the middle of all that, and I can give you more things that are going on all at one time and just hoping with all your might that you don’t kill someone by mistake because you are making 100 decisions at one time.
It was nothing like I thought it would be. What happened to the caring and being able to take the time to be with patient’s and practice all the good things you were taught in nursing school? Those things went out the window because you just don’t have TIME. Then you feel like a horrible nurse.
Many times nurses that have been a nurse for a long time “eat their young” meaning that they treat a new nurse like a dog and a punching bag. I’ve been eaten by them many times.
I could not imagine what a doctor goes through. I could never go through that kind of stress. I worried about Kaitlyn becoming a doctor because I knew how stressful the education and the career was though she never acted stressed over anything. I did not, however, know about the high incidence of depression and suicide in medical students and physicians.
Anyway, after she died I quit my nursing job and don’t plan on going back. I don’t know what I will do now. But I will tell you that there were many times on the floor of a hospital where I wished I could be doing anything else…..working at Walmart….digging ditches….anything that did not involve this high stress.
People complain that they don’t get enough time with their doctors or nurses. They have no idea why they don’t.
And much of this production-line mentality started when the hospital nuns at the helm were replaced by MBAs. Do you realize in the 1970s nurses gave hospitalized patients a light back rub and a hot towel around the neck before bed. “Care” is no longer cost effective. Many of our leaders in health care are heartless and soulless and they are trying to train the next generation of doctors to be the same. This is an assault on humanity. Zero tolerance for abuse on our doctors and nurses.
thank you for telling what happened….I feel very sad
As I read this post, I read an email from a patient cancelling her appointment because her bill was too high….
I saw her in the evening as a new patient. She was hostile at first because I am not able to access our local big box imaging system and have to rely on getting the CD’s in the mail and all I had was the written report not the images. I spent 90 minutes with her working past my normal hours. I charged her insurance company $350 for the visit. I hadn’t even sent her a statement. Her portion is $150. I have no idea what the xrays were billed at.
When I get those calls or messages after giving and giving to the point that I don’t get home until after the kids are in bed and I haven’t had dinner…and I ignore my own needs such as eating but also using the restroom it truly causes me to feel devalued.
I have been applying for other jobs not in the medical industry. 17 years of this mess…I just don’t want to do this anymore. It doesn’t matter how much I care for my patients. Most ladies will happily drop down large chunks of money for nails, and hair and waxing and tanning but not for quality medical care….that is, unless they know that insurance will cover it.
BTW, this patient left the message on a Sunday marked “urgent”….
Yes. The sooner doctors stop taking the abuse the better. Sad to drop out of the profession entirely, but I certainly respect your choice to put yourself first. If we can not care for, love, heal ourselves, we can not (and should not) be caring for patients. And there is no reason why doctors need to be bullied by ungrateful patients, employers, or other third parties. People who disrespect and devalue me are not welcome in my personal or professional life. I would hope others would hold the same standards. NOTE: I was not always like this. I was as battered and beaten down as most of my colleagues 10 years ago.
I read this blog feeling so very sad about the state of medical education. Why do people think that the way to create competent, compassionate and caring physicians is by exposing them to abusive and uncaring treatment. Young doctors need to be appreciated and understood while they train under rigorous mentors. I was a teacher for 24 years and I left education when it became about test scores and not a nurturing learning environment where children were excited about gaining new knowledge. To Janelle: when my children were in school, I reminded them that education was like a game and that the school and instructors “owned the ball” so they needed to play by their rules. However, when they graduated…they received their own “ball” and could design their own game. Stick it out and start dreaming of what your new “game” will look like. It is your life and you can be creative in your design…have fun and live the life you dreamed of….all the while maintaining your “essence” and purpose of compassion and kindness as you heal others…
Janelle’s story and all of the above comments make me cry. Is the educational process for becoming an astrophysicist, an engineer, or a pharmacist as abusive, grueling, and dehumanizing as becoming a doctor? Why is medical school like this? Why is the field of medicine overseen by tyrants and abusers? The more I read about this problem, the less I understand, it doesn’t make sense to me.
Rhonda I am so sad for you that you lost your dear daughter to a grueling time in medical school and how it has stopped you working yourself.
Pamela, I am struck by the similarities between what is happening in the US and what is happening here in Great Britain’s NHS. I lost a GP (family physician) colleague to suicide this year. The box ticking and funding cuts for state NHS GPs is driving many to burn out just as I can imagine medicare/medicaid bureaucracy and paperwork for billing and CMS inspections is affecting US family physicians.
We now face GP surgeries going bankrupt and a drop in doctors wanting to be GPs.
I too am searching for an answer to save doctors’ lives from burnout, depression and suicide. What makes a doctor acquire learned helplessness? Why does the system persecute the bullied? Why does it not address institutional bullying, ie senior bullies? How do we change the system to one of nurture, support and mentorship?
My NHS GP colleagues are reading your blog in the UK!
Yes. There are similarities between how docs are treated around the world. High physician suicides rates were noted in England back in 1858. Things have gotten worse since with all the third parties meddling in (and making great salaries from) doctors’ professional lives. Doctors acquire learned helplessness from their colleagues and the dominion medical culture. Medicine is an apprenticeship profession. If all your colleagues are being abused and bullied and are fearful of losing their professional standing if they don’t support the status quo, then young physicians line right up behind them and we all fall off the cliff together. The system persecutes the bullied victims because those in charge are making a great living from enslaved doctors. Did the slavemasters really want to release their slaves in the South US? I think not. The plantations and cotton fields were dependent on the enslaved. We change the system when the bullied and abused doctors (and nurses) have had enough and they stand up for themselves. Doctors can not be healers and victims at the same time.
RE: “But really what I’d like to do is treat people with respect and provide therapy and run groups and teach mindfulness meditation. I just don’t know how to get from here to there.”
YOU GO GIRL! If that’s what you want to do, go for it! You don’t have to know how to get from here to there, you will find your way. (There doesn’t have to be a clearly defined path in the beginning, we create our own path by walking in the direction we want to go…) I am just one year ahead of you (same specialty) and I am convinced that it CAN be done, it IS possible to practice the way you want. In fact, I think the kind of genuine and caring doctor you describe is exactly what patients are looking for.
The main challenge coming out of residency is of course that you probably have little to no cash, but don’t let that stop you. (1)Right now you’re used to living off of practically nothing, you can take it a little longer. -and- (2)Lucky for us, we have very cheap overhead, especially if you can find some other mental health professionals who have space to sublet. But you still will need a little money to squeak by on in the beginning. In my case, I did Locums work for 6 months and have about a year’s worth of living expenses saved up from that (from a nadir of $200 in my bank account last fall!), so now I’m trying to set up practice. (Starting up is admittedly slow – so I’m really needing that savings to fall back on right now.) Other options might be looking into one of those physician loans, or finding a part-time job somewhere (like a couple 1/2-days per week at a community clinic or something). (Whatever you do – don’t sign over your soul to some employer that expects 40-hours-per-week from you & has some ridiculous non-compete clause!)
But honestly – you have learned a lot in residency. You may not have the business basics, but you know how to take care of patients, how to do an intake, how to write a progress note, etc. You KNOW what you are doing. So just call around & get some malpractice quotes, order up some Rx pads, and you’re good to go! The rest will fall in place with time…
YES! Absolutely true. Psychiatrists are in the perfect position to run a low-overhead office with very little equipment. Remember: Cognitive specialties only require enough square footage to house your brain.
P.S. – I was just re-reading the 1st comment above from Alex, along with Pamela’s “Let’s Do It” reply – Pamela – feel free to forward along my contact info to Janelle and Alex if you think it would be useful. I don’t know if I can exactly claim to be a “mentor” considering I’ve only been in business for about 2 weeks now, and only have 3 patients at this point, but I’m happy to share my experience with them if it can be of use. I’m just shy about putting my name out here on the internet for public consumption, especially since there is a second plot-line in my story that I might feel inspired to anonymously share about at some point, in one of these comments sections… (Plot-line number 2 would be related to the fact that yes, there really needs to be more places where residents can find non-judgmental support to help keep the fire in their souls alive…)
Thanks for mentioning the nuns, that’s what
Really angers me… Most people aren’t old enough
To remember but for most people in the US,
they could always get medical care even if they
Couldn’t pay, every state had tons of “charity”
Hospitals run by Catholics and Methodists and Jews
Etc…the reason we are in the state we are in part
Is in large part because they were run out of business by the
Sheri, as an astrophysicist, it isn’t quite as grueling
We don’t routinely work 80 hour weeks etc…
The worst we do is stay up all night observing and then
Have to teach classes the next day on no sleep,
It is humiliating though, some of the things I hear
Resonate… I was specifically told that we were
“Lower than whale shit” so don’t complain about
anything, your lucky just to be here… I think that’s
A big part of the problem…. Getting in us so competitive
That there is some truth to that, but if you *buy in*
to that, will you speak up…I was in years and depressed
Until I talked to my brother who was a marine
Corp Sargent and related it to boot camp… that they’re
Trying to toughen you up which can be helpful,
However u think fundamentally it just draws
Abusive/alcoholic personalities who derive satisfaction
from abiding others as they are abused, and goes
Way beyond what is necessary… The thing is to remember
That no matter what, no one has the right to
Abuse you, you don’t have to accept unacceptable behavior.
I know residents get no sleep, but one thing
that might change culture is requiring all residents,
and people who supervise them have to attend
6 sessions of Al-anon!
The medicine industry is in a state of disrepair and decay. People are trusting it less all the time. I would like to encourage MDs who want to perform real healing, to study natural healing methods.
“Physician, heal thyself” now that you have been so beaten down and beaten up. It is essential for you to release the fear that was instilled in you in med school. The fear you carry will infect your patients. You learn to relax and patients will flock to you for that very quality.
Beyond the physical, many non-MDs who practice healing are acutely aware that what causes the body to go into a state of dis-ease is stress – literally a lack of ease, lack of peace – due to chronic negative thinking and fear. When we are afraid, we contract our muscles and even the inner organs can do the same. Result: things don’t work well and “pathology happens”. Drugs do not necessarily go to the root of that problem – loving kindness does.
People are hammered with fear these days. They need help on a mental, emotional level. They need peace of mind. And peace of mind leads to a healthy body. Eschew pharmaceuticals and demeaning diagnoses – they just increase the fear.
You can still practice healing. People will be attracted to you simply because you have an “MD” after your name. You can practice gentle healing methods once you learn how. But you don’t need to be a perpetrator… you can let go of the horror and abuse you encountered in school and learn to breathe again. Pamela can help you set up a practice that does not rely on ‘the system’ as much.
A simple, natural diet, clean air, pure water and a release of all mental tensions – fear, anger, sorrow, guilt, etc – is the most healing thing you can do for yourself… and please help your patients get there too. Many MDs on the web are leading the way. Read their books, watch their videos. And don’t be afraid to go outside the box… there was a rather healthy world before the AMA and Monsanto took over.
AND I am SO sorry you were treated cruelly in med school and residency. I know how bad it is. A book you might find comforting is “Heart Failure – – Failure to Thrive” by Michael Greger, MD. There is nothing wrong with you and your reaction to the training. There is something VERY wrong with the system. I wish you all well.
In line with Young Doc’s and Alex’s comments above, I would also love to be connected to others that have the same feelings about the current state of medicine.
I’m a first year Family Medicine resident in Canada, and since starting residency have not been able to stop thinking that I am in the wrong profession. Alex’s statement “I can’t tell if I’m burned out or just don’t like being a doctor.” I am only 2 weeks into starting my residency (internship), and although my partner (also a resident) tells me I feel this way because of the abrupt change, I think I feel this way because I’ve never had a more true sense of what it feels like to be practicing medicine (almost) on my own.
I day dream about doing almost anything else (starting a bakery, becoming a speech and language pathologist, a stay-at-home mom), but cannot get over the fact that I have over $170,000 of debt, little-to-no assets, and no other practical real-world experience. I definitely feel trapped and foolish for not anticipating this earlier.
Although I initially went into medical school with the intention of truly helping others, I’ve never actually thought of myself as a healer. I feel I currently most identify as a Survivor, actually.
I think it is good that you are able to express your feelings at this time….you are in a tough situation……from an old medical doctor
Canadian resident doc—-I am a survivor also…you can get out of traps…don’t kill yourself…don’t start taking drugs….from the old medical doctor
Hey Janelle – I think the future of psychiatry is bright and exciting. The recent finding about anticoagulation improving psychosis may not be a cure-all but nevertheless the semi-anecdotal observations are truly remarkable. The presence of encephalopathy (inflammatory or otherwise eg anti-NMDA) and intrusive thought disorder is a real challenge and eventually the only remaining challenge will perhaps be enabling patient management compliance in psychiatry – not always easy. Eventually maybe TNA-ase inhibitors will be the answer. Exciting indeed. Imagine treating a DVT patient in hospital with warfarin and seeing their persistent thought dysfunction just melt away. That is why we do medicine.
You go girl! I’m a licensed professional clinical counselor and a Ph.D., and yes! there is the same abuse in the mental health-behavioral health field. It doesn’t make sense to me. Why do mental health executive directors bully staff with threats of termination when therapists care about quality client care? There was abuse in my Ph.D. counselor program from professors who had been therapists. Why do adults bully adults?
Thank you so much for standing up for clients. I am recharged to carry on my mission for the rights of all clients to be treated with respect.
Barefoot shoemaker? Obviously some of our mental health professionals are the ones who need mental health services.
Its very sad learning about the bullying going on in the medical field. However, bullying is everywhere, and it does not choose by color, intelligence or personality. It just exists in all fields, in and outside medicine. It exists in corporations, we all know this, I am just learning now that it is prevalent in hospitals and private practices too. And from reading the comments above, it seems people in UK, Australia all go through similar forms of bullying. I know that PhD students in the social as well as natural sciences in US, Canada, UK and Britain all go through serious bullying (you can google their blogs). This is really a societal problem, not just exclusive to physicians, nor patients, nor students. We have to cultivate in ourselves a tradition of empathy, a tradition of knowing the signs of unfairness and bullying, and a tradition of speaking up on behalf of our fellow human beings, whether doctors or children or teachers or nurses or restaurant workers. We as humans have to somehow unite on some fundamental human values, otherwise we are all just victims of bullying one way or the other, more or less. I wish that more of us can translate Dr. Wibble’s ideas into all areas of our lives, starting with our work places, our friends’ workplaces, our bank services, our kids’ schools, etc.
Agree 100%. The only thing we can do is change ourselves and SPEAK UP when we witness unjust treatment. I am particularly disturbed by bullying in medicine not just because I am a doctor, but because this is HEALTH CARE. People come to us for healing. Healers want to heal the suffering and instead young med students are bullied and this gets passed down from generation to generation and then the poor patients who come of care – so many of them get mistreated.
You picked the wrong thing. Leave. You are too good for psychiatry. Pay off your loans and find something else. Plan. Run. You are too smart for psychiatry.
Is sad but true
The human medical field is not alone in this unfortunately. It very much extends to veterinary medicine as well. Daily I question my place in my residency and it has nothing to do with medicine or patient care. I deeply love what I do, just not what you go through to be able to do it. One day at a time, I only have a year and a half left.
I know. Feeling under appreciated after overcaring and running on fumes is rampant in so many professions. Hang in there!
If not dismissed, my post is very insightful. Apologies for straying from the topic, but I’m going to impart priceless info that will hopefully aid the psychiatrist to understand the gravity of the job. Psychiatry is not a science. It’s open for interpretation. Roulette with pills. They only have the words of the patient, and unfortunately, we (patients) don’t know what we’re talking about…in the eyes of the shrink. They are puppet masters with people ranging from having minor anxiety, to myself, a man who has dealt with excruciating anxiety for 20 years. It’s not thought related, It’s either nervous system, thyroid/pituitary, or brain related. It’s a debilitating sense of fear, panic, and shock. I’ve been on ssri’s, changing occasionally, for 20 years. Nothing. Still miserable. The only effective medication that I have found to relieve my suffering are benzodiazepines. They calm my nervous system and provide relief. Temporarily. I just have the diagnosis of anxiety. Which is a mental disorder. A misnomer. Neurophysiological maybe? No desire to help find the cause, cure or any helpful solution by dozens of shrinks over the years. Just adamant suspicion that I’m trying to get “high” or sell the pills. It can’t be seen like in other md fields. So, essentially, psychiatry is playing with people’s lives. The ambulance chasers of medical doctors.
Janelle: I hope you are still reading these comments. Firstly, I’d like to say thank you for having the courage to be open enough to express these thoughts and feelings. You may have just saved someone’s life (possibly figurately, possible literally).
Secondly, I want to get behind you and second you. So, I’m a psychotherapist and I can relate. Thirdly, I want you to know that I’ve worked with quite a few doctors and psychiatrists who are either in, or fresh out of, training. Your voice is not unfamiliar. Many feels burnt out or start becoming a bit mechanical in how they see people. Cut off and cold.
Almost all regained their humanity after spending some time in psychotherapy and slowly finding the space to process their experience. No fancy manualised treatments, just a plain and simple engagement with another person in a safe enough space to start opening up about how the experience made them feel. Once you have more time and emotional space, you can start finding ways to become the kind of doctor that you are happy to be and this is going to be truly rewarding.