Physician burnout and medical breakthroughs: a patient’s story

I entered my doctor’s exam room worried about my health. I exited worried about his.

A lack of pressure when he placed the stethoscope over my heart. His ghost-eyed look when I spoke. His nearly inaudible voice. All of this registered as the most severe depletion of spirit — or what is sometimes and inadequately referred to as burnout — I’d seen in one of my doctors. And I’ve seen a lot of doctors over the years.

When I was 32, I was diagnosed with ovarian cancer. Lucky enough to survive, I spent several years housebound as I grappled with the fallout from chemotherapy. Tanking blood pressure levels. Hours spent lying on my hardwood floor to avert blacking out instead of legging it out the door to work. Innumerable texts to family and friends that started with “V sorry to cancel.”

Trying to identify why my pre-cancer health had not returned and how to get it back, I gunned it to doctors’ offices with an I’ll-do-anything-to-get-better mindset.

I believe that the diagnoses and treatments I ultimately and thankfully received would have been made years earlier had my doctors been empowered to dedicate themselves to my case with a singular focus instead of being pulled in disparate directions. In a nutshell, I was unable to get well while my doctors’ wells were empty.

Although faced with what three primary care physicians described in a recent First Opinion as “the corporatization and bureaucratization of medical practice, which impinges on our professional autonomy, leaving us less flexibility to do what needs to be done for each patient,” most of the doctors I saw have done what Dr. Danielle Ofri referred to in her nerve-hitting New York Times op-ed last month: “An overwhelming majority do the right thing for their patients, even at a high personal cost.”

Take the doctor whose first and last words uttered to me were, “I’m sorry.” Initially for being late and then for having to cut short our appointment. She was point-blank overscheduled, trying to care for patients whose needs (like mine) were increasingly complex while also mired in completing never-ending documentation tasks.

Although I sensed that this doctor doled out apologies throughout her day, for situations out of her control, I knew she meant it. How? She gave me her cellphone number, a blunt recognition that she would never be able to sufficiently address my multilayered case within the allotted time slot.

While she, like many of the other doctors I saw, seemed actively disempowered and possibly afflicted with burnout, I tried to play the empowered patient role. Over the years, I learned that to get my doctors up to speed as quickly and thoroughly as possible, I should provide them with what I jokingly referred to as my “starter pack.”

This five-page document summarized years of medical history, listed wide-ranging symptoms in bulleted form and laid out self-identified triggers. I labored over every word. My goal was that these clues might be a part of what helped a new doctor solve my case.

When my doctors did begin to make diagnoses and treat me for the neuropathies and other chronic conditions that had kept my world small, my health and life returned. Although I experienced more than one of these medical breakthroughs over the years, they all occurred under the following conditions:

The doctors had the mental energy and space to lock into my case. With a Dr. Gregory House-like intensity, they cross-examined me, asking unexpected questions about my symptoms. They were charged with purpose, interacting directly with me, not inputting information into their screens. They exemplified a point made by Dr. Paul Griner, an expert on doctor-patient relationships: “Doctors need to be in tune with their patients, asking, listening and connecting the dots. They can’t do that effectively if they’re burned out.”

These were not first appointments. Over the years, I received letters from various health organizations telling me that one of my doctors was leaving and presented the name and photo of my new one. These letters inevitably landed when my doctor and I were getting to know each other, and I was feeling positive about making some meaningful progress. Their arrivals dinged my hopes.

My doctors’ possible burnout, which contributes to physician turnover, was causing my own. I sadly watched my printer unspool yet another starter pack which I would hand to my new, yet-to-meet doctor.

The appointments were the last ones of the day. Over time, I learned that to capture more of my doctors’ undistracted and uninterrupted attention, the trick was to book the last appointment of day. I banked on the fact that they’d blow past the clock to sink time into my case, which many did. All of my breakthroughs occurred near sunset. Of course, and unfortunately, my strategy contributed to the doctor’s workload. I felt guilty about this, recognizing that the cost of possibly better days ahead for me meant a longer day for them. I wish it hadn’t been an either/or.

As the health care industry wrestles with how to best tackle the physician burnout crisis — and realizes how urgently it needs to act — let’s recognize the depth to which physician well-being and patient well-being are inextricably linked.

Aisling Carroll is an ovarian cancer survivor and freelance writer at Cannonball Copy.