Dear Dr. Horton #4: Burning Out

Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

Looking back, I know there were many reasons I wanted to enter this field — but with the overwhelming and increasingly hectic nature of medical training and residency, it’s sometimes easy to forget what those were.

I don’t want to become jaded so early in the game, but can feel some of my initial idealism ebbing away and cynicism setting in. What are some ways to remind ourselves of our passion for medicine?

Signed,

Burning Out

Dear Burning,

Sometimes my idealism wanes, too.

Sometimes I think I’m not making a difference, even though the evidence to the contrary is literally right in front of me, every day.

The way you make a difference doesn’t always look the way you envisioned it would look when you first started out. It’s often a matter of scale. But there is a thread in most of our lives that connects us to why we are in medicine. The very real problem you’re facing is that it’s hard to hold on to a thread in a tornado.

My thread connects me to my older sister. She had a brain tumour before I was born, and it left her with a complex cluster of severe disabilities that made her life brutally hard. I watched how badly some physicians treated her as a vulnerable and disabled person, and it changed me in ways that are really, really personal. All the kindness I show, all the compassion I have in my clinical interactions and as an educator, and even my identity as a physician, traces its way back to her.

Heavy stuff. So heavy that, to be honest, it crushed me at first. Why? Because I started out thinking I was on a Hero’s journey. It turns out that Heroes have to do a lot of decidedly banal things in medicine. This creates a huge gulf between our expectations and our earliest professional reality. It sets the stage for a wave of disillusionment that some people never recover from.

I am still hit by waves like that as a doctor and as an educator, Burning. Times when I think nothing I’m doing matters, or occasionally times when people I stuck my neck out to help or teach reciprocate by trying to cut my head off. It injures your idealism. Cynicism can spread to every part of your psyche before you even realize you’ve been infected. You start thinking that the reason you are here was naïve and maybe even futile.

But I can show you right now that what you are doing does matter.

Think back to yesterday, then last week, then last year. Take a minute to generate a list of people who did kind things for you during each of those times. Maybe a ward clerk greeted you with a smile when you arrived for your new rotation and it made you feel less out-of-place. Maybe an attending took time to speak to you openly about how difficult medical school is and helped ease your fears. Maybe you had some contact of your own with the health care system, and you remember the first nurse who assessed you — how vividly you sensed his concern and care when you were afraid. If you’re anything like most people, your mood was elevated by these interactions. They restored a sense of rightness and safety in the world.

Now think again about yesterday, and last week, and last year. Think of the small, unnecessary indignities you experienced. A resident who knows your name ignored you in the hall. A colleague rolled their eyes when you spoke in tutorial. The x-ray tech barked at you like you were a convicted felon. Did it spoil some part of your day, no matter how briefly? Did it alter your neural chemistry and your mood? Did it affect how you treated someone else later in the day? There’s a good chance it did. That’s not because you’re weak or too sensitive. It’s because we crave a more relational existence, and we’re all temporarily emotionally injured by these small acts of social violence.

Our teaching, learning, and clinical environments are aggregates of all these interactions and choices, and the smallest interactions are impactful. It’s your job to believe this, because believing it will permanently alter your behaviour and the behaviour of people you come into contact with, even on days when you’d rather give in to cynicism. Most importantly, it will alter how you treat patients, and how they treat you in return.

To stay connected to this principle in my clinical life, I use the practice of setting an intention. What is my intent for this day? It could be something like: to be fully present to suffering. It could be to lift my team up, to show them compassion, to model a way of speaking to patients that represents the way I would like to be spoken to when I am the one in need.

Ask yourself: what is the thread that connects you to why you’re in medicine? Remember that you are in the midst of a tornado, and just holding on won’t be enough. You have to weave or stitch it into some part of yourself so you and that thread are inseparable.

On the surface, these things might seem the same; but they are not, not at all. They are the difference between “staying human” — a model where you think of patients and medicine as trying to “steal” a humanity you are clinging to — and becoming human — a model where you think of medicine as your Hero’s journey, one that will make you even more human, one interaction at a time.

Yours,

Dr. Horton

 


Dr. Jillian Horton is a graduate of McMaster Medical School and completed her residency and fellowship in general internal medicine at the University of Toronto in 2004. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine. She has won awards for mentorship, professionalism, and teaching at the undergraduate level. She is also a mother, musician, and writer. As an Associate Dean, she cared so much about undergraduate students because she never forgot what it felt like to be one of them.

One thought on “Dear Dr. Horton #4: Burning Out

  1. Harry J Zeit

    Thanks for the beautifully written article.
    It read like a letter from a wise old friend.
    I’d love to teach the hero’s journey with you one day, we share a passion of sorts.
    I will take a moment and check my stitches today, making certain the connection to my thread is strong. Unlike the ones I put in during my many years in ER, these ones are not designed to be removed.

    Reply

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