R. Murali Krishna, M.D. President

It wasn't a typical going-away party.

At the party a physician friend of mine recently attended, three people weren't just leaving their co-workers to move on to new jobs. They were on the brink of leaving the profession, too.

The party was for three internists leaving a thriving medical practice – each in their thirties and forties. One was going to devote his time to a small patient practice. Two more were leaving to take some time for reflection, to search for answers, and perhaps to find a new career.

The reason for their departure? Burnout. The art of medicine is suffering under the burden of cold science and heavy bureaucracy:

• Twenty percent of all physicians say they're dissatisfied with the profession.
• Almost a third of physicians 50 and older plan to retire early.
• Half of all female physicians will experience a mental disorder in their lifetime.

The numbers point to a problem in one of civilization's most important endeavors. It's a dilemma that will challenge our entire society over the next decade. Just as we witness exponential advances in the technology and science of medicine, the human side seems to be waning. And managed care increasingly places a strain on the relationship between healer and those who need to be healed.

Physicians and nurses are expressing this trend by burning out. Nursing school enrollment is down, and hospitals struggle with retention of their nursing staffs. Suicide, chemical dependency and alcoholism are on the rise among the healing professions.

The same could be said of many professions, as the demands of daily life in this new century are compounded by information overload, too many choices and schedules that remain too hectic. The solutions to the problem, also cut across all strata of society.

But we've all been dazzled by the light of modern medicine and science – so much that we've all lost sight of the importance of relationships between patients and physicians. The days of house calls and long-term family physicians have all but disappeared.

Some promising signs show this trend can be reversed. At the University of Oklahoma's medical school, where I teach, the curriculum now requires humanities courses: for example, medical students must read poetry, short stories and novels to fulfill a literature requirement. It's an attempt to combat the tendencies of medical schools to turn young aspiring doctors into scientific "robots." Instead, OU's medical school wants to create physicians who maintain authentic relationships with their patients.

Return to the Roots
But what about doctors who are already practicing, dealing each day with the demands of modern medicine?

Doctors must return to the roots of what brought them to the profession in the first place. It is the noblest of all professions. But there are times when the healing profession needs healing itself.

The best way for the medical profession to fight this is to recognize burnout and do something about it. For other professions coping with the same pressures, the same strategy can help.

The symptoms for burnout correspond remarkably to those of depression.

When people reach the stage of burnout, they completely lose interest and enthusiasm. They often become like automatons, moving through daily life with a mechanical air. Jobs become simply a dollars and sense chore. This progresses into a feeling that the job is overwhelming and, at the same time, boring.

For physicians, burnout particularly manifests itself in a preoccupation with the failures of the modern medical system (ironically, this has a foundation in fact, but there is a way to deal with it).

People approaching burnout stop wanting to learn or relate to people in an enthusiastic way. Insomnia often sets in, as does difficulty concentrating and a feeling of pervasive exhaustion. Appetite and sex drive decrease. Irritability and cynicism increase. People in the spiral of career burnout often develop cardiovascular, gastrointestinal and immune system problems.

In short, it's not a pretty picture.

In medicine, as I've pointed out, burnout is the legacy of structural flaws in our current healthcare system. Too many institutions, corporations and pieces of technology conspire to place a distance between patient and doctor. Super-specialization among physicians is also driving this trend, with most patients and doctors having contact only about specific health problems. General practitioners used to go to a patient's home and grew to know a family over many years. Now the relationship is purely diagnostic, rather than holistic. And insurance plans have added a third leg to this already overburdened system (think about the term, "third-party insurance").

But there's good news: a new attitude is creeping into this miasma of discontent.

Doctors and nurses must return to the reasons why they learned the healing arts. Overwhelmingly, most doctors and nurses experienced some profound event in their youth that made them see the potential for healing. They wanted to make a difference in other people's lives. Doctors and nurses feeling burned out should reach out once again to this altruistic purpose.

And physicians and nurses must enact the principles of balanced living, just as all professionals should. Redefine why you want to be a health professional, or a lawyer, a writer or an investment banker.

If you're in it for the money or the prestige, then reassess your own reality. Focusing on such shortsighted goals is the quickest path to burnout. Instead, begin to see your work as a highly spiritual experience. You are making a difference in helping other people cope, adapt and heal. See this work as a spiritual experience for both you and the patient. Or if you're not in healthcare, try to see the same exchange with your customers or clients.

This spiritual interaction rejuvenates us, because we see that we have a higher purpose to our lives. We reemerge as vibrant human beings with meaning to our existence.

Doctors may ask, "Fine, but what about managed care? What about reality?" My answer for doctors, nurses and patients: Become active. Organize. Educate the public. But don't let your anger blind you. Redirect it instead.

Commit to change. Reclaim your rights to a more intimate relationship between healthcare professionals and patients. Don't give up the desire to change a dysfunctional system. You can fight for causes you believe in, but you don't have to let this battle ruin your original purpose.

If you don't resolve anger or cynicism in one area of your life, it will spread to others. Frustration will translate into your relationships. Instead, take your anger as a challenge to change.

While resolving your emotional and spiritual turmoil, you can also learn certain practices that will have an impact on your health. This advice is nothing new, but it's easy to forget amid the daily concerns of work and family. Simple exercise is a start. You can also expand into relaxation techniques – such as prayer, meditation and yoga. Focus on diet and nutrition.

Develop a passion outside of your career that stimulates you. More than a hobby, learn a new skill or a new language. Learn to enjoy nature. It's a strange thing, but most modern urbanites have lost this skill – even in a relatively small city like Oklahoma City. We must reconnect with nature to reawaken our inner spiritual strength.

If your problems are serious, practice what I call "re-ism." Remove yourself from your job. Reexamine your life. Regroup. And recharge your emotional batteries. It's all part of going back to the beginning. Finding again what is already there.

Finally, match your expectations with reality. For physicians, this means re-thinking the ideal of being the perfect healer. Or projecting the persona of a successful doctor and all of the accoutrements that come with this false identity. You can work comfortably and still live comfortably. Sometimes we lose sight of the fact that to reach the level you think you want, you don't have to work yourself to death.

Hippocrates wrote that, "Wherever the art of medicine is loved, there also is love of humanity." And medicine is just that: an art. It's about more than bones and blood.

It's a divine gift for humanity to possess the knowledge, skills and willingness to serve and heal others. And still manage to make a living out of it for your family.

Practice your profession as an art, and the rest will follow.

About the Author
R. Murali Krishna, M.D., is president and COO of INTEGRIS Mental Health Inc., one of the state's largest providers of mental health services. He is also president of the James L. Hall Jr. Center for Mind, Body and Spirit. He has maintained a private psychiatry practice for more than 25 years and is a clinical professor of psychiatry at University of Oklahoma Health Sciences Center.