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Who Is Taking Care of the Caretakers?





Most people fail to recognize just how hard physicians train. To become a doctor of medicine it takes a minimum of four years of undergraduate study and four years of medical school. Once you graduate from medical school you're technically a "doctor". However, in order to be able to write prescriptions and practice medicine, a doctor-in-training needs at least one additional year, which is traditionally referred to as internship. Then, depending on your chosen area of specialty, additional training known as residency can take anywhere from 2 to 6 years!

Medical school, internship, and residency represent an emotional roller coaster fraught with all kinds of obstacles and experiences, both good and bad. During these times most, if not all, doctors-in-training question why they've chosen this career path. We have doctors and nurses to care of the sick and dying... But I pose the question of who, then, is taking care of the caretakers?

Physician well being is not a topic that is routinely addressed in the public media. Medical doctors experience a very high rate of professional burn out. Long hours, poor reimbursement, malpractice worries, and lack of quality time with family and friends all contribute to this. Doctor's like everybody else are human, and have very human desires that are too routinely pushed to the side by their clinical duties.

Not to mention how it feels to make an error. Forget the stress of possibly being sued... When a medical mistake is made the emotional burden the physician faces is often times worse than any legal mumbo-jumbo that may ensue. Doctors go into medicine to help people; when they make errors they've failed to uphold that fundamental tenet of medicine: first, do no harm. Errors for many docs-in-training can mean sleepless nights, increased irritability, and decreased self confidence. Many young docs may even question their suitability to be a physician; in fact, a significant number will act on that doubt and pursue another career outside of medicine.

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Despite our best efforts, most of these problems are not something that can be solved. Take for example the 80 hour work week implemented in the United States in the early 2000s. It is amazing how much of a struggle it has been for the medical community to accept this change. In my honest opinion, if you cannot learn to do something in 80 hours you should give up and do something else. Not to mention it's as if spending only 80 hours a week in the hospital somehow magically provides that much more time to enjoy life outside the hospital.

In addition, most people enjoy their weekends free from the work place, doctors-in-training have a special name for such an event - the "golden weekend". It is called this because it is a rarity in medical training to have more than 48 hours free from responsibility in a row unless you are on vacation. Have a close friend's wedding to attend across the country? Better book the red eye and pop some caffeine pills because you have to be back at the hospital in a few short hours for your next tour-of-duty...

Like most mid-20-somethings, many physicians-in-training also have young children and spouses at home. So we fight through the urge to sleep after a 36 hour shift in an attempt to be great parents and loving spouses. Missed birthdays and special events often leave loved ones disappointed (and not to mention the physician as well).

Ultimately, with the demands of both physician hood and family most docs-in-training relinquish their hobbies and passions outside of medicine. There simply isn't enough time to be a good doctor, loving spouse, supportive parent, and cultivate any "guilty" pleasures.

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Ultimately, patients often wonder why many doctors appear curt or uncaring. The short answer is that many have seen so much pain and suffering (from both their patients and themselves), and have sacrificed so much of their own lives during training, that unless you are actively dying they are probably thinking, "How could someone be complaining about something this minute?"

It would not even be a stretch to say that some docs may truly stop caring. This, for some unfortunate physicians, is the only way to stay sane at a career that often times requires an insane level of commitment.

Clearly, I have painted a draconian picture of physician training. And to be perfectly honest, doctoring, as a profession, is chocked full of unbelievable experiences. The emotional high of making the right diagnosis and administering the treatment that saves someone's life is truly without parallel! This is why, despite the poor pay, terrible hours, and time away from family, it will (hopefully) continue to attract the best and brightest students the world has to offer.

However, if we, as a society are not careful about "taking care of the caregivers" we may find ourselves with caregivers who themselves simply no longer care...

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Related Articles

- A speech to the graduating medical school class

- When is enough, enough? Overt abuse of the health care system

- Are we dumbing down resident education in the United States?

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References and Resources

(1) Chisholm C, Heyborne R, Short T, et al. Reflections about "burn-out". Acad Emerg Med. 2009 Jun;16(6):567-71.

(2) Jones AM, Jones KB. The 88-hour family: effects of the 80-hour work week on marriage and childbirth in a surgical residency. Iowa Orthop J. 2007;27:128-33.

(3) Schwappach DL, Boluarte TA. The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability. Swiss Med Wkly. 2009 Jan 10;139(1-2):9-15. Review.

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