Query

I'm tired. Not of the usual things, mind. Not of demanding patients, of dumps from other physicians, of a desolate home life, of debt, of soccer practices and swimming classes and dance classes, of call, of office staff sick time, of an Emergency Department that functions as a holding tank, of a hospital infested with MDs who fiercely protect their turf, of committees that function only to generate further meetings, of bad hand-overs, of an ongoing marathon lawsuit, even of the uncomfortably hot weather.

Figure. Photo by: Fred Sebastian

I know, the weather? I don't want this to be misconstrued as whining. To the contrary, I merely mean to catalogue my usual woes to differentiate how I feel now as compared to just a few months ago, when plagued with those same difficulties. I'm taking pains to make a distinction because, when I started to feel this way, I thought it whining too.

Soon after starting here, I accepted these problems after learning about them. In short, I bought in, and as a shareholder I know I'm entitled to shouldering my share of the problems. Yet lately this attitude hasn't helped. I've told myself just to be stronger, to ignore a few ineffective people and focus my energies on a few efficient ones, to remind myself that I'm not alone in despising the system I'm mired in. (A few close colleagues gather informally a few times a month. We grouse, we laugh.)

But these strategies aren't working. I'm tired in a way that I wasn't before. Before, I could deal with the Emerg backlog and feel relatively little pressure (after all, the sickest get seen, and the rest have to wait, I would think). I could listen to an aimless lecture by one of our department chiefs and depersonalize instead of taking every comment as an affront. I could do a night of call and not resent the fact that as I frittered away time in the hospital the clock was ticking down on my marriage. I could do my work, do it well, and spend a minimum of time with the diversions and distractions that come with that work. I cared; I tried to change things.

Now I seem mired. I feel the atrocious Emerg backlog as representing me personally. Furthermore, I avoid hospital meetings in order to preserve my mental health. Most of the time I am there I want to shout, “But don't you realize we're not actually doing anything, we never actually do anything?” And I can't get the lawsuit out of my mind. It haunts me. Periodically I receive correspondence from the CMPA that serves as a mental hot poker.

Lately I've engaged in magical thinking: if I don't hear from anyone about a problem, then these problems don't exist. But one problem I can't hide from is a big one in my own office: I grind my teeth and try to still my urge to complain to other staff about one employee who chronically misses many days of work. I know if I complained, it would be unprofessional, and word would filter back to that employee, making things worse. I know I should call her into my office, find out what's wrong. But the problem is: I'm tired. I've fought long enough, and hard enough.

I used to be resigned to these sorts of things. Now I'm moving past resenting them into the dangerous land of Not Caring. I used to do the best job I could do, now I trudge through drudgery. Even seeing patients — which used to be a pleasure — has become toil. So, these are the questions I'm left with:

Is this whining or is this burn-out? And, if it's burn-out, then who is the one burning out — me, or the system I work in? — Dr. Ursus