Quality care for the patient is the source of vocational satisfaction and also a measure of physician well-being. Both are impacted positively by the spiritual life of physicians which contributes significantly to resiliency in the midst of current stresses in medical care. Additionally, a majority of patients identify spiritually integrated care as desirable in their physician's treatment. The author examines qualities of vulnerability, humility and compassion integral to the person of the physician who offers quality care to patients and which is prophylactic to higher risk of suicide among medical practitioners compared to other professionals.
The original intent of the Hippocratic oath and the desire for a genuinely humane healing partnership has been under siege for some time now. Since Henry Ford introduced the mass assembly line, business has sought increasing efficiency in production with the consequence of increasing depersonalization of the healing relationship. The advent of computers and health care management as a business has reconfigured physicians to more and more cumbersome record-keeping 'providers' who in some cases are under pressure to see a new patient every 8-12 minutes.
A surgeon bemoaned, "I am measured on productivity and they want to keep track of my time also in order to find ways to squeeze more out of me". Meanwhile, patients have morphed into passive 'consumers' who are allowed one problem per visit and conversation must be kept to a minimum. This helps us understand why 67% of physicians, interrupt their patients [median = 11 seconds] after asking them what problem brings them for a consultation [1,2].
A 2018 survey of 15,000 doctors in the United States, reported that 42% of physicians feel burned out, with the highest rates being in the specialties of critical care (48%), neurology (48%) and family medicine (47%) [3]. This is twice the rate existing among professionals in other fields [4]. And there does not appear to be significant change over the past 40 years. A longitudinal study published in 2017 calculated that annual productivity loss of medical services in the United States that is attributable to burnout may be equivalent to eliminating the graduating classes of seven medical schools [5].
But overwork is not all that is going on. Dr. Richard Gunderman suggests that physician fatigue and burnout are not a function of enduring the situational factors and stresses of medicine, but are more closely related to the physician's own neglected soul. Gradually going unnoticed and untended over time, the gradual loss of meaning and betrayal of the personal nature of the healing vocation in the corporatizing of medical care is giving rise to the spiritual pain inherent to a loss of vocational satisfaction that comes from being able to care for patients.
"[B]urnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. [Physicians] find themselves expressing amazement and disgust at how far they've veered from their primary purpose" [6].
Gunderman's observation identifies spiritual pain accumulating from a thousand endured papercuts of conscience that brings to mind the words of playwright Anton Chekhov. "Any idiot can face a crisis-it's this day-to-day living that wears you out [7]". Why? Because the action and intention of being fully human and personal in the healing partnership is a pre-requisite for sustaining quality of care and vocational satisfaction over time.
The healing partnership is not a one-way technical exchange, as the language of "providers and consumers" and emphasis on "best practices" would lead us to believe, nor can it be continually shaped into corporate service as a "healthcare mill" to meet financial demands without losing its personal dimension.
A distinguished graduate of Harvard Medical School and member of its faculty, Dr. Francis W. Peabody served in war and disaster conditions around the world, contributed significantly to research in polio and typhoid, survived bouts of serious illnesses and was a beloved mentor for many a young doctor. In his lecture to the 1926 graduating class of Harvard Medical School shortly before his death, he made an oft-quoted observation that remains as true today as it was then, which takes us to the heart of the spiritual problem of physician vocation and patient care which is increasingly under assault. The ethics, vocational fulfillment and secret of patient care can be summed up in one word. He writes,
"The personal bond [with the patient] forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for… the secret of the care of the patient is in caring for the patient [8]". [my emphasis]
"The secret of the care of the patient is in caring for the patient". Lest we underestimate the profound observation captured by Dr. Peabody's double entendre, let us call caring for the patient what it actually is: "Love". The healing partnership grows out of and depends on love, but not any old kind of love. The ancient words of St. John the Apostle orient us to the fulchrum upon which success or failure in love depends: "In this is love, not that we love God but that God first loved us… [9] Medicine is in its largest context, an act of synergy in partnership with the Only Healer and Lover of Humankind, rather than one of individualistic self-sufficiency or technical expertise.