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Wounded Healers -
The Struggle over Physician Burnout and Suicide
continued from page 9

The 24-Hour Shift -
A Good Educational Tool
But a study by ACGME concluded that the 80-hour workweek
and 24-hour shift are important ways of training future doctors
for schedules they will occasionally have to endure during their
career. And at least one extensive study of residents in such shifts
has concluded that the hours do not cause mistakes.
An associate dean for a resident program in a big city university
hospital, who did not wish to be identified, believes the shifts serve
an educational purpose. "Being a doctor is stressful," he said. "Part
of what residency is doing is preparing people for their future careers
which will be stressful. Long hours and difficult patients and tough
decisions are part of a doctor's life. It's a stressful occupation. It's not
surprising that residents feel stress."

Response from Doctors
But the associate dean is the only physician we spoke to who
thought the 24-hour shift was reasonable. Interviews with several
doctors, young and old, did not find one who thought the 24-hour
shift was a good idea. All of them had worked the shift and longer
ones in their residencies, and thought shorter shifts, a couple suggested
12 hours, would meet a resident's educational needs.

Reaction in the Chat Room
While Drs. Puri and Wible were speaking after the documentary,
dozens of medical students, residents and physicians who were
watching, took part in an online chat that revealed their frustration
and anger with the system.
Several of them wrote that physicians must unionize. "Unionizing
is not a dirty word to me. Show me a union and I will jump in."
Another wrote, "There is a reason physicians feel less than human
and patients feel less than human."
"To help treat burnout," another wrote, "we need to restore
physician autonomy and put physician-patient relationships back
at the center of health care. Remove, or at least minimize the
middlemen - insurers, administrators, legislators, employers. Let
doctors be doctors!"
Several were critical of wellness officers. "Wellness officers are a
big joke." Another added, "Our wellness officer encouraged us to
do yoga at lunch. I ate lunch about three times in residency. Having
a wellness officer - the sole purpose - was to reduce health care
premiums for employers."
Another wrote, "Wellness officers, equal lipstick on a pig."
Then there was this comment: "We emergency physicians are
among the most abused. We're not going to take this BS anymore."

Dr. Paul Puri, a psychiatrist who works at UCLA, says the long
Wendy Dean, a medical doctor who has studied the similarities
shifts often fail to meet a crucial element - emotional support. Dr. between physicians and wounded soldiers, said in a May Psychology
Puri recently took part in a discussion on physician burnout and Today article, "Teaching people to meditate, making them more resilsuicide after a Zoom presentation of "Do No Harm," a documentary ient - the problem doctors are facing is not about the individual at all.
on the subject.
"Doctors are caught in the double bind of taking best care of
He said that especially during the pandemic, it's essential for patients and meeting the demands of the system: make sure that
physicians and nurses "to find community wherever you can... There's you have enough volume; make sure you're billing correctly; make
a capitalistic obstacle here. Hospital systems are being managed by sure not to refer anyone outside the system. It's impossible to serve
MBAs. They're just trying to squeeze out every last dollar." Dr. Puri two masters.
said doctors need to take back the administration of hospitals from
"There is a place for yoga and resilience," she concluded, "but they
the MBAs.
are not reasonable ways to fix a structural problem." *

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Philadelphia Medicine Summer 2020

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