COVID-19 Stress and Physician Burnout - The Case Against Altruism
A recent article in the CMAJ exhorts doctors to "Emphasize the altruism of working in health care and serving of the greater good" in order to reconnect with purpose and make it through COVID-19.
I disagree and I am not alone.
ALTRUISM and the HERO and SAINT PROJECTION onto healthcare workers in impossible working conditions, is dangerous and self defeating.
In this blog post let's examine the case against Altruism as a healthy core value in pandemic times.
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Here in the 3rd wave of the plague that is COVID-19, people are struggling to understand what motivates doctors, nurses and the rest of the care team to keep showing up to work day after day.
Everyone can see the massive stress, physician burnout and psychologic trauma splashing on everyone who must wear PPE to do their job.
Inside and outside of healthcare we all see the pictures of the refrigerated morgue trailers and the lists of healthcare workers dying of the very same infection.
How can you explain such sustained effort in dangerous and overwhelming circumstances?
How can you express your gratitude for such service?
One coping mechanism is to put doctors on a pedestal, to attribute them with superhuman capabilities
Two myths/stereotypes/categorizations appear to be top of the heap at present.
Theses doctors and nurses and other caregivers are HEROES
They must be SAINTS - altruistic, selfless servants of the greater good
The Heroes and Saints idolization of physicians and other front line staff is a complex phenomenon. On the surface it seems a simple expression of awe and thanks for their massive contribution of caring and skill in this time of desperate need. Thank you.
And hang on just a second. Doctors are not saints or heroes, they are human beings just doing their job the best they can under the most extreme of circumstances.
When you carefully listen to doctors - and other front line caregivers - you quickly see that the Hero/Saint projection is ultimately damaging to the doctor's physical and mental health.
This idolatry actually makes things worse for the doctors and nurses and all the aides and techs because they cannot live up to the images we project upon them.
=> We cannot live up to our own expectations of what we can and should do in a pandemic.
=> We cannot live up to the standards of a HERO or a SAINT - yours or ours - no matter how hard we try.
=> None us have Superman or Wonderwoman levels of endurance and strength. Everyone's tank of compassion has a limited supply.
=> Every time your behavior does not hit the mark of what a SAINT or a HERO would do, guilt crashes in and steals away even more of our precious energy.
The Reality is this:
You can't give what you aint got.
However you can die trying if you hold yourself to these impossible standards!
There must be time and space to recharge, refresh, rest and refuel - or you will kill or permanently traumatize the physicians and staff.
OUR ADVICE IS THIS:
- STOP trying to live up to HERO or SAINT stereotype. Just let it go.
- [ If you don't work in healthcare, PLEASE STOP talking about healthcare workers in these terms. They are human, just like you. ]
- If you are a doctor, nurse or other healthcare worker ... give all you have to your patients and coworkers when you are at work
- THEN Circle Your Wagons:
---Take care of yourself and those closest to you in every minute where you are not actually caring for patients.
- Hang on through the peak demands and pray for the best.
We will pray with you.
We would love to know what YOU think.
Please Leave a Comment
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Current Physician Writing on this "Case against Altruism"
This blog post is based on this letter to CMAJ by Jillian Bailey MD - an extended quote is below:
Emphasizing altruism is problematic for physicians
CMAJ July 27, 2020 192 (30)
Here is Dr. Bailey's letter:
As a family physician in small-town Ontario, my heart sank when I read the CMAJ commentary “Mitigating the Psychological Effects of COVID-19 on Health Care Workers.”1 At first I wasn’t sure why, but on further reflection, it was the following statement that worried me: “Emphasizing the altruism of working in health care and serving of the greater good will help health care workers to be reminded of their purpose in a time of crisis.”
I fear that the call to altruism may lead to worsening compassion fatigue and burnout among my colleagues. I would like to suggest that we encourage each other in the pursuit of meaning in our careers. Altruism and meaning are quite different concepts.
Altruism is defined by Google as “the belief or practice of disinterested and selfless concern for the well-being of others.”
I believe that, as physicians, we limit ourselves by seeking only to be altruistic. Having a “selfless concern” for others implies putting my own needs last or, even worse, that meeting my needs and my patient’s needs are mutually exclusive concepts. I believe that couldn’t be further from the truth! Physician burnout contributes to poor patient outcomes, poor patient satisfaction and increased health care costs.2 The personal toll burnout can have on a doctor’s life is also grim — contributing to the physician suicide rate being double that of the general population.3
Altruism is not the solution. I suggest that we encourage ourselves to reconnect with meaning, our “why” that we are in medicine.
The pursuit of meaning may be what brought us to medicine in the first place. As young doctors, we may have felt drawn to fulfill an inexplicable calling, to leave a legacy or to develop important connections with our patients. In their book Burnout, Emily and Amelia Nagoski define meaning as “the nourishing experience of being connected to something larger than ourselves.”4
As physicians we have the unique privilege of being part of our patients’ lives in profoundly meaningful ways. We participate in life from birth to death, pandemic or no pandemic. Sometimes we offer heroic treatments, sometimes we are a listening ear or a quiet presence. Connecting with why I am a physician goes way beyond altruism; finding meaning enriches my life and my patients’ lives as well.
So let’s stop putting altruism on a pedestal. It is short-sighted and diminishes the humanity in each physician. Instead, as physicians battling the coronavirus disease 2019 pandemic, we should remember now more than ever to put on our own oxygen mask first, then turn to those around us and help however we are able. By caring for ourselves, we will be vastly better equipped to care for our patients.
Here is my reply published in CMAJ as a response to Dr. Bailey's letter:
Very cool ... thanks for sharing.
There is no such thing as selfless ...
only pure service with no regard to self
Not possible in a human
What you can do is practice exquisite and aggressive self care
and use the accumulated energy reserves to making a difference and a contribution
from a place where it is VERY PERSONAL ...
unique to me
Something only me, myself and I can provide
something I have invested my whole life in learning
it is the opposite of selfless somehow
Here is another reply by Brian M. Cornelson [MD], family physician, University of Calgary
Well said. Emphasizing altruism sounds noble but is ultimately hollow and insidiously depleting. Emphasizing meaning allows a sustainable virtuous cycle of contribution and affirmation.
PLEASE LEAVE A COMMENT:
- Are you a hero or a saint or would you describe your caring for patients in some other way?
- How does it feel when you hear these words applied to you during this pandemic?
- How are you taking care of yourself to maintain your energy and compassion during this difficult time?