On Thursday night I attended, along with hundreds of young medical students, Dr. Hunter Campbell “Patch” Adams’s presentation on “The Joy of Caring.” Dr. Adams, whose life story was made famous in the 1998 film starring Robin Williams, spoke at the Biosciences complex. The talk was organized by the Aesculapian Medical Undergraduate Society. We were invited to hear an inspirational lecture that included “The exploration of burnout prevention for caregivers and the power of care, not only in the patient’s life, but also in the caregiver’s life.”
As a comion fatigue specialist and someone who devotes nearly all of my time to providing education on burnout to health care professionals, I was very interested to hear Adams’s thoughts on this topic.
I was moved and rather awed by Dr. Adams’s total devotion to his life’s goal—which is to offer free medical care to all—and the love and acceptance he conveys toward his patients across the globe, particularly the most neglected of society. However, as I heard Dr. Adams speak, I grew increasingly uneasy about some elements of his message.
Throughout his talk, Dr. Adams described his routine of working from 7 a.m. to 3 a.m. daily and having rarely—if ever—taken a day off work in his many years as a physician and therapeutic clown.
He also spoke of a 12-year period during which he and other physicians lived with their children and spouses in a six-bedroom house they ran as a free hospital, living with “Five and sometimes 50 patients at one time, sharing bathrooms, living rooms and bedrooms. Having no privacy whatsoever.” Although he didn’t advocate we all do the same, I wonder how his lifestyle came across to medical students around me—did some of them see this as something to aspire to—a gold standard of self-sacrifice, the sign of a truly dedicated doctor?
I was then startled by Dr. Adams’s main advice which was that, in his opinion, “There is no such thing as physician burnout when you offer [the kind of medical care he offers]. Burnout is not possible when you care.” I agree with Dr. Adams that it’s often the system that burns us out rather than the patients themselves: the increasing volume of work, insufficient staffing, inadequate referral resources, etc. But to state that “burnout does not occur when you care” is simply not true.
Based on very strong research from 1995 onwards—Charles Figley, Beth Stamm, Karen Saakvitne and health-care professionals have shown working with patients can lead to comion fatigue, vicarious trauma and burnout. These problems can degenerate into clinical depression, post-traumatic stress disorder, anxiety disorders and can lead to alcoholism, suicide and serious clinical errors—to name a few.
The good news is that there are simple and effective strategies that can protect doctors and help to mitigate these effects. Doctors can provide care without suffering, and the answer is certainly not to deny or blame themselves for experiencing burnout.
My concern is that Dr. Adams’s message to medical students Thursday night was that if you don’t devote every waking hour of your life to patient care, you are a failure and possibly a shallow, selfish, materialistic human being. Dr. Adams may be thriving in his own rapid lifestyle and is clearly accomplishing wonderful things in the world. But for the rest of us mere mortals, the best way to provide care to others is to first and foremost start with ourselves.
Charles Figley, the highly respected founding father of research in comion fatigue, said it best: “First, do no harm to yourself in the line of duty when helping or treating others. Second, attend to your physical, social, emotional and spiritual needs as a way of ensuring high quality services to those who look to you for as a human being.” This isn’t a zero sum game: you don’t take away from others by caring for yourself—it is, in fact, quite the opposite. I believe doctors can be far more effective caregivers if they have their own emotional house in order.
Françoise Mathieu has a Masters of Education and is a certified mental health counsellor and a comion fatigue specialist.
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