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Living in the Moment: A Mindful Countering of Burnout

The topic of burnout is huge in today’s medical community. Multiple articles and studies have been published demonstrating that burnout is prevalent in all levels of medical training from the day-one medical student to the most senior practicing attending.

For the student, the reasons for burnout are numerous. From a testing standpoint, exams seem endless. Step 1, Step 2, and beyond tower as immense hurdles one after another. Countless hours, days, and months are spent studying such a wide array of topics that “drinking from the fire hydrant” feels like drowning.

Later in the medical curriculum, the stresses of being constantly watched and evaluated, of being “pimped” on obscure factoids and trivialities — made even worse when the attending does not follow-up with teaching — and of being pressured to show up to unpaid work day after day feigning cool confidence whilst internally panicking about poorly formed assessments and plans, only add to the overwhelming feeling of losing oneself to a system that demands every ounce of one’s being. The pressure to perform perfectly indoctrinates students to minimize one’s own needs and even evokes guilt for taking time for oneself — because anything less than cutthroat dedication might be construed by evaluators as “not enough.” Out of this toxic brew of insecurity, remorse and resent, burnout is born.

In these low moments, misery loves company. Discontented conversations on the topic of burnout with fellow students often end with the pacifying mantra of Hang in there. These frustrations are just temporary. When we’re attendings, life will be better. Nights out with sympathetic friends, fatigued and occasionally intoxicated, are just enough to ease the depression and burnout with the thought that tomorrow will be a better day. Implicit in these statements is the spark of hope in a better future, a light at the end of the tunnel.

But while nights like these serve their quick purpose as a cooling balm to the “burn,” and hope remains a powerful weapon against negativity — attending physicians also suffer from burnout. The struggles of insurance and reimbursement, of patient quotas to meet and patient dissatisfaction to address, continue. As significant relationships and perhaps the thoughts of starting a family enter the scene, work-life balance only becomes harder to achieve. Looping back to the idea of “not enough,” even in the attending world, there will always be another achievement to chase, another rung to climb on the way up the academic ladder. Even life as an attending has its struggles, and it would be naïve and ultimately self-destructive to believe that the future will be easy and that in the glorious light of attendinghood, we will suddenly be fulfilled.

This reality check is not meant to discourage one from hoping for a better tomorrows; rather, it should serve as a gentle reminder to not place empty hope in a false endpoint. In striving to prevent a mental bubble of unrealistic expectations from bursting down the line, recognize early that in this highly revered and highly regulated field of medicine, expectations of perfection will continue to prevail; stress in some form or another will always be present.

So, stop chasing this fantasy of future happiness. Stop seeking a perfect ending to the long path of medical training; there is no end to the work of medicine. There will always be a million external pressurizing forces in medicine that push you to do more, to be better. If you chase an ideal goal, you will never be happy. Of course, continue to hold yourself to high standards of aptitude and professionalism, but know that there is no such thing as perfection. Realize that in this atmosphere of god-like expectations, we are only human. Be kind to yourself, allow yourself to live life now, or you may find your once-pure altruism and motives for entering medicine soured with resent.

After a hard day’s studies, instead of dwelling on all the work left to do, choose to enjoy a night out on the town. After a long shift at the hospital, allow yourself the time to relax. Refuse to allow others to dictate your needs and your priorities, refuse to lose yourself to the endless work of medicine, and refuse to be part of the perpetuating force that makes future generations feel that they are “not doing enough.”

At the end of the day, stop and smell the roses. Reflect on the supportive people and moments in life that have touched you, and reach back to those roots — reconnect with your loved ones, seek those moments again. Be mindful what you need to be happy and take a stand for your right to leisurely pursuits, your right to be carefree. You need not wait for the light at the end of the tunnel. Live in the moment so that ten years from now, you can look back fondly with no regret of a life spent discontentedly looking for something more.

Kathleen Tzan Kathleen Tzan (2 Posts)

Contributing Writer

Sidney Kimmel Medical College

Kathleen is a third-year medical student at Sidney Kimmel Medical College in Philadelphia. She is strongly interested in holistic and alternative medicine with a focus on primary care and is planning on pursuing a career in Family Medicine.

  • Hannah Day

    Thank you. While not a medical student yet, but as a med school hopeful in the thick of the application cycle and working full time in a busy community clinic, I greatly appreciate your perspective here. You have articulated so well both the origins and remedies for burnout in medicine. I am working through the admissions process, dealing with the stress of wondering whether I will be seen as “good enough” for admission to medical school, while working long days in the clinic with back to back patients. The laundry lists of chronic diseases that many of our patients have, the inability to afford their medications, and constantly running late on appointments because patients need more time can cause us to feel as if we aren’t doing enough- that we can’t do enough given the limitations. These feelings of not being or doing enough are a manifestation of what Brene Brown describes in The Power of Vulnerability as the “culture of scarcity” that exists in American society. The antidote, as you describe in your piece, is mindfulness of where you are and what you are doing now. Are your actions in line with your values for the way you want to treat yourself and others? There is never a place we get to in life where we are complete in some way or will be able to let go of all responsibility. It is not possible to front-load all our work and effort in life with the idea that once we have sacrificed enough, we will have earned a life free of worry. Like you said, there will always be work to do, in medicine and in our relationship with ourselves and others, but our lives need not become work only; we always have the power to come back to gratitude, joy, and appreciation. We can also learn to find relaxation and self-acceptance in any moment, no matter how high-pressure. In fact, we will not only be more content and experience more meaning and enjoyment of our work, but we will perform better, without even trying.

    • Kathleen

      Hannah, thank you for adding your reflections to my article. I completely agree with your comments and believe that mindfulness is a lifetime practice. Though I still often struggle with leaving my stresses and complaints at work, I am realizing more and more just how much happier, peaceful, and fulfilled I feel when I take the time to be self aware. Good luck with your medical school applications and interviews! I know the process is stressful, but I think that your insight and mentality will take you far.