The Vanishing Oath

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

I received a copy of the documentary, The Vanishing Oath, from the the films producer Nancy Pando.   I’m not sure I can best Dr Wes’ review, but would like to add my impressions.  The documentary film  was directed by a young emergency room physician, Ryan Flesher, MD and produced by a former clinical social worker, Nancy Pando, LICSW.   Dr. Flesher’s own dissatisfaction/disillusionment with medicine led to the films production.

Physician burnout is an important topic and as with most job dissatisfaction is not due to just one thing.  The film addresses many with interviews of physicians, the public, and one lawyer – long hours, need to see more patients in less time, threat of malpractice lawsuits, increasing paperwork, increasing pressures from outside sources (government, insurance companies, etc).

Being a surgeon, I was particularly struck by the young aspiring hand surgeon who left (video clip) medicine after all of his years of training because of the toll it took on himself and his family.  I would love to know what he is doing now.  What job replaced medicine and surgery for him, because no job is without it’s own problems and exasperations.  Time management or life balance is always a “juggling” act which some are better at than others.

I will admit here and now that I have experienced some of this, so I was hoping (as I think Dr. Flesher was) that the film would show me better ways to guard against all those forces that take my joy of practicing medicine away.  Sadly, it didn’t, but there were two physicians interviewed who seem to always (or almost always) love their job.  I “soaked” these two up, especially the segment of Dr. Peter Rosen who advises “the most important thing is to revive your ideas, why did you want to be a doctor?”  I love his story of his first patient when he was 8 yrs old.  He has retained that enthusiasm. 

I am now working to get this shown in my community as Dr. Wes managed to in his.  No dates set as of today.

Physician Burnout

Updated 3/2017 --  all links (except to my own posts) removed as many no longer active. 

Dr. Wes and Kevin,MD have both written reviews of the documentary film “The Vanishing Oath.”   I started the process rolling of trying to get the film shown locally.  No date yet, but looks like it will happen before the year is out. 

This is not a new phenomenon in medicine (or any profession).  Dr. Robert Goldwyn wrote a nice essay on the some of the issues that can lead to burnout though not once did he mention burnout specifically.  The title says much:

“I Bargained on Working Hard as a Surgeon,  Not Working hard to Be Able to Work Hard as a Surgeon”

The preceding title is a quote from a letter written by a resident in the last year of his training (S. A. Teitlebaum, August 20, 1994). It reflects the gloom besetting the young in particular but certainly not them exclusively. We all are uneasy about our futures, professionally and economically. Bandied in the corridors at a national meeting was a dismal figure: 1:100,000, the presumed proper ratio, as determined by Health Maintenance Organizations, of plastic surgeons to population. That 1 million Americans need only 10 plastic surgeons seems wrong and idiotic to me, but it makes good economic sense to health providers and insurance companies. Their coffers swell as they collect the same or higher premiums while curtailing what they provide.

When I started in practice 31 years ago, Massachusetts had a population of about 4 million and had 14 board-certified plastic surgeons. Now, with a slightly increased population, there are 104 plastic surgeons. If we go by the 1:100,000 rule, we should expect only 60.………

Lisa Chu, MD has an essay, Burnout is common to teaching violin and practicing medicine, in which she discusses the topic:

I’ve recently started reading blogs and articles about “physician burnout” and I can’t help but notice that there’s a lot of blame being placed on “the system”. Doesn’t this kind of storytelling just reinforce that physicians are victims? I’d like to see physicians adopt a way of thinking that will enable them to create the desired changes in their own lifestyles, levels of satisfaction, and ultimately patient care…..

REFERENCES

"I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon"; Plastic and Reconstructive Surgery. 96(1):177-178, July 1995;  Goldwyn, Robert M.

"I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon"; Plastic and Reconstructive Surgery. 114():102-103, October 2004;  Goldwyn, Robert M.