The exhausted physician

If you can wait and not be tired by waiting,

Or being lied about, don’t deal in lies,

Or being hated, don’t give way to hating,

....

If you can dream—and not make dreams your master;

If you can think—and not make thoughts your aim;

....

Yours is the Earth and everything that’s in it,

And - which is more - you’ll be a Man, my son!

Rudyard Kipling, “If—”¹

Fatigue: A physiologic state caused by prolonged engagement in intense intellectual or physical effort and the subsequent difficulty to maintain this effort or engagement.²

Physicians often experience fatigue.³ They are stretched to the limit and cannot take on more.

Expectations for physicians are very high. And they are clearly much too high for family physicians, who are expected to be able to work in all fields of medicine: outpatient care, hospital care, obstetrics, pediatrics, geriatrics, intensive care, palliative care, etc. They are also expected to check on their patients at nursing homes and long-term care facilities, and do home visits. They need to demonstrate professional competencies⁴: in addition to being experts, family physicians also must be excellent communicators, remain up-to-date, be engaged contributors, be capable managers, be good advocates, and always act professionally, regardless of the situation. And in each area and skill set, family physicians are expected to be on par with their other specialist colleagues who work in much more specific fields. Basically, family physicians are expected to know everything, do everything, and behave in an exemplary manner at all times and in all situations. In other words, they must be perfect, at all times and in all things!

It comes as no surprise that so many family physicians instead focus on one area of practice and develop a specific expertise. Neither is it surprising that after completing their general training, many residents choose to take additional education leading to a targeted practice.

Every profession obviously has its share of challenges and hurdles. No one thinks that the professional life of nurses, orderlies, teachers, or receptionists is any easier. They have their own issues. However, in medicine, and particularly in family medicine, when things do not go well the physician is the one who is blamed. Tweets, social media reviews, complaints, investigations, and all sorts of legal action come from all directions. Is the family physician the captain of the ship with ultimate accountability? It is no surprise that so many family physicians are exhausted.

I invite those who are feeling discouraged, or who feel they can never do enough, to meditate on Kipling’s “If—.”¹

And for those dealing with exhaustion or fatigue, I suggest reading “The novel disease of the family physician and its cost-effective treatment options” by Sangeeta Vaideswaran, on page e131.⁵

A great read!

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