We have all heard of the 4 Cs that we are currently living and working through: the interrelated effects of the ongoing COVID-19 pandemic, the rising cost of living, global conflict, and the climate crisis. To this, we could add another global phenomenon—that of feeling cynical about the lack of support we believe we are facing as a discipline.
We all remember the few weeks early in the pandemic when the sound of banging pots outside our homes and practice offices kept us going. It seems this has given way to feeling abandoned and facing increasing anger from the public about issues that seem beyond our control. It is little wonder that we are feeling angry ourselves.
Global burnout in family medicine is real. I facilitated a workshop at the WONCA (World Organization of Family Doctors) World Conference 2023 in Sydney, Australia, with former College of Family Physicians of Canada executive director and chief executive officer Dr Francine Lemire; Dr Felicity Goodyear-Smith from New Zealand; and Dr Ichsan Ichsan from Banda Aceh, Indonesia. We titled the workshop “Finding joy in practice after despair: the importance of regaining morale for our patients and for ourselves.”
We presented data showing that 50% of family physicians are facing some degree of burnout in Canada. We were not entirely surprised that the same holds true in Australia and in many countries represented at the conference. What did surprise us was the reaction of our Indonesian colleagues.
On Boxing Day 2004, nearly a quarter of a million people lost their lives in a devastating tsunami that struck Aceh province in Indonesia,1 where Dr Ichsan is from, and other countries in or bordering the Indian Ocean. He presented agonizing depictions of the event and of the solidarity of the medical community in its aftermath. He also urged conference attendees to try to connect with a higher sense of meaning during such seemingly indiscriminately cruel times.
It got me thinking: What is the deeper meaning of our collective suffering as the acute phase of the pandemic shifts into a more chronic one? It is one thing to spring into action to combat a catastrophe, but how do we maintain momentum for what is turning out to be a marathon?
Having been to Banda Aceh myself, I can confirm that that is precisely what they are doing: There is a sense of regeneration there and of order and harmony. Having spoken with family doctors and policy-makers there, I find it difficult to point precisely to what has led to this. Certainly, integration of efforts among government, public health, and primary care stakeholders has been important. But there is something more intangible as well, and according to Dr Ichsan it has to do with trying to find meaning at the personal level.
This might seem absurd in response to a senseless calamity. But does COVID-19 offer us a chance to reflect on what is failing us at the system and local levels? Does it give us an opportunity to seek efficiencies and integration, without which we would have seen losses sooner or later? And, at the personal level, does it offer us an opportunity to reflect on some bad habits that we had been getting away with only because life, generally, had been pretty good? These are questions we should ask and answer.
Burnout is not just about having too much work and too little time to complete it. It is also about pointlessness. And lack of hope.
We collectively must face these questions as a global family medicine community: How do we continue to press governments to support our sector? Evidence demonstrating that investment in primary care is associated with lower health care costs and better population health is overwhelming,2 and our advocacy efforts must not cease. How do we engage the public to support this cause, even as multiple sectors are suffering? And, perhaps most importantly at this time, how do we retain solidarity with one another and avoid becoming divided?
We are not alone. Wherever I go and work, I witness kindred colleagues trying to reconnect with something that seems elusive at present. Some call it a sense of purpose or meaning, others are content to call it the satisfaction of a job well done. It is there but hard to reach, despite being bigger than ourselves.
Notes
Dispatches is a quarterly series coordinated by Dr David Ponka, Director of the Besrour Centre for Global Family Medicine at the College of Family Physicians of Canada. The series presents personal reflections from home and abroad as they relate to the Besrour Centre and the discipline of family medicine.
Footnotes
Competing interests
None declared
Cet article se trouve aussi en français à la page 213.
- Copyright © 2024 the College of Family Physicians of Canada