The profession of medicine is grounded in self-sacrifice, Surgeon General Vivek Murthy, MD, told a recent gathering of medical students in the nation’s capital. “We give and give and give ... [but] the bottom line is we don’t value self-care in our profession nearly as much as we should. And valuing it means we have to do more than talk about it.”
Dr. Murthy’s remarks came during a talk with medical students at the AMA’s Medical Student Advocacy and Region Conference. The three-day conference brought together medical student members of the AMA from throughout the country to learn about health care policy, meet legislators and other medical students from their regions, and participate in clinical workshops.
Mental and emotional well-being is one of the surgeon general’s eight stated priorities, and Dr. Murthy suggested strategies for promoting it among America’s physicians.
It is critical, he said, to first understand what causes burnout. And that is not necessarily a large workload.
“What causes burnout is when people feel a lack of self-efficacy, when they feel like they’re working hard and it’s not meaning as much as it should, when they feel like they aren’t valued in the community they’re practicing in,” he explained. “Those things will accelerate burnout even with a reasonable workload.”
Policies are not enough
Operational changes, such as reduced paperwork and smarter application of technology, cannot fix the entirety of the problem, Dr. Murthy said.
“Some of that is important to do—don’t get me wrong,” he said. “But we also have think, ‘Is there something internal to how we’re operating as individuals and a profession that maybe we should link to burnout?’ And here I think there are things we need to change.”
Chief among them is the culture of the medical profession.
“Culture and policy are both important, but culture will trump policy every day of the week,” Dr. Murthy said. “Culture change is what allows policy initiatives and policy intentions to be sustained.”
Changing medicine’s culture requires enabling and encouraging physicians to develop the skills they need for self-care, he said. It also requires creating an environment that supports people who actually exercise those skills.
“We know, for example, that there’s a very strong correlation between sleep and emotional well-being,” Dr. Murthy said. “If we say we’re going to create a culture where sleep is protected and valued ... but then we don’t actually allow people to have sane call schedules, or we deride people who take too much time off ... if we’re not walking the walk, then that doesn’t serve us.”
As a case in point, he cited recent efforts to limit work hours.
“There were times when programs were told to do one thing, and they said that that’s what they were doing, but … everybody knew that culturally that was a no-no,” Dr. Murthy said. “So we have to root out that culture of excessive self-sacrifice and excessive self-negligence. Because that’s really what it is: We’re neglecting ourselves and our well-being.”
Self-neglect might seem like a noble practice in service of one’s patients, he said, but it’s ultimately detrimental to the profession “because nobody wants a doctor who is burned out and bitter and cynical.”
It also hurts the profession by corrupting the sense of medicine as a calling that physicians and medical students ought to have.
“When they’re thinking about a career in medicine, nobody wants to hear, ‘You know what, the glory days are behind us. You should look for something else,’” he said. “Unfortunately, that’s what a lot of students are hearing these days.”
Medical students as change agents
“You can make the profession more hospitable by helping shift the culture around self-care and emotional well-being,” Dr. Murthy told the audience.
“In the hierarchy of medicine, it may feel like … you don’t have as much of a voice,” he said. “But I have seen more and more examples of where medical student and resident leadership has, in fact, changed how business is done.
“That change should ideally come from the top, but we can’t wait for it to always come from the top. It has to come from the people who are most impacted.”
What the Code says
The AMA Code of Medical Ethics offers guidance on physician well-being. In Opinion 9.3.1, “Physician health and wellness,” the Code explains:
When physician health or wellness is compromised, so may the safety and effectiveness of the medical care provided. To preserve the quality of their performance, physicians have a responsibility to maintain their health and wellness, broadly construed as preventing or treating acute or chronic diseases, including mental illness, disabilities and occupational stress.
Read more from this opinion.
