Physicians have long been seen as superhuman—able to jump the academic hurdles required to gain entrance to medical school, willingly delaying many of the gratifications associated with young adulthood, surviving long hours during training and later when in practice, keeping a cool head amidst crisis.
In many ways, we physicians thrive on this image. Personally, I was unaware of how much I enjoyed the mantle of hero until I shed my white coat and left the clinical world. I felt a catch in my throat at giving up the identity of being a doctor. Truthfully, I enjoyed feeling superhuman sometimes. It was an adjustment to let that image go.
But when has the notion of physician as superhuman gone too far? I thought about this question often during my residency training. Working continuously for 24 or even 30 hours (I trained before the current duty hour restrictions) seemed like a lot to ask of a human body.
I was faced with this question again recently when a physician courageously spoke out about a cause of burnout that I hadn’t considered sufficiently before: the expectation of virtually constant availability.
During the question and answer period after a talk I gave on preventing burnout, the male internist, a faculty member at a university medical center, told the audience that hospital administrators had recently begun requiring that physicians list their cell phone numbers with the contact information on the organization’s website. There were no guidelines included about when and under what circumstances patients should use the numbers.
He told us, “I now get texts from patients who expect an immediate response. I was recently in clinic seeing patients when a patient texted me twice in an hour, then when I didn’t reply called the office and yelled at our staff. This summer I was out of the country on vacation with my family and received multiple texts from patients. No matter the time of day or the seriousness of the medical condition, patients have complete access to contacting me. I feel like I’m never off.”
Improving patients’ access to timely information about their health conditions and care is a good thing. But why do we fail to consider the cost to physicians? Why would anyone expect that an individual could work long hours in an inherently stressful and cognitively draining field and not need protected time to recover? Would we expect airline pilots or military personnel to perform well if they received emails and texts 24/7?
Why does it seem as if taking the Hippocratic Oath is equivalent to signing away our human needs? The electronic health record has made many physicians feel like robots, but the truth is, we are not. The current burnout rates in this country—50 percent or more in several studies—show that we are not superhuman and that everyone pays when we (or organizational leaders) act as if we are.
Questions to consider:
- Physicians: How do you handle the changing expectations about your being accessible by text and email? Does your hospital or practice have guidelines for you and your patients about your availability after hours?
- Other clinicians: What are you experiencing with regard to expectations about your availability?