Part Two: Physician Burn Out and Suicide – The Road She Forged.

Dr. Mamta Gautam developed complications in her pregnancy and, after delivering twins in 1991, she was in a coma for days. She was soon forced to return to work with an open abdominal wound. She realized then and there that, “Medicine doesn't care about the health of their healthcare workers.”
What Dr. Gautam did with this knowledge was to carve out a new way to do medicine. A psychiatrist by training, she became the “Doctor’s Doctor” and, in the 1990’s, began work with individuals and organizations to address burnout and suicide before it was on anyones radar.
A pioneer in the field of Physician Health, Dr. Gautam founded the University Of Ottawa Faculty Of Medicine Wellness Program, the first in the world to deal with physician health issues. She is now an international expert in physician health and leadership. 

So, when I was searching for answers on how to help reduce burnout and suicides in physicians, I reached out to her to find solutions.

Dr. Gautam said, “Before I answer, I want to talk about complexity theory.”

At this point, I had my pen poised. When interviewing people, I always wait for what Virginia Wolfe eloquently asked of them: “…to hand you after an hour’s discourse a nugget of pure truth to wrap up between the pages of your notebooks and keep on the mantelpiece forever.” I was a little disappointed to be sidelined by a theory I hadn't heard of, rather than an actual solution to the serious problem we were discussing.

Luckily, my disappointment was short-lived because that theory, and how it applies not just to medicine but all professions, actually was a nugget of pure truth. So, here it is for you to wrap and put on your mantelpiece. Forever. Whatever your profession.

• Dr. Gautam explained that some problems are Simple and can be solved by following simple instructions, like baking a cake. There are instructions, and if they are followed, we have a cake.
• Some problems are Complicated but can be solved by following more detailed instructions and require expertise, like sending a man to the moon. With the right expertise, we can again have a solution that we can replicate.
• Some problems are so Complex that their solution cannot be boiled down to a list of steps and and expertise doesn't always help, like parenting. If you add people in, we have different outcomes depending on the person (in this case both the child and the parent). So, we are better off with guiding principles, rather than strict recommendations and rules. 

With physician burnout and suicides, prevention is best thought of in terms of guiding principles, at the level of the individual physician, the culture of medicine, and the healthcare system.

One key principle is the need for community. For some this may be implemented by re-creating the doctors’ lounge. This where we can gather and talk about the day; the hard parts, the best parts and the funny parts. It is the ability to break out of the isolation and connect. For all of us, no matter what profession we are in, the trauma of our day can haunt us. For physicians, this might be the patients who died despite our best effort, the metallic smell of the blood that covered the patient, the room and us in surgery as we struggled to save a trauma patient, the young baby who fought valiantly and the breathless sobs of her parents after she died. Those traumas we need to talk about. 

The next part - and the crux of the matter: doctors are human. They should not be so tough that their hearts aren't wrenched when patients suffer. We can and should viscerally feel the often soundless sobs of the families that mourn. That is who we are, and that is the best of us. So, there must be an end to the ‘tough doctor’ and a new opening for the human doctor.

This is a principle for all healthcare workers and for all professions. We have many ideals that we strive towards, never being able to truly fulfil them but always keeping them in mind as we move through life. Many are worthy ideals. However, the ideal of the very strong, very together, never broken and beaten down person is an ideal that many of us hold dear. That person, that ideal, is actually a Trojan horse: if we let it into our lives, it will become stuffed full of all that will defeat us. It will be filled to the brim with the guilt of not living up to this ideal and the feelings of vulnerability that we stuff in it because we are terrified that the feelings are not worthy of the person we should be. It will be filled with the trauma we face, the small and large wounds we suffer but do not speak about. So, it is time to find another ideal and recognize the Trojan horse for what it is. We need to be human, striving to be strong when we need to be and allowing ourselves to be vulnerable, weepy and sad, infuriated and needy too. Because our empathy, our compassion, that makes us vulnerable, is actually the true iron in our spine. Wholly and wonderfully complexly human.

So, how to recreate community where we are allowed to be fully human?

Dr. Gautam said, “There is not one answer. If people accept the need for community and allow each person to be human, how they create that community depends on where they are and what they need.” 

So, Dr. Gautam asks for solutions to this, from each of us. The principle matters, the execution of the solution, like all good answers to difficult problems, is written on water and open to life. 

She sees this article, and others like it, as an opportunity to ask each person what they need and how to carve out this solution. It is a beginning of a conversation we all need to have.