On my last day of clinical practice, I hung my white coat, my name in red embroidery above the pocket, on the back of the office door. Then it dawned on me that I wouldn’t be returning. I carried the coat gingerly across the icy parking lot to my three-year-old silver Corolla, proudly purchased with funds I’d made moonlighting during my last year as a resident. I unlocked the car, placed the coat carefully on the back seat and collapsed behind the steering wheel.
I stared at my hands, trembling in my lap. I was overwhelmed with conflicting emotions: intense sadness at leaving patient care, which I loved, and intense relief, because the experience was slowly killing me.
Hypervigilance and constant worry about my patients coming to harm in the chaotic, poorly designed (some say never designed) health delivery system had led to insomnia, physical symptoms and intolerable effects on my home life. I was no longer myself, and I could tolerate it no longer.
I was lucky. Because of my liberal arts education at Williams, I made a virtually painless shift into health care writing and accepted a position at a medical education company. Hired to verify the accuracy of the sales training materials the company created, I found myself drawn to the writing itself.
In 1999, I re-invented myself as a freelance writer, and I’ve been writing about the flaws in (and potential fixes for) the health care system ever since.
It wasn’t until a few years ago that I stumbled across the definition of professional burnout and finally recognized what had driven me to leave. Burnout is a human, predictable reaction to extreme stress in the workplace that manifests as emotional exhaustion, depersonalization (or cynicism) and inefficacy, which is a low sense of personal accomplishment at work.
Burnout is not caused by individual weakness or susceptibility but by features of the workplace, such as work overload, lack of control and incongruence of values. I finally understood that I had left not because I “couldn’t hack it,” but because of the makeup of the work environments in which I trained and practiced.
In the years since I left clinical medicine, burnout among physicians has escalated, driven by a myriad of factors, including changing reimbursement models, a surge in clerical tasks due to new regulations, the often inefficient electronic health record and increased financial pressures. National studies have demonstrated burnout rates of 50 percent or more among practicing physicians.
I shared my story publicly on CommonHealth, an NPR-affiliate’s website, in 2013. Physicians began contacting me privately to share their personal experience with burnout. Their stories are heartbreaking—these are dedicated, caring clinicians who are so defeated they are “looking for an exit plan.”
I spent the past 18 months collaborating with another physician to write a book on how to prevent the problem. We interviewed dozens of physicians, researchers in burnout, experts in health system design and others, to better understand how to turn this crisis around.
The feelings and experiences of the physicians we interviewed precisely matched my own. However, the underlying causes were different—for me it was the chaos; for many physicians today, it is the burdensome clerical work, the productivity quotas and the whittling away at time spent with patients.
I do miss seeing patients and regret that my clinical career ended so abruptly. But I’m incredibly grateful for my deep-yet-broad undergraduate education. I studied organic chemistry, biology and physics to complete my pre-med requirements but also was challenged to expand my cognitive abilities in philosophy, art history and women’s studies. I learned how to write, and I learned how to think.
Those abilities were my professional parachute. When being a physician became an unsustainable proposition, my Williams education allowed me to transition into a second career that I also love. My work provides me with a new way to alleviate suffering—by offering reassurance and hope to physicians in distress, calling attention to the problem of burnout and highlighting potential solutions.
Instead of a stethoscope, today my primary tool is a keyboard. Although I’m no longer a clinician, through my writing I hope to make a difference in the world. I’m convinced there’s no richer reward.
Dr. Diane Shannon ’85 is a writer, physician advocate and change agent. She’s also an internist who left medical practice due to burnout. As a health care writer for 18 years, she focuses on strategies that address the issues that curtailed her clinical career. You can find Diane on the web at mdwriter.com.
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