Addition by Subtraction

When Corinne [Corinne Rao, MD] asked me to contribute to this site, she asked if I could comment on how important it is to change a toxic work environment before it burns you out

First of all I believe that it is critically important to change your situation if you’re in a toxic group. It actually may be a matter of life and death.

That said, I think that it really depends on what you mean by “change”.

Most of us, when we talk about changing our toxic environments, are referring to changing the group structure into a more holistic and nurturing place to be for all. So what makes a group “toxic”?

Many of us work in environments where we are neither heard nor respected. We are perpetually asked to sacrifice more of our time and talent with no meaningful compensation in return. Our “leaders” feel completely empowered to do so and shamelessly invoke guilt and shame as emotional levers to enforce compliance. What is more tragic is much of the work has little to do with the health of patients and more to do with the health of the executive’s bonus. We work in hospitals where our involvement on committees or work groups are ceremonial rather than substantive. Our clinical judgment and opinion is subordinated to the need to generate revenue.

Our mental health is often secondary to the larger objective of maintaining peace and tranquility in a group. Our leaders believe burn out is akin to a psychological sprained ankle, a condition that can be walked off. If we aren’t able to meet that expectation – well these leaders have no issue placing these doctors in the warm embrace of Human Resources. Once there these suffering and struggling doctors are not referred to mental health resources or counseling. They’re put on performance improvement plans and threatened with termination. Nothing nourishes the soul of an anxious, depressed, struggling human being than the knowledge that the slightest misstep leads to the loss of career and livelihood. That Physician Burnout is a fatal disease and that physicians have the highest suicide rate of any profession is completely irrelevant to these medical directors and HR managers. If an affected doctor kills themself as a result of this, well that’s just the cost of keeping the peace and doing business – it would seem.

So I agree that it is important to make changes to preserve our individual and collective mental health. The problem is that we can’t. Look what happens when one or two doctors stand up to try to fight for change. If they’re lucky, they’re just isolated, marginalized in the group, and denied any further advancement. If they’re not lucky – they’re fired.

The reality is that we aren’t going to ever change this environment because every shred of power has been taken away from the physicians and handed over to the MBA’s and the medical directors that serve them.

So what do we do?

We need to realize that we’re not ever going to get rid of the toxic philosophies that govern health care leadership in the United States in the 21st Century. So we must support each other. We need to be there for each other emotionally and physically. If we see a physician struggling, burning out, stressed out – we need to embrace that doctor and support them. If we know a colleague is getting grief at home for not being home on time, maybe we take that late admission for them? Maybe we stop looking at doctors trying to protect their mental health as being “weak” and “not team players” and see the behavior for what it is – self preservation. We need to stop being afraid to get help when we are hurting – whether we seek that help from our friends and colleagues or with a professional.

We start showing ourselves and each other the compassion that we will never get from those appointed to be our overseers. Once we do that, then perhaps we have a chance to change the toxic culture of so many hospital medicine groups and save ourselves.

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