Even Superheroes Can Burn Out in Oncology

Yara Abdou, MD, a clinical hematology/oncology fellow, Roswell Park Comprehensive Cancer Center

Yara Abdou, MD

I was 13 years old when I decided to become a doctor. At that age, I could not have guessed how challenging that path would be. Seven years of being immersed in textbooks, then 3 years of intensive internship and residency followed by a 3-year fellowship.

Now I am 30 years old and reminiscing about a life built on hard work and sacrifice. A sacrifice of my 20s, sleep, and even health. But apart from being able to prescribe medications, what has changed?

As soon as the title of MD is added to our names, expectations skyrocket, and anything less than perfection turns into a disappointment. We enter a world of tremendous internal and external pressures to flourish, and without knowing it, we join a malicious culture. A culture of toughness and boldness but also a culture where vulnerability is considered a weakness and any feelings of doubt or fear are buried. A culture that fuels our obsession with perfectionism and fosters unrealistic expectations. A culture that inevitably leads to emotional burnout.

Despite our bravado, our confidence, and our skill, not everyone makes it. I lost a bright, compassionate, and caring colleague during residency. His suicide was a shock to everyone, including his family, because he was a cheerful doctor who had shown no signs of struggle or depression.

Doctors master the art of compartmentalization and disguise. The world sees us as superheroes. We expect to be superheroes. So how can we admit to fear or vulnerability? How can we acknowledge our weaknesses or confess to our exhaustion? How can we set aside our superhero masks without being judged or feeling shame?

The truth is that physicians are more than twice as likely to kill themselves as the rest of the population. Around 400 doctors in the United States commit suicide every year, more than 1 per day, a higher suicide rate than that of any other profession.¹ And for every doctor who dies by suicide, thousands more contemplate the act. Good people are dying, friends of mine and friends of yours. It’s time for a change.

Our jobs can often lead to complete physical and mental exhaustion, yet our culture has taught us to suck it up and refuse to seek help. Oncology, in particular, is one of the most stressful medical specialties. It takes a great amount of physical and emotional energy to care for patients with terminal cancer. Watching patients deteriorate and suffer, in addition to repeatedly breaking bad news, can be emotionally draining.

Results of a qualitative study among oncologists showed that exposure to frequent patient death motivated clinicians to improve patient care (66.7%). However, it also led to exhaustion (62.0%), burnout (75.9%), and compartmentalization of feelings at work and home (69.6%).²

Furthermore, we are expected to stay ahead of a constantly advancing field and novel treatment strategies, which is a challenge on its own.

Coping Mechanisms

So how do we deal with careers that often lead to complete physical and mental fatigue? We often hear the same suggestions: mindfulness classes, meditation, wellness retreats, resiliency training. These are great. However, doctors are resilient by nature. The problem is not our lack of resiliency; it’s numbness to our feelings. We see far too much pain to pretend as though it’s nothing. We need to be able to voice our worries and fears, share our vulnerabilities, connect with our feelings, and find comfort in our peers. It’s time to put an end to a culture that supports bravado and intolerance. Asking for help is not a weakness.

Emotional resilience fluctuates over time, and recognizing when this resilience is wearing away is important. Acknowledging our feelings is the first step toward a healthier state of well-being. We can start by simply asking ourselves at the end of each day, “What are the 3 most difficult things I had to deal with today?” Once we are comfortable with identifying our own feelings, we then become capable of sharing these feelings with friends and colleagues.

Talking about those stressors is an important step in fighting burnout. A study done at the Mayo Clinic found that giving physicians time to spend with their colleagues in small groups for private discussions provided them with mutual support to deal with challenges, resulting in lower burnout, greater well-being, and improved job satisfaction.³

A shout-out to all my friends and colleagues in residency and fellowship who helped me become the resilient physician I am today. It is vital to encourage community at work and cultivate an environment of collegiality and support.

We all go through a similar path of struggles and challenges, so why not share our fears with one another? Pamela Wible, MD, is a family physician in Eugene, Oregon, who has worked to combat physician suicide and burnout since 2005 and encourages healthcare providers to defend and protect one another. As she put it in a 2015 Ted Talk, “If we all shine our lights together, then there is no darkness to fear.”³

Being a physician is not just a job, it’s a calling—a calling to be that superhero who saves lives. We have chosen a long and difficult path filled with ongoing daily sacrifices, yet we take pride in the work we do. Nonetheless, it is crucial to recognize that everyone experiences burnout, even superheroes.

There is no higher calling than being able to help people in need and alleviate suffering. However, we can’t give patients care that we have never received. Therefore, let us care for ourselves, and care for one another. Only then we can fulfill our calling and be true superheroes for our patients.

Yara Abdou, MD, is a clinical hematology/oncology fellow at the Roswell Park Comprehensive Cancer Center.

References

1. Medscape national physician burnout, depression & suicide report 2019. Medscape website. medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056. Accessed April 4, 2019.
2. Granek L, Ariad S, Nakash O, et al. Mixed-methods study of the impact of chronic patient death on oncologists’ personal and professional lives. J Oncol Pract. 2017;13(1):e1-e10. doi: 10.1200/JOP.2016.014746.
3. Wible P. Why doctors kill themselves. TEDMED website. bit.ly/2YsyUEO. Accessed April 26, 2019.