How to Discourage a Doctor


Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.

Within a minute, an administrative secretary came out and escorted him into one of the offices. Exhausted from a long call shift and lulled by the quiet, I started to doze off. Soon roused by the sound of my own snoring, I started and looked about.

That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.”

No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. It seemed to be the product of a health care consulting company, presumably the well-dressed man’s employer. Fearing that he would return any moment to retrieve it, I perused it as quickly as possible. My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said:

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One of the Vulnerable


I will be 79 next month. What do I think? I think the country should open back up, albeit cautiously. I’m embarrassed to think that people have to up-end their lives for older people like me. For one thing I’ve lived a hell of a life.I’ve been around the world, I’ve been a mom, a foster mom, and a grandmother, and an entrepreneur besides. I have written a few crummy books.

As one of the vulnerable, I’ve been stuck in the house now for six weeks, learning every detail about the Coronavirus. I have seen only about half a dozen people who are part of my quarantine barrier: people with whom I walk my dogs outside in the morning, my roommate, my barista and the woman who sanitizes my home once a week. And that group is considered too risky for most, but I’ve always been a risk taker and I’ve known my housekeeper for 25 years. I know she will do her best not to cause my death.

What do I do all day? Mostly I exercise, walking or taking Zoom yoga. What do I wish I could do? Hang at the bar at Hillstone. When will I be able to do it? Safely, probably not for two years.

Right now Arizona is on lockdown but we are preparing to re open soon. Our case numbers are not declining although the increase has slowed. We are part of the wild west, and our social distancing is not as strict as California’s, or my daughter’s in London. For example, I took a walk along the canal near the Arizona Biltmore hotel on Sunday and there were couples laying in the grass near the putting green of the golf course. They were drinking mai tais and beers and reinterpreting social distancing in their own ways.

They were young and I’m sure they didn’t perceive themselves as vulnerable. There were also more than 10 of them and they were oblivious to the numbers. I was jealous. I don’t want to be one of the vulnerable. I wanted to join them and have fun.

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A Revolutionary Old Vaccine For Physician Burnout


Burnout has become an obsession in the medical profession.  I am almost 75 years old and am not feeling any of the symptoms of physician burnout.  I do not state this out of any sense of pride, but I have tried to be introspective about this to offer some advice as to how to avoid this problem.

My approach is fourfold.  I shall begin by reviewing the definition of burnout, emphasizing physician burnout.   To address the individual issues, I think it is important that we are all on the same wavelength and are using the same definitions.  Secondly, I will review some facts about the reality of American medicine as we now experience it.  Third, I shall articulate a paradox between what seems to be an epidemic of physician burnout in the context of the reality of American medicine.  Finally, I will offer a nine-point set of suggestions, which are meant to help to avoid the symptoms and signs of this syndrome.  

 Burnout is not a new idea, and it is not specific to medicine.  It has been in the psychiatry literature for quite a long time, but it was brought to our attention in medicine in a series of papers by Zeev Neuwirth, who, at the time, was an internist at the Lennox Hill Hospital in New York.  He wrote several papers on related subjects and published an article in the lay press in 1999 that was entitled “The Silent Anguish of the Healers.”  Since that time, it has become evident that “burnout” is an important issue in medicine that needs to be addressed.  Neuwirth and others have defined ”burnout” as a feeling of complete emotional exhaustion characterized by cynicism, depersonalization and perceived ineffectiveness.

An Epidemic of Dissatisfaction

In recent years, many have argued that “burnout” is extremely prevalent; not only in society in general but especially in medicine.  It has been said that 50% of physicians have at least one of the three cardinal features:  exhaustion, depersonalization and inefficacy.  The problem with these kinds of data is that are no adequate controls; especially controls from others in the learned professions.  It is probably quite common for many people, at some point or another, to experience one or more of these cardinal features.  The real question is whether this is more prevalent than in a control population and whether they are persistent, rather than transient, symptoms.  That information is not available.  For these reasons, it is likely that the problem of “burnout” is being exaggerated.  Nonetheless the problem undoubtedly does exist in an unknown proportion of physicians.

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