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A Piece of My Mind
October 16, 2018


Author Affiliations
  • 1Geisel School of Medicine at Dartmouth; Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
JAMA. 2018;320(15):1537-1538. doi:10.1001/jama.2018.14435

It has been a while, but I had a rough go of it as an intern. At some point, deep into a long first winter of adjusting to calling myself “doctor,” I was found sobbing in a corner and sent to see a counselor. He was a grandfatherly man who quietly asked me if I had been feeling sad. I said, yes, I had, and elaborated on how I felt my new job was making me sad. My job, at that very moment, consisted of an unending series of hours in a neonatal intensive care unit tentatively prodding tiny infants at the edge of viability and crossing my fingers that maybe just one of them would do well. The month prior, I’d been on oncology service where I’d hoped beyond hope that the young child with stage IV neuroblastoma would make it. Before that, I was on pulmonary service where I wished for one good thing to happen to the teenager with end-stage cystic fibrosis, diabetes, and liver failure.

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    2 Comments for this article
    What next
    Sarosh Shareef, MD | Civil Hospital Karachi Pakistan
    As someone working with a patient base totally comprised of the poor and disenfranchised segment of population, and someone who had to take a break from self-diagnosed burnout, where does this essay take us? What is next in making us capable of continuing to work for people I really want to work for without letting it make me apathetic? These problems will not be disappearing in our lifetime and most probably will increase. How as physicians can we continue to give our best without becoming depleted?
    We Need Systemic Change
    Lisa Nelson, MD | Community Health Programs Great Barrington MA
    I don't have easy answers for the issues raised in this essay. But certain solutions seem to lie squarely outside medicine. VOTE, and help other people (particularly those at risk/disenfranchised) have access to voting. Raise the minimum wage. Decriminalize addiction and Improve access to mental health counseling and addiction treatment. The list goes on. In the meantime, we physicians and nurses and NPs and PAs and mental health counselors need to address the emotional exhaustion and hopelessness that fuels our burnout, and do whatever we need-- rant, organize, change jobs, change systems, sleep, eat, breathe-- to keep going.