Burning a little more

“We didn’t burn out, perhaps, by burning a little more.” ~Siddhartha Mukherjee

I’ve been getting close to the edges of physician burnout as a PCP the past few years. Since I plan to continue practicing for several more decades, burnout is something I want to make sure I take steps to avoid.

This is why I found the recent read in the NYT magazine important to pay attention to and take notes on: “For Doctors, Delving Deeper as a Way to Avoid Burnout.”

Mukherjee is the author of one of my favorite medical books from years ago “Emperor of All Maladies.”

Burnout has become a well known problem in medicine. But what is it exactly? There are three main areas:

  1. Emotional exhaustion: Feeling fatigued

  2. Depersonalization: Lacking in empathy

  3. Loss of personal accomplishment: Feeling like nothing is being achieved

Mukherjee then nicely brings in Viktor Frankl’s “Man’s Search for Meaning” - another of my favorite books. How do we find meaning in our lives?

  1. Purpose: Find purpose in what you do

  2. Mastery: Develop expertise and skills in your area

  3. Autonomy: Get some independence in what you do

Mukherjee concludes that he thinks he (and some of his colleagues) may have avoided burnout through delving deeper into their specific niches — for him, that is as a researcher/writer in the oncology field. He is not doing paperwork and typing notes all day — which is how a lot of my time is spent as a PCP.

He suggests that instead of backing away when we start to experience burnout, what about burning more? Are there ways we can actually deeper into them to find more purpose, mastery, and autonomy?

Write. Research. Create. How can PCPs find ways to do more of this?

5 things I like about being a family doc

There are a lot of things to complain about in primary care. Catch me on a bad day and I’ll be one of the first to name some of the issues I face daily.


But, there are also a lot of great things about being a primary care doctor, and expressing gratitude is important

Here are the top 5 things I love about being a primary care doctor:

1.     I truly look forward to seeing many of my patients. Yes, having several thousand patients on my panel is far too many, but I do feel lucky to get to know many of them and truthfully enjoy many of our meetings.

2.     I get to take people off of medications. Many people come to me on a long list of medications. Some may be needed long-term, but some can often be discontinued once we work on addressing underlying causes.

3.     I get to talk a lot about food as medicine. Our food and lifestyle choices have the power to lead to disease or to optimize health, and I see people reverse diabetes, lower blood pressure, and improve cholesterol levels without medication.

4.     I get to see a newborn and 97 year old in the same day.  Being the doctor for people through all phases of life means moving from infant development to erectile dysfunction to menopause to depression to end of life care all in one afternoon. It doesn’t get boring and I’m always learning something.

5.     I get to see the big picture. Healthcare these days is frustratingly fragmented with doctors assigned to each body part or organ. But as the family doc, I pull together the constellation of symptoms, specialist input, studies done, and patient goals and desires to help come up with an overarching plan towards better health.

Why Family Medicine


A version of this post was originally published at KevinMD.

It's easy to forget how lucky I am to be a family medicine doctor. To see both a 2 day-old newborn and a vibrant 97 year-old on the same clinic day. To see multigenerations of families. To help make healthy changes in people's lives and see how that plays out over time. 

Instead, it's easy to feel overwhelmed with the day-to-day drudgery of primary care. The rushed visits, the paperwork, the time spent documenting, etc.

I thought I would repost this article I wrote years ago at the end of medical school at KevinMD. I wrote this in a pre-residency burnout state, and is a mindset that I strive to return to:

Family medicine is the kind of revolution we want to join
It never surprised me when my medical school classmates said they would “never do family medicine.” 
I knew exactly how they felt: why would we choose to go into a field where physicians are undervalued, underpaid, buried under administrative paperwork, and where patients do not get the time or attention that they need?
Despite the warnings against it, I am pursuing family medicine as a career. And I am not alone: more medical students are doing the same — the numbers matching in family practice went up 11% from last year.
Why? Because we know primary care needs to be better and we want to help change it.
Primary care challenges us to master the full breadth of medical knowledge. With humility, intelligence, and an appreciation for physical, emotional, and spiritual health, more medical students are aspiring to be complete physicians for their patients. Primary care is difficult to access in our current system, and patients want a doctor who understands them and can be “their” doctor.
The residency interview trail provided me with an opportunity to talk with leading family physicians across the country. As I went through this process, it became clearer to me that family medicine is on the brink of an exciting revolution. There is an unsaid manifesto in family medicine that motivates many of us to join the field, and it includes the following:
1. Change. Family medicine will be leading the implementation of vitally needed changes ahead. As primary care becomes central to our healthcare system, family physicians will be part of new and more effective models of care, such as the patient-centered medical home (modeled by systems like Kaiser Permanente and Geisinger), accountable care organizations, and the growing numbers of direct-pay practicespopping up across the country.
2. Prevention. The focus of our healthcare system must shift away from costly procedures and treatments and towards simple and cost-effective lifestyle changes to prevent many of our modern afflictions (cancer, heart disease, obesity). Primary care physicians are leading the effort to emphasize prevention over cure.
3. Innovation. New technology and social media tools have the potential to radically improve communication, medical treatment, and patient-education. While the current model is failing in many ways, primary care is thirsting for new ideas and innovations to facilitate their work (such as virtual doctor visits and smartphone apps to monitor patients’ blood sugars and weight).
4. Relationships. Family physicians create and sustain the health habits of our country through the relationships they cultivate with individuals, families, and communities. Despite the exponential growth in technology, effective doctoring starts with the basic human-to-human relationship, and changes happen through these relationships.
5. Health-equity. Family physicians are deeply committed to caring for vulnerable and underserved populations. Our challenge lies in designing a system that provides accessible, equitable, and affordable health care to all people, from inner city refugee populations to remote Native American reservations.
6. Value and centrality to system. As the value given to primary care increases, family medicine will no longer be a field people go into because they don’t have high enough board scores to take the “R.O.A.D. to success” (Radiology, Ophthalmology, Anesthesiology, Dermatology). Rather, family medicine will be what medical students go into because they are at the top of their class. They are drawn by the responsibilities and challenges of handling a medical career central to the healthcare system.
7. Teamwork. Family physicians get to interact with a large team of people to improve patient and population health: nurse practitioners, physician assistants, health educators, policy-makers, researchers, nutritionists, physical therapists, and more.
Through consistent and long-term relationships with patients, primary care physicians see changes over time, determine when to refer patients to a specialist, and provide preventive treatments that limit future costly procedures and hospitalizations. The entire medical system relies on them.
Many of us came to medical school driven by ideals and passion. Family medicine allows us to transform our idealism into reality. That’s the kind of revolution we want to join.