Summary Of The Personal Toll Of Practicing Medicine By Elaine Shattner

In her article The Personal Toll of Practicing Medicine, Elaine Schattner issues the physician burnout due to work overload and physical demands based on her personal experience as a working physician who specialized in blood diseases and cancer, cell biology laboratory researcher with one time NIH grant, teaching professor as well as a wife and a mother of her two children. She argues that there is few to not existing resources and support for medical providers who experience toll on their health as a result of increasing demands and pressure during everyday workloads. She asserts that clinicians need support, multiple resources, back-up, rest, and protection in order to promote long-term health and maintain compassionate healthcare for their patients.
At age of six, Schattner developed scoliotic spine which required implantation of a steel rod along her spine followed by her hospitalization that influenced her career choice. She described her early experience as a physician to be a challenging yet satisfactory. During her two pregnancies, she managed procedures and

administered cases. She did not take long maternity leave. Schattner described her hours as "odd" (Schattner) during weekdays and "brutal" (Schattner) during weekends. Her patients required fast-paced and life and death evaluations in the middle of the night or during weekends. Plus, she was "'on service'" (Schattner) and responsible for handling hospitalized patients. In addition, she focused on her research and wrote proposals for grants to NIH in order to protect her lab and salary. teach students and give lectures, meanwhile, her requirements to take "other activities" (Schattner) in the medical field added to her workload. She did not complain since she "enjoyed it" (Schattner) at the beginning.
However, by 2001, she was frustrated with her work and loss of NIH grant and stopped her research and closed her lab. She developed depression but seeing patients made her feel better since it stimulated her "self-worth" (Schattner) after feeling of failure. Physical demands took toll on her spine and elicited back pain caused by deterioration of her vertebras which necessitated dangerous surgery. On top of that, she developed breast cancer which according to her she did "not have time"(Schattner) for it because she worried about her job. She even worked with bandages under her bra after needle sonogram and worked during her chemotherapy procedure. Adding to her bad luck, she fell and broke her arm which revealed osteoporosis that caused difficulty in performing work and simple tasks like writing and typing. She showed an insight into her health problems as a practicing physician.
In march of 2003, her spine surgery was performed and it required at least 12 months off from her work. But, she returned only after 5 months due to clinician shortages. Since she missed time from her work, she was assigned to be on service most of her time where she had to take care of thirty to fifty hospitalized patients. Even after asking for less workload due to her worsening health conditions, her supervisor suggested to shorten doctor-patient time. But she did not like the idea of decreasing quality time with her patients, so she decided to open her own clinic in 2005. However, as her knowledge of rare blood disorders increased, more referrals of challenging cases increased thus increased her workload. She could not manage the amount of work she dealt with on top of her own physical and emotional burnout. She felt as if she was a "burden" to her collogues and a failure to her patients even if she was board-certified in hematology and medical oncology. At the end she missed quality time with her family, physical therapy, delayed breast reconstruction, gained weight, and considered suicide which prompted her to close her clinic. She showed how her work negatively impacted her health and recovery.
Schattner strongly suggested for shortened work hours for any clinicians in order to promote their wellbeing. According to her, ACGME executed work hour limit only for early-career physicians. This limit discriminated against professional senior physicians who also need time protection since according to American Journal of Medicine, physicians worked for more than "eighty hours per week and thirty consecutive hours without rest" (Schattner) which can take toll on their health and quality of their work. She also argues that even if there were many organizations that help physicians who were already suffered from burnout, there were no organizations that maintain physicians' wellness nor protected their time. She suggested that Telemedicine is good way to go in order to limit time of work but it is imperfect. Other policies are needed fast, because in order to meet increased demands, physicians need time to take care of themselves as well.
She also argues that there should be novel regulations on practitioner's pace of work. Schattner suggests that there should be decrease the number of patients assigned to a single physician and increase the time spent with patients for improving quality of healthcare and maintain wellbeing of clinicians by reducing their stress levels. One of her sources, Innovation: The Aliki Initiative by McQuay, demonstrate the most innovative approach, The Aliki Initiative at John Hopkins Bayview Medical Center, to care for patients. McQuay and Schattner agree that healthcare practices suffer from low quality of caregiving due to increased number of patients per physician and decreased time for doctor-patient interpersonal connection. Thus, initiatives like Aliki that challenges students to "personalize care for each person’s needs and preferences" (McQuay) which can solve this crisis. Or in other words, students who were taught to see patients as individuals they need to get to know and not as generic diseases may initiate learned compassionate behavior at slower pace that can be carried out at the faster pace and "improved [patient] experience" (Schattner).
Physician Burnout by Linda Gundersen also suggest that physician burnout cause loss of interest in work and personal life like Schattner did not spend quality time with her family nor find her job satisfactory which impacted patients.

Gundersen argues that decrease in "moral" of physicians caused by their constant increased demands, sleep deprivation, and overall work overload such as described in Schattner experience as a physician. But, Gundersen also stated that physicians like Schattner still loved to spend time with their patients and felt great satisfaction in doing so. But, doctor-patient quality of interpersonal connection and unethical healthcare approach was evident in Schattner article when she described her superior's suggestion for decreasing time with her patients. Gundersen insist that well defined policies on workload and psychological support are crucial to fixing the

problem.
According to Gundersen, both ACP-ASIM Renewal Project provide and Dalhousie University Medical Humanities teach students about burnout stressors, raise awareness in order to avoid it by teaching balance in personal and work life. Canadian Medical Association instruct about self-care and collective responsibility for care. CMA mostly focuses on medical students’ exposure to more career options and medical practices similar to Aliki Initiative described in Schattner article. These given resources could have helped Schattner to deal with her own burnout if she learned how to balance her life before starting her career and many other physicians. Gundersen called for more research and novel policies to protect physicians.
Gundersen, Schattner, and McQuay agree that burnout can be avoided and clinicians' health can be maintained if there were more resources available to them and more policies to protect them physically and mentally. I agree with their argument since I experienced the consequences of physician burnout as a patient myself. I was submitted to ER with migraines that caused nose-bleed and high temperature. I have been hospitalized for few days and upon release antibiotics were proscribed. But, there was a mistake made by doctor who prescribed wrong medications. I received steroids for my migraines during hospitalization but took antibiotics instead. They called me and apologized for the mistake. I received free full dosage of my pills. I am sure that my doctor made huge mistake because she was tired. It would have been dangerous situation if I had allergies for this drug or any other complications.