burned-out or lighting the way?

burned-out or slightly illuminating?

A column of mine, that became a blog post, was recently linked at KevinMD.  The topic was my perception that there are those who don’t really deserve our efforts at health-care reform, as they consistently do things that will cost America vast amounts of money.  Here is the link to column as posted in the Greenville News

http://tiny.cc/nolKa

and as it appeared at KevinMD (my thanks to Dr. Kevin Pho for putting it up on his excellent site!)

http://www.kevinmd.com/blog/2009/08/do-some-patients-not-deserve-health-care-reform.html

Now, I don’t really want the government to cover our health-care, so I don’t actually want to limit anyone’s behavior for the purposes of cost savings.  (I’d like to change some behaviors for other reasons, but not generally through fines, litigation or legislation.)  But the point I was making is this:  if we’re all going to collectively pay for everyone via taxation, why should I pay for someone’s consistently bad habits or mores?  How will we decide when enough drug abuse is enough?  Or when repeated STD’s are too much?  When will we kick people off of disability for abusing the system?  You can read the column and get the tone of it.

Well, of course, I was a much hated and insulted individual in our local newspaper.  Fine, that doesn’t really bother me at all.  I don’t care what anyone says when they sign their name anonymously.  It just takes all of the weight and merit out of the discussion.  Anonymity in opinions should be reserved for struggles with violent dictators or mob bosses.  Otherwise, tell me your name!

But the one comment that struck me most was on KevinMD.  The writer said that I should consider getting out of emergency medicine because I might be heading for burn-out.  I understand his point, and my following tirade isn’t directed at that concerned doc.  He’s right; lots of emergency physicians have issues.  But are they burned-out?  I wonder.  The whole thing made me think about why we use the term, and what it means.

Now, I never said anything hateful or cruel in my column.  I didn’t call down brimstone on anyone.  I just asked, from my personal experience, ‘ if we’re all paying, how much will we collectively bear?’  And I based it on real-world experiences I see in practice, day in and day out.

And then it occurred to me.  The modern paradigm suggests that if one criticizes humanity, questions human motives or speaks what one sees as the truth and that truth hurts, then one is considered hateful or small-minded; puritanical or ‘judgmental.’  And if that one is a physician, he or she is diagnosed with burnout.

The implication is that a physician who is functioning normally could never have an adverse opinion of anyone else.  A normal, healthy physician would sail right past uncompensated work, false addresses, profanity, insults, the threat of lawsuits, the abuse of the system by the pseudo-disabled, the manipulation of drug addicts, the manipulation of the government and all the rest.  A normal, well-adjusted physician would simply smile and mutter about sunny skies, blue-birds of happiness and the great mass of amazing creatures that populate the earth and are called humans.  Perhaps anything less is burnout!

Look, I know people in many walks of life.  I know grocers and politicians, I know police-officers and physicians, teachers, attorneys, business-owners, DSS case-workers and retail sales-clerks.  I know paramedics and fire-fighters, soldiers and construction workers.  What these people have in common is that day in, day out, they have to deal with real, live human beings.

And when I talk to these folks, they echo my sentiments.  After working with the public in all their settings, they agree with me on some very fundamental tenets of human behavior.  People are amazing and delightful.  People are in need and struggling.  People are broken and filled with sorrow.  And some people are just, plain-old bad.  They are abusive, manipulative, self-centered and unrepentant of any of the pain they inflict on society, either physically, emotionally or economically.

I wonder, does this mean I’m burned out?  Does this mean that everyone who works with the public is burned out?  Perhaps, in medicine, it means that people who work in controlled office practices with regularly scheduled hours are not burned out, but that those who ‘man the wall’ in ER’s across the nation are uniformly burned-out!

On a larger scale, it may imply that those who work in quiet cubicles with soft music playing on NPR (who are never threatened, never blood-stained, never exposed to death and misery, never exposed to infectious disease, are not burned-out) are objective and rational observers of the health-care system, while those who do experience those things, and come away with strong opinions based on reality, are just mean-spirited and small-minded and all of the other compound-word descriptors that modern man can invent and string together!

I find the term ‘burn-out’ to be grossly inadequate and frequently false.  First of all, if I am, I earned it.  Day in and day out, my partners and I have striven to do our best for every person who came through our emergency department doors.  We have saved lives and lost them, but we have been there.  We have endured abuse and danger, we have been misused both by the public and by other physicians!  (I’ll get to that post in a day or two!)

But second, in and through all of our medical labors we have come to see people as they really are.  And they are shockingly, painfully beautiful.  From the infant with the fever to the ancient couple holding hands as one passes from the earth, humans are truly made in the Imago Dei.

But, humans are imperfect, broken, and fallen.  You don’t have to believe the Genesis story to grasp that (as we say in the South) ‘somethin’ ain’t right.’  Humans, so magnificent, are capable of unimaginable cruelty and epic horrors.  We are doers of evil.  And physicians, as well as patients, reflect that truth every day.

In fact, the dual nature of man, God-like and broken, is one of the most important evidence-based facts on the face of planet earth.  Disagree if you will, say society causes evil (which is a nonsense statement since society is composed of individual humans).   But if you work in the real world, with real-people, you’ll eventually see the truth.  You may swallow that truth like broken glass, you may stamp your feet and cry that it isn ‘t so, you may blame money or religion, culture or politics, but that’s no different from attempting to explain the wave/particle nature of light.  It defies description and comprehension, but the evidence remains incontrovertible.

So I don’t think my colleagues and I are burned out just because we might state hard truths.  An oncologist isn’t burned-out if he diagnoses cancer based on what he sees.  Nor are we burned out because we diagnose hard realities in the world based on our observations in the emergency rooms of the land.

I think we’re just good scientists.  We observe and report.

And I’m here to say, I’ve observed a lot of humans.  I love them deeply.  But I’d like to report that they’re messed up.  And so am I; but God loves me, just like He loves all of the other messed-up folks who cross my path.

But I’m not burned-out.  Maybe, the fire we call burnout is a light to keep us seeking the truths of this hard life.

Maybe, I’m burning but not consumed, like the bush in the desert.  You don’t put those fires out.

Have a great day!  And do not hesitate to speak the truth in love.

Edwin