The Death of Romantic Medicine: Physician Disillusionment and Burnout

The Doctor as a Warrior in a Garden

Within the innocent minds of children, being a doctor often reigns supreme. You can imagine that for Boomers, still the largest subset of doctors, growing up as children imagining themselves as Bones verbally jousting with Captain Kirk on distant planets. Alternatively, they might have resonated with Hawkeye from MASH, flitting around the battlefield transitioning between austere surgeon and dashing philanderer . The doctor was the synthesis of the determined man-of-action and the bookish scholar.

Yet, behind the scenes, a stark reality is unfolding—one marked by disillusionment and depersonalization among physicians.

Surprisingly, among children, being a doctor still holds the prestigious title of the number one dream job. It's a testament to the enduring archetype of the altruistic healer. However, the journey from dream to reality has become increasingly fraught with challenges that chip away at this romanticized notion. People may quibble and claim that this is a temporary symptom of the pandemic, but this has been a decades-long trend.

A Problem of Scale

Doctors today are grappling with a myriad of artificial structures that contribute to their disillusionment. One prominent factor is the mounting administrative burden imposed upon them. Endless paperwork, bureaucratic red tape, and electronic health record systems have transformed the practice of medicine into a bureaucratic labyrinth. Instead of focusing on patient care, physicians find themselves drowning in a sea of paperwork, struggling to stay afloat

It would be very easy to say: "Do away with it all! A pox on all this!" However, the current medical system is a Byzantine labyrinth of negotiations between various competing interest groups that were responding to the rapid changes in scale during the course of the 19th and 20th century. For instance, as the interests between the burgeoning labor class were still colliding with that of the capital owning class, a third party in the form of FDR's administration entered the ring. As a means to combat inflation during wartime, the 1942 Stabilization Act prevented emloyers from raising wages. In response, employers competed for labor by packaging healthcare with employment. Et voilà! This is just a small taste of how growth in labor, capital, and government collided to create this much revered American institution. Society has only continued to scale in complexity.

The result of all this complexity is that physicians are simply doing what they can to wash their hands of it. This is why physician owned and private practices have shrunk and the average practice size has blown up. Why deal with the red tape when you can join a healthcare group with specialized staff to handle it all?

Unfortunately the problem of scale reemerges once more. As more doctors retreat to joining hospital groups, each individual doctor degenerates into a mere employee. Compounding this issue is the impression of a lack of support from fellow doctors and staff. Medicine, once characterized by camaraderie and teamwork, is now plagued by feelings of isolation and competition. Scale and complexity has succeeded in gradually transforming the noble occupation of legendary physcians such as Galen and Paracelsus into "toothpaste cap-screwers" à la Mr. Bucket.

A Rewilding of Medicine?

The romantic view of medicine as portrayed by wandering healers like David Livingstone, roaming the land healing, teaching, and studying, has faded into mythos. In its place is a grim reality—one where more physicians are feeling like souls trapped under the glare of a fluorescent lamp, punching away at a keyboard to avoid litigation.

Amidst all this disillusionment, I have started to come across a class of characters that still want the role of healer, but with none of the stultifying trappings of the white-collar environment. They have started to gaze into a domain lost in the West, choosing to look East and towards mysticism. The rising public awareness of chiropractic, osteopathy, therapy, accupuncture, traditional Chinese medicine, and a host of other traditions that can broadly be tossed into alternative medicine, has shown a shift in the zeitgeist. The bleak trajectory of the modern healthcare system is sowing discontent in all parties, the centre cannot hold.