Medicine, Burnout, and the Stories Doctors Tell

“Over the course of a career, a physician never stops striving to learn more, to develop greater clinical judgment, to be better,” write Mark Goldstein and Kathy May Tran in the new book Becoming a Better Physician. “But what does it mean to be a better physician? How do we become one?”

To address that question, they asked attending physicians, residents, and medical students to share their own, often very personal, stories of struggling to overcome and learn from challenges they have faced during their time in medicine. The authors cover a wide range of topics, but they share a willingness to be vulnerable about the obstacles they’ve encountered. A surgeon opens up to her colleagues about her treatment for a mental health crisis. A cardiologist reconsiders his approach to end-of-life care while watching his father die of dementia. A resident wonders how to balance her commitment to medicine with her commitment to her partner, who is also a physician.

Goldstein and Tran say that this openness was one of their primary goals when working on the book. “We often think of vulnerability as a show of weakness,” says Tran, an HMS instructor in medicine at Massachusetts General Hospital. “We’re professionals, we keep it together, we hold it tight, all of those things. As a whole, our profession is still like that.”

“We hope this book will help inspire people to be open,” says Goldstein, an HMS associate professor of pediatrics at Mass General.

Goldstein and Tran talked with Harvard Medicine editor Amos Esty about the book. The interview has been edited for length and clarity.

Mark, you write in the preface that you were inspired to work on this book after reading about the prevalence of burnout among residents. How did your interest in burnout lead to this collection of essays?

Mark Goldstein: As a resident [in the 1970s], I never even thought of burnout. Maybe it wasn’t defined at that point, but I never had any of the symptoms. I thought, why don’t we do a book on how to deal with burnout from the perspective of physicians who are dealing with the challenge. None of the essays actually speak directly to burnout, but the book may help people deal with challenges as they progress through their careers, and in that respect may help prevent some of the symptoms of burnout.

Kathy May Tran: There was a time when burnout was not a common word. Now every single physician knows what burnout is. It’s an epidemic. How do we address burnout? A lot of it is just to give ourselves time and space and community. So that’s what this book is all about.

Some of the essays discuss dealing with very personal challenges. Is it any easier now in medicine to be open and vulnerable in that sort of way than it was in the past?

Goldstein: I think it is becoming easier now. I wrote about the suicide of my nephew, which was a topic that I hadn’t discussed at all after it happened more than thirty years ago. I felt I couldn’t talk about it. This is the first time I wrote about it, and I felt liberated by the opportunity. I felt better talking and writing about it. I hope my essay will help readers understand the issues that people who have a history of suicide in the family can encounter, and maybe they can help identify others who could be at risk for suicide.

Tran: You’ve touched on something that’s really important. We’re thinking about burnout and community, but one of the most important missions of the book is to make it easier for people to share their own stories. We’re grateful to the writers for being willing to share some of these really hard stories about getting fired or having addictions, for example. These are not things that we typically celebrate, but we’ve given these essayists a safe space to make it acceptable to share.

We hope that this will be a small part of a chain reaction in which other people will think it’s OK to share their stories. We hope that it builds a community of understanding, of empathy, of acceptance, and ultimately of healing and resilience. That’s the main goal of the book.

What is it about storytelling that you think is important for people in medicine?

Tran: I really see our role as storytellers. As physicians, we have a really honored position in that our patients let us into their lives. We’re gathering their story when we get the history of present illness and when we interview patients and then when we try to figure out the story, what’s going on with diagnostics and therapeutics. Storytelling is what we do.

But we as physicians have stories ourselves. We’re really good at taking care of other people. We are much less comfortable taking care of ourselves, thinking about ourselves, and understanding our own story, let alone telling our own story.

Physicians and others who work in health care are obviously a key audience for the book. You’ve talked a bit about what you’re hoping they will take away from this. Is there anything in particular you would like people who are not clinicians to take away from the book?

Goldstein: I would love to see people read this book before they even enter medicine. I wish I had read this before I applied to medical school. It wouldn’t have changed my career, but it would at least have given me some sense of what others who are in various stages of their career — students, residents, attendings — are going through, how they face these issues. For example, having a patient complain about communication — how do you deal with that? I would’ve loved that.

Tran: I was going to say the same thing. I wish I had had this book before I went into the field. Even now, I wish that my family, friends, and colleagues who are not in medicine would read it too. This is really a book for anyone interested in doctoring. It gives a sense of what it means to be a doctor and what it takes to be a doctor, how much we gain from doctoring, but also how much we give to doctoring.

Being a doctor is a part of our identity. It’s not a job, it’s not a career. It’s who we are. I hope that for nondoctors, for nonclinicians, this book will shed light on that. It’s not all of these stereotypes that people think about when they think about doctors. Doctors don’t always make the right decisions. Doctors are not always celebrated by the communities around them. Doctors struggle a lot. Doctors face obstacles. Doctors face failures. And this book embraces all of that. We’re humans just trying to do the best we can.

Illustration: Diana Bolton