Dr. Raymond Barfield discusses physician burn-out

(upbeat techno music) – You have spoken a lot about physicians and the mental health of
physicians and the practice. And you have said, you have cited a figure that says that 50% of doctor’s report have significant amount of
burnout in their profession. Which means that they’re not
happy with their profession, with their jobs. And one of the things that you have said is that perhaps it’s because of the fact that many physicians
don’t feel that connection with their patients or that
perhaps they don’t have the time or the agency to process
the things that they see, that they are in need
of telling or developing their own story about their work in a place of illness and suffering. Is that how you see that issue of burnout? – I think burnout is a
placeholder for something that is important and
relevant to the discussion of present and suffering and injuries. I don’t know what exactly burnout is. I think it’s a word that needs… It’s not self evident. It needs to be populated. And it needs to be populated carefully because whatever it’s pointing to, is a complicated problem, it’s a problem that a lot of times in
theology medicine and culture They are talking about some
of the difficult problems that group addresses the
kind of wicked problem. It’s borrow and steal it
from the business community. It’s a wicked problem when
it’s so hard that you have to begin to try to solve it and fail and then figure out
why it failed, in order to even understand the
problem well enough to come up with a second iteration of … Okay, well now I understand it better, now we can come up with a better response. It’s that deep of a problem. I think that there has been
some changes in medicine that have moved us toward
a concept of efficiency. That is much more fitting on if the model of the body as a machine. End of story. Full stop, were true. If the body as a machine, full stop, then I think that the kind of
efficiencies that corporations tried to build into systems,
make a lot of sense. But if at the Ford factory, for example, all of a sudden, all the
cars in the factory line became sentient and capable of suffering. So that every time the machine… It screamed, there would
be a lot of concern in the Ford factory. (crowd laughs) That certain unexpected needs on the part of these sentient cars were
not currently being met. It would be newsworthy
and there would be protest that evolve and things
would need to change. And so I think that when
we talk about burnout. What we’re talking about
is why are these people that we’ve asked to… We’ve given them intimate
access to our stories, to our bodies, to things
that might shame us, to our blemishes, to our
inability to function in important ways and
maybe an inability to see. Oh, now I can’t drive. Maybe impotent, something
that’s deeply related to our identity. Maybe breast cancer and
losing something important about my body that changes
fundamentally my identity. But I can’t talk about it. I’m not gonna go to church
and say you know my breast is going to get cut off
and it really bothers me cause my breasts are important to me. How do you… Where do you talk about that? But you know what, it’s true. Augustan knew it was true. Augustan pointed to small things, to point out how important they were. He said in the middle of the
city of God, it’s a book. It’s like that… It get to a place where he says, “You don’t think small things matter. “I’ll tell you what, shave off one eyebrow (crowd laughs) “and then walk around and
see how your day goes. “See if you think about
anything other than the absence of your eyebrow”, right? It’s just a little bit, does nothing. This little bit of hair is a wist. Nothing, nothing. So, burnout is if we’re
placed in positions where there are these delicate but vital forms of
fragility, vulnerability. Please, from people to
be seen and not ashamed. To be seen in reality, so that they can take
their mask off and do it, trusting that you are
worthy of this trust, right? So if we put people in a
place where that’s the gift that me as a patient that I’m
giving to you as my doctor, but you’re placed in
a position to function with maximum efficiency that’s more appropriate to a machine, then you’re placing a genuine crisis. If you’re trained to do nothing but take care of the machine, but my thing I’m doing is showing you, Dr. Jeff, like, here’s
my fragility, right?. And you were like, whoa, we
don’t do fragility around here. Really, you don’t do
fragility around here. Guess what, bird, you’re the only one who has legal permission to bear witness to certain kinds of fragility, right?. So you better know something
about what to do with it. And so we began to feel
this, like disconnect between the role that were
asked by patients to play, the role that patients wants to plays, very often, I think, the
role that we envisioned for ourselves and then we
find ourselves 10 years down the training in an institution that has a completely
different set of priorities, that fit a completely
different model of the world, a machine, mechanical
kind of view of the world, than at the body. And the skills that we’ve
been given are the skills that were decided on
by a series of schools that have bought into that kind of model. And then there we are, we close the door, and all of a sudden, this
person is asking for something that we are utterly unprepared for. And so I think that there
are things like that, I wouldn’t reduce the problem
of burnout or moral injury or whatever you want to
call it, to just that. That, to me, is the flavor of the crisis. And the reason I say it’s
irrelevant to this issue of suffering and presence is
that I think it’s these kinds of things that break my radar so that I can’t pick up
the signals in the room. It may be that, and I learned
this from social workers, nurses and chasmus,
whose radars are working. And who apparently have
felt or sensed or seen or heard something in the
room that I just missed. And when they get to know me, they know that I invite critique. And that I want to know
if I’ve missed something. And many of them take me up on that offer. And so I’ve been on the
receiving end of quite a bit of criticism, but it’s
been so helpful, painful but helpful, and it’s
like it did 10 years ago, lead me to a different kind of question, how can I repair my radar?
How can I acquire skills that I don’t yet have
so that I can respond when I pick something up? I believe that if we address
more of those kinds of things, that we would be at least
on our way to addressing this issue of burnout,
but I think we would also be on our way to addressing
the kinds of questions this conference is asking. So how do you walk into a room
where there’s great suffering and established presence?. How do you find the courage to remain when you have no words to say?. No idea how to fix the thing and where your first inclination until you gain a maturity
in this, is to leave because it’s uncomfortable. I think that both of those things will be answered by side by side. (upbeat techno music)

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