On being alone in Medicine

Excerpts from the ACP post on Kevin MD about isolation in Medicine: Recent cultural and societal changes have led to markedly increased levels of isolation of our patients with a dwindling size and activity of their social networks. Loneliness – the resulting negative emotional response to their perceived degree of isolation – is growing rapidly. Former Surgeon General Vivek Murthy has called this an “epidemic of loneliness” that is estimated to be nearly as prevalent as obesity, and we are just starting to understand the markedly detrimental effects that these increasing levels of isolation and loneliness are having on both individual and public health outcomes. But what is often not discussed is the isolation and loneliness that physicians experience and the impact this has on our personal and professional lives. It’s increasingly evident that both play a significant and often unacknowledged role in the increasing rates of physician burnout. Alarmingly, recent surveys have shown that up to a quarter of physicians regularly feel isolated in their professional lives, and that this sense of isolation correlates directly with increased rates of burnout at a time when this “moral injury” to medical professionals is already at extremely high levels with associated consequences such as depression and suicide. The mental image that often comes to mind when we think of physician isolation and loneliness is the individual doctor in a small practice, toiling away caring for patients with little support by or connection to other physicians. But isolation and loneliness can affect all doctors, ranging from that independent solo practitioner to specialists and subspecialists in the largest of groups or medical institutions. And it’s difficult to imagine anyone delivering high-quality, compassionate care or experiencing professional fulfillment when feeling alone and alienated from others. It seems that many of the traits that draw us to medicine in the first place and help us succeed as physicians also serve to separate us from each other. People in medicine tend to be highly intelligent, inquisitive, and compassionate with a commitment to others that entails significant personal sacrifice. But we are also extremely driven, competitive, and perfectionistic, even to the point of being somewhat obsessive-compulsive. Thus, we effectively self-select for those things that may make it more difficult for us to connect to others, including our own colleagues. And the nature of our medical training also doesn’t help. Getting into and succeeding in medical school requires an extraordinary amount of solitary work. Our clinical training also consumes a tremendous amount of time that separates us from the social activities and life experiences of our friends and colleagues which can further enhance our social isolation. Plus, medical training necessarily places strength and equipoise at the front and center of what we do. And while this may be essential to navigating the frequent and intense emotions involved in patient care, it doesn’t encourage us to express or manage the way they affect us on a personal, human basis. I firmly believe that nurturing our doctor-to-doctor relationships is key to rebuilding this sense of community and decreasing the isolation so many of us experience. Increasing our connections with like-minded colleagues facing similar professional and life challenges can help fend off feelings of loneliness by knowing that we aren’t alone and help us renew our purpose as physicians. And because building our relationships with other physicians is something tangible we can do right now, coming together can empower us at a time when most of us feel powerless.