How Coyote Taught Me a Lesson

The Clinician's Anti-Burnout Manifesto

If you’ve done any reading about healthcare recently, you know that medical culture can lead to burnout. You know that depression and suicides among physicians are rising at alarming rates. You know that work-life balance is practically nonexistent and self-care is almost impossible.


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In the last 10 years, doctors-in-training have been enabled and empowered to limit their work hours, to limit the number of patients they see. Older doctors scoff, saying the younger ones are being babied, that they’ll never be well-trained if they don’t continue at the same grueling pace that physicians have always worked at. The macho culture is long and deep. Recent changes in the system, especially electronic medical records (EMR’s) have exacerbated the crisis by decreasing flexibility and autonomy for all clinicians.

I had to set parts of myself aside when I became a doctor. I set aside reading novels and writing poems and singing Mozart. This experience, it turns out, is not an unusual one. In my convalescence from training, I discovered Rachel Naomi Remen’s books. She wrote about her lives as a physician and as a patient. She taught me that the threads I dropped in medical training could be picked up again and woven into a beautiful tapestry.

Now, I use poetry writing as a way of self-discovery. I’m not able to write in prose about my relationship to the field of medicine. I’m in the realm of the ineffable, and that’s why poetry works so well. Some things can only be said with images and juxtaposition.

I wrote a poem about tricksters, those mythological beings who hold the way open between worlds, between the living and the dead. Until I wrote this poem, I didn’t know I was fascinated by how doctors, especially hospice doctors like me, mediate between life and death. My experience as a breast cancer patient also informed this discovery.

A Brief History of My Life as a Coyote

I’m not cóyotl, the Aztec trickster,
the death decliner who succeeds
through failure and holds the way
open between the worlds.

I come from that original deceiver,
Prometheus the clever, who got caught.
He paid with pain and regeneration.
Disposing of the dead is a necessary

unpleasantness. Raven and I are free
to wheel about the earth and sky.
We create when we destroy.
We are the bringers of fire.

As I showed my poems to others, they were intrigued by the perspectives of one who had been both doctor and patient. Danielle Ofri, MD, in What Doctors Feel: How Emotions Affect the Practice of Medicine, noted that doctors are privileged to interact with their work and with their patients in a way few other professions interact with their clients. Clinicians are entitled to see patients at their most vulnerable, and if we’re skillful, we can use that vulnerability in a therapeutic and healing way.

What we do is sacred at times, but it requires an inordinate amount of support in order not to become burned out, in order not to dehumanize and depersonalize our patients. So what can clinicians do to prevent and treat burnout? The keys to healing include both increasing resiliency and fixing the broken system. The next step is to start from where you are.

  • Begin a pilot program in your practice to make Clinician Wellness a priority.
  • Talk to health system administrators about starting a Clinician Wellness Committee.
    • To improve patient outcomes
    • To improve the patient experience
    • To save money by decreasing physician turnover

Most importantly, set aside time to reconnect with the pieces of yourself you left behind when you went into healthcare.

Question: What piece of yourself did you have to leave behind while you went through medical training? Were you able to pick it up again? You can leave a comment by clicking here.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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