Inside Nevada Medicine

Inside Nevada Medicine | November 6, 2018

News for A Healthy Nevada

Thomas Schwenk

Reflections from the Dean

By Thomas L. Schwenk, M.D.

Is there a link between physician burnout and the modern health care model? University of Nevada, Reno School of Medicine Dean Thomas L. Schwenk, M.D., weighs in. The full version of this article is available in the medical journal JAMA.

In 1948, Life magazine published what has become an iconic and, for many, nostalgic photographic essay depicting the life and work of Dr. Ernest Ceriani, a Colorado general practitioner.

Among the 38 photographs is one of Dr. Ceriani attempting to save the eye of a 2-year-old girl who was kicked by a horse, another of him carrying an 85-year-old man to the operating room to amputate a gangrenous leg and another showing him holding a newly delivered infant.

His expressive face shows anguish, anxiety, uncertainty, exhaustion—and triumph. Nowhere in the article does the word “burnout” appear. 

The photographs of Dr. Ceriani document the seemingly unimaginable stress and loneliness of his job, but there is no evidence of the depersonalization, loss of job satisfaction or inability to care that characterizes the current reports of physician burnout.

On the contrary, Dr. Ceriani's face shows the compassion, dedication and engagement that physicians have traditionally associated with the practice of medicine. He appears to be certain about both the obligations and rewards of his covenant with his community and patients.

Physicians could do little for patients in 1948 compared to modern day, but what they could do provided a deep sense of professional obligation and satisfaction.

Seventy years later, that obligation and satisfaction appear to be in peril, based on a crescendo of reports of the high level of burnout, discouragement and career dissatisfaction experienced by today's physicians. The rates of medical student and resident depression have increased to epidemic levels. A high level of stigma precludes appropriate access to mental health care, and the high risk of suicide among students, residents and physicians casts a pall over the entire profession.

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