What’s Causing Your Burnout? Altruism Creep

“Altruism” is the “practice of…selfless concern for the well-being of others,” according to the New Oxford American Dictionary (via Google, of course).  The site also notes that in zoology, altruism is a “behavior of an animal that benefits another at its own expense.”  I don’t remember the day in medical school when I learned that my patient’s needs came before mine.  But I remember gradually learning to moderate my liquid intake lest I need to use the restroom during rounds or in the OR.  Ignoring my aching bladder merged into ignoring my grumbling stomach, and eventually, those two sensations just stopped happening.  When I’d overeaten to a BMI of 35 because I couldn’t tell when I was hungry?  Maybe that’s when I started to exemplify the zoologist’s more-aggressive idea of altruism.  

I think it’s still a given that naturally altruistic people find their way into medicine, even though the personal statements of undergraduate applicants to medical school that I read rarely talk about altruistic tendencies anymore.  Still, with the cost of medical education and the reality that medicine is no longer an unquestioningly prestigious profession, I suspect those going into medicine still skew to the right of the bell curve regarding the personality characteristic.  As an ethicist, I’ve often lectured that physicians are obligated to act in a beneficent manner for their patients, and it wouldn’t be much of a leap for me to say that we’re obligated to act in an altruistic manner too.  We’ve used the societal resources of time out of the general workforce and hundreds of thousands of dollars in loans to gain the unique skillset of medicine; the non-physicians we disadvantaged by using those societal resources then come to us for help when they’re in their most vulnerable states (from the risk of mild illness to frank life-and-death situations).  It’s probably not too much to ask that I skip a meal if one of my patients acutely needs me and I’m the only one who can help her.  

As of the writing of this piece, the term “altruism creep” did not come up when I Googled it, so here it is, I’m coining it as my own.  I look forward to it being considered for Merriam-Webster’s Word of the Year 2024.  Altruism creep is when our altruistic tendencies move from being directed at patients to involving all the things that impact our patients when given a big enough lens.  It’s when we rationalize putting the needs of our division or physician group before our own because if our division is doing well, then our division’s patients will do well.  I’ll buy that.  But then the argument goes, “When my institution does well, my patients will do well, so I should put the institution’s needs before mine too.”   A bit more of a stretch, but okay, I’ll buy that too.  The institution’s part of a more extensive hospital system, though, so that should probably come before me too.  Then the argument continues, “Well, when my medical learners do well, then their future patients will do well, and they could be considered an extension of ‘my patients’?”  Zooming out further, if my research goes well, my patients with my condition of interest will do well (even if those patients are spread all over the world and aren’t all directly known to me).  While we’re talking about patients who aren’t directly known to me, if the professional organizations I’m involved in do well…    

We take the appropriately altruistic idea that “my patient should come before me,” and all of a sudden, the altruism creep has led to the needs of the patient, division, institution, hospital system, medical school, GME learners, research undertakings and professional organizations coming before our own.  And then what happens with those we would actually want to put ourselves at a disadvantage for?  Our children?  Partners?  Families, biological and chosen?  God (by whatever name He or She goes by according to your faith)?  With so many needs put before our own, we have nothing left to give to the people we would consciously choose to benefit at our expense.  If we have something left to give to those people, it’s typically not freely given with love but instead doled out from a place of lack with a begrudged obligation.  That isn’t what I want.  I don’t want to resent my patients.  I also don’t want to blame them for how I treat my family and friends.  

So, what’s the fix?  I don’t think it’s putting myself in front of my patients.  My needs should come after theirs.  But I use my altruism judiciously when I’m not directly caring for patients.  Mo (my lovely spouse) comes first when he needs me.  And then my biological and chosen family.  I’m putting my colleagues with “chosen family” because I am well when they are well (the patients doing well is just a serendipitous bonus).  Depending on their acuity, my needs move around in the mix of those things.  Everyone (and everything) else’s needs can come after all of that.  You get to choose where your needs go.  If you want to forgo meals and sleep to conduct your research, do it by all means.  But make those sacrifices for your own benefit so that they build your altruism instead of depleting it.  When not directly caring for patients, prioritizing your own well-being and that of your loved ones will ensure mental and emotional buoyancy when you’re in a situation where you’ve previously become burnt out.  The division can wait.  So can the institution.  And the health system.  And the learners.  And the research.  And the AMA, or whatever your professional organization of choice may be.  They can all wait while you meet your own needs, I promise.    

In the unit, I will still miss meals, lose sleep, and ignore my bladder.  But for now, I go unapologetically off to answer my growling stomach.