Where’s the Canary in the Healthcare Coal Mine?

Coal mining is a profoundly dangerous profession. Before there were federally mandated safety measures, these early pioneers were aware of the risks of their profession especially from the accumulation of potentially explosive gases that could entomb miners miles underground. The tradition of using canaries goes back to 1911 to detect carbon monoxide and other toxic gases before they would injure in these workers.


The canaries are more sensitive to the colorless and odorless carbon monoxide and other poisonous gases than humans. If the bird became ill or died, that gave miners a warning to quickly evacuate. These little birds would indicate if something were radically wrong in the workplace of the miners. In other words, the death of the canary was a barometer, a signal of an impending disaster.


But we do not need canaries to tell us what is radically wrong in the current medical care delivery system. There it was: the headline in the New York Times (September 29, 2022):


Physician Burnout Has Reached Distressing Levels, New Research Finds


We patients need to take note. The pandemic of provider burnout had reached an alarming level.


The article reports on a study in the Mayo Clinic Proceedings, an iconic, well-respected peer-reviewed journal, that 63% of physicians surveyed documented at least one symptom of burnout at the end of 2021 (compare with 38% in 2020 at the start of the pandemic). Dr. Tait Shanafelt from Stanford University is a major clinician in this area, and he sounded the alarm, “It just is so stark how dramatically the scores have increased over the past 12 months.”


The study found particularly alarming burnout among ER docs, pediatricians, family practice docs, and especially among female physicians.


But let us step back for a minute and analyze the numbers. What exactly are we talking about?


There is general agreement that burnout reflects a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. So why is this a big deal?


Well, it’s a big deal because burnout is symbolic of another kind of “pandemic,” and the results can be catastrophic. Burnout may erode professionalism, influence quality of care, increase risk of medical errors, promote early retirement, and account for more patient dissatisfaction.


This condition also affects the providers in terms of broken relationships, chemical dependency, and the risk of suicide. The suicide of a beloved chair of emergency medicine, Dr. Lorna Breen in New York City, achieved national headlines during the peak of the COVID pandemic.


Dr. Breen had been the consummate overachiever, one who directed her life with confidence. She was described as gifted, confident, clever—and unflappable. When she called her sister, it became clear that she was nearly catatonic and unable to answer simple questions. She developed COVID; she was miserable; she was destroyed by the suffering and the escalating number of patients she could not save.


Although COVID was obviously the catalyst for the explosive increase in physician burnout, this phenomenon was present long before the pandemic started. Physicians were already experiencing symptoms of burnout fueled by myriad factors including a burdensome and time-consuming electronic health record, and an explosion of medical information.


Several decades ago, the body of medical knowledge doubled every five to ten years. Now it is doubling about every 72 days. Moreover, mergers, and acquisitions have relegated physicians to the role of employees, and their autonomy and independence are profoundly jeopardized. The stage was set for the perfect storm.


As COVID loomed, the medical care system was hardly immune to seismic changes of short staffing, attitudes of anti-science, and incivility. Personal protective equipment such as appropriate masks were in perilously inadequate supply. And providers struggled with a fundamental moral crisis. Patients who were immunized and took other preventive measures did far better than those who were antivaxxers, and this presented those front-line nurses and doctors with a fundamental moral conflict. Moreover, in many hospital settings, there was a lack of trust between patients, families, and the provider community largely fueled by political divisiveness.


The healthcare delivery system was also hardly isolated from sweeping changes in society including social justice issues, violence related to guns, economic chaos, and the geopolitical unrest in Eastern Europe. Shall we throw in the kitchen sink too?


What about my doctor?


Stepping aside from the facts and figures and the numbers and the statistics, how do we as healthcare consumers know if our provider may be in the midst of burnout? There is no proven formula or recipe, but there are some indicators we should not dismiss.


  • Your doctor seems detached, indifferent, withdrawn in speech and demeanor. The joy is gone. And providers are rethinking why they went into medicine in the first place.

  • The nurse seems hassled, distracted, with clipped speech and little genuine interest in you as the patient. Just going through the motions. We’ve all been there.

We need to trust our “gut feeling.” You are the canary in the coal mine.


If you have had a long-term relationship with the provider, a question of concern would be very appropriate: “Doc, you do not seem yourself today. It seems like you are someplace else. I feel like I am interrupting you.”


As patients we have a right to deserve compassionate, empathetic care, and a caring presence. If these are absent or have been seriously diluted, we owe it to ourselves and our families to move on to get the care that we need and deserve. After all, no one has a greater stake in your health and well-being than you.


Photo courtesy Wix Media.


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