Dr Keyes and colleagues recently presented a study of burnout among oncologists in the BCMJ, with symptoms of exhaustion, cynicism, and inefficiency occurring at alarming rates. The authors concluded that “[b]urnout is primarily a system-level problem driven by excess job demands and inadequate resources and support, rather than an individual-level problem triggered by personal limitations and lack of resilience.” While that may be true, it may not be helpful unless the “system-level problem” is more clearly identified. I suspect that the problem is the delusion that medicine is a job, not an adventure.
Burnout is a common problem. A clue to its pathogenesis is in the old saying “All work and no play makes Jack a dull boy.” It may have become more prevalent in the industrial age when more people got jobs and developed a “job mentality.”
“Job mentality” means seeing life as a job—predictable, black and white. It is all about work, control, discipline, conformity, and responsibility. When you get a job, you get your job description. What happens after is your responsibility. If you follow the job description, you get paid; if you don’t, you get fired. It is boring, unimaginative, and stupid.
The opposite is a “game mentality,” seeing life as a game—unpredictable and full of challenges and surprises. This refers to games that are played primarily for fun, like tennis, hockey, or chess, not to devious strategies for taking advantage of others, which are also sometimes referred to as games. Games are about skill, experience, ingenuity, and quick thinking. At the beginning, their outcome is unknown, and it does not depend only on what we do; it depends also on all the other players, chance, luck, and circumstances beyond our control or even knowledge. Games have rules, and fair play is essential. While we don’t have control over the course or the outcome of the game, how we play matters; it can make the difference between winning or losing. It is exciting, adventurous, and fun.
The “job mentality” probably occurs spontaneously in obsessive individuals, driven by the need for control, security, and predictability. It can be contagious and can become part of a toxic organizational culture, a system-level problem. The practice of medicine is replete with unexpected and uncontrollable situations, and it cannot be just a job. It is much more like a game, with an uncertain outcome. Doctors can be seen as professional players, facing formidable opponents—diseases and death. They cannot control the game, but their skills and ingenuity can make the difference between life and death.
This is probably particularly true of oncology, which I would not expect to become a specialty of fun and games anytime soon. However, most oncologists do not experience burnout, so there must be a way around it. Having seen (in psychiatric practice) people suffering from symptoms of burnout regardless of their line of work, if any, I think that burnout is related to the “job mentality” rather than work demands, and the idea that life is a game, not a job, could help to overcome burnout, replacing it with “a sort of ecstasy of curiosity and hope” of earlier years.
—Vaclav Hyrman, MD, FRCPC
This letter was submitted in response to “2020 BC Cancer core medical staff work engagement and burnout survey.”
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2. Popova M. The six steps to cosmic consciousness: A pioneering theory of transcendence by the 19th-century psychiatrist and adventurer Maurice Bucke. The marginalian. Accessed 2 November 2022. www.themarginalian.org/2019/04/11/cosmic-consciousness-maurice-bucke.
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