Wounded to Heal: Provider burnout and its treatment through the eyes of faith
“The doctor is effective only when he himself is affected, only the wounded physician heals.” – Carl Jung
Carl Jung’s quote about the capacity to heal highlights the archetype of the wounded healer, which has significant implications for discussions about provider burnout and empathy fatigue. There are countless articles written with advice about how to recognize and treat burnout, many of them with healthy recommendations for work/life balance, taking adequate rest and vacation and reducing administrative burdens; but I would argue do not address two crucial underlying truths: we are meant to be wounded through our profession and we are also the ones in need of a physician.
The Wounded Healer has been a presence throughout history, deriving in part from Greek mythology, where the physician-healer Chiron was incurably wounded yet dedicated his life to the healing arts. For his sacrifice, Zeus granted him a place among the stars. Asclepius, whose staff and snake have come to represent medicine in many healthcare logos, was similar. His birth, being pulled from the body of his recently murdered mother as she burned on a funeral pyre, and abandonment by his father, Apollo, into the hands of Chiron meant his medical knowledge was born in deep pain.
Apollo entrusts his son Asclepius to the centaur Chiron by Christopher Unterberger, 18th Century. Oil on canvas.
Not only is our work often born in great suffering, but we suffer as a result of our work. In my graduate schooling, I set out to study the concept of burnout as it relates to empathy (our ability to step into the suffering of others). I conducted a cross-sectional survey of physician assistant students in their pre-first, first (didactic), and second (clinical) year using a validated tool called the Jefferson Scale of Empathy. The surprising result of this research was that students in the pre-first and first years remained statistically stable in their rates of empathy, whereas those who entered clinical practice, even for just one year, experienced statistically significant declines in their empathy (see Figure 1). This reveals a crucial aspect of the burnout and empathy fatigue process: it isn’t simply overwork or administrative burdens that lead to this state. The didactic year of PA school was the hardest year of my time in schooling, including doctoral work. Often, two exams a week, practicals, daily lectures, and countless hours studying stressed us to our limit. Yet, by the empathy scale, our empathy remained consistent, and even increased, though not with statistical significance. It was only when we were sent into the clinic to suffer alongside patients that our empathy began to wane.
Figure 1. Physician Assistant student empathy through graduate education.
Was there something wrong with our program? Did we encounter terrible preceptors or longer hours in the clinic than we had during our first year? Not at all. What all providers come to realize is that this wounding is medicine. The unsympathetic provider doesn’t just provide inadequate or subpar medicine; they don’t deliver medicine at all. As Jung says, “Only the wounded physician heals.”
A break, vacation, meditation, or Prozac may provide some relief, but those of us who have taken up the call to practice medicine know we must reenter the war. Our patients are soldiers on the battlefield of life, and when we rush to their side, we face the barrage of bullets that caused them to need the very healing that we are offering.
It’s when we feel the sting of suffering on behalf of another that we are reminded of the second crucial fact. We are in need of a physician ourselves. On one level, we need another like ourselves, a healer, to come alongside us and lift us up when we have fallen, but we also need someone greater than ourselves, someone who brings ultimate healing; we need The Great Physician.
I’ve written elsewhere on the shortcomings of our symbols of healing. Chiron, despite all his medical knowledge, was unable to cure his own condition. Asclepius refused to treat many patients, including pregnant patients, slaves, and those he deemed incurable, preferring instead to advocate for a program of eugenics to rid humans of disease. Only Christ exists as the true Wounded Healer, “But he was wounded for our transgressions, he was bruised for our iniquities: the chastisement of our peace was upon him; and with his stripes we are healed” (Isaiah 54:5). Yet, in our fallenness, we fail to recognize this. We point to him and say “physician heal yourself” (Luke 4:23), “come down from the cross” if you can (Mark 15:29-30), and “he saves others but he can’t save himself” (Mark 15:31). All this while he comes as the only one not in need of healing and wounded to heal.
It is an honorable and noble thing to come alongside a fellow provider to offer healing and support, and we approximate our savior by doing this. He condescended to us that we might be given an example of how to serve one another (John 13:15). Yet, we cannot save each other. We need the savior.
The secular medical world responds, “So you are saying the provider who is so stressed by their work that at times they despair of life just needs Jesus?” Indeed. All of the other good things we recommend: rest, vacation, work/life balance, self-care, everything flows from the heart of the Savior towards his people, specifically, and to the world as common grace. Yes, take a break. Yes, take a vacation. Yes, advocate to the administrators to reduce the number of patients seen, but know these efforts do not solve the problem because, as I’ve argued above, the wounding is “baked-in”. It’s in the ethos of the profession, and until we understand that, we will kick against the goads. We are wounded to heal.
There are days when I shut my laptop after a day of work, and I think, “Can I keep doing this?” In those moments, I don’t need Jamaica, I need Jesus. It’s only when I look to him and see the honored position I take as someone who is wounded on behalf of others, imitating him in his ultimate work of healing, that I am able to press on another day.
As a final note of encouragement, there is strength in your wounding. Long before the philosopher Nietzsche said, “Was mich nicht umbringt, macht mich starker” (what doesn’t kill you makes you stronger), God exhorted us through Paul “When I am weak, then I am strong” (2 Corinthians 12:10). Your hardest days, deepest woundings, and darkest despair are working for you a weight of glory not worthy to compare with our present sufferings (2 Corinthians 4:17). All of it comes to us from the hand of the one who knows our position better than any other and waits to commend us “well done, good and faithful servant” (Matthew 25:21).
