November 12, 2015
Dr. Kildare Doesn’t Work Here Anymore: The Perfectionist Paradox, and Other Lessons My Mother Taught Me
By Warren Holleman
Have you heard of Dr. Kildare? When I was a kid, he was the most popular doctor in the world. He was smart, courageous, and handsome, and every week he did something amazing to save the patients of Blair General Hospital.
One week he was a surgeon performing a risky operation. The next he’d be an oncologist curing cancer. And the next he’d discover a new treatment for malaria.
What’s more, he managed to do all this with beautiful nurses fawning all over him. He was whatever you wanted him to be: smart doctor; courageous action hero; dreamy soap opera heart-throb.
Because of Dr. Kildare, our generation grew up viewing doctors as gods, capable of performing superhuman feats. (Okay, the invention of antibiotics also helped, as did the development of various vaccines and improvements in cardiovascular surgery.)
Dr. Kildare wasn’t real. He grew out of the imagination of novelist Max Brand and was portrayed each week on TV by a young and dashing Richard Chamberlain.
Thanks to my mother, however, I grew up hearing stories about a real-life Dr. Kildare. We’ll call him Dr. B. He was something of a legend in the state of North Carolina, where I grew up.
My mother was a nurse anesthetist in the hospitals in Raleigh, and that’s how she became acquainted with Dr. B. When she first met him he was simply B, a Duke University medical student. This was during World War II, and many of the medical school faculty were serving abroad. B was such an outstanding student (according to my mom, “The most talented student ever to attend Duke Medical School”) that they recruited him to serve as a faculty at the same time that he was a student. He taught classes, trained the other students clinically, and did all this while earning his own medical degree. He was a paragon of virtue and the over-achiever’s over-achiever.
In the Raleigh hospitals where the Duke students and surgery residents trained, “B” was the “go to” person for every job that needed to be done. He was smart medically, skilled clinically, and on top of all that was “the nicest person you ever met.” People would say, “How does he manage to do so many things, and to do them so well?” What they didn’t realize is that while he was a superhero on the outside, he was suffering on the inside.
He was too nice a person to say “no,” and the medical school and the hospitals literally worked him to death.
Early one morning the perioperative team entered the OR to discover a bizarre sight. The OR had been trashed and somehow the large, steel OR table had been cut in half! That’s right–it was cut into two pieces, right down the middle.
The hospital where this happened was Dorothea Dix, one of the largest psychiatric hospitals in the United States. So, the first thought was that a group of “inmates” (the term for patients in those days) had gotten hold of a hacksaw and taken turns sawing all night long. Even with a group of men, this would be an incredible feat of passion and strength.
It turned out that all this was the work of one man, and it was not a patient. It was a surgery resident and superstar physician: Dr. B.
They hospitalized him at Butner, North Carolina’s other large psychiatric hospital. A few days later he was found dead in his room. He had hanged himself.
My mother, and all those worked with him, considered Dr. B the best there ever was. He could do any job assigned to him, and do it better than anyone else. The one thing he could not do, however, was just say “no.”
Dr. B’s death had a profound impact on my mother. By nature she was a hard worker. But after Dr. B’s death, she worked on her own terms.
On at least a dozen occasions my mother told me the tragic story of Dr. B. It has proved to be a cautionary tale for me, both in terms of how I view my work and how I counsel others who are feeling overwhelmed in their jobs and in their careers.
From this tragedy my mother taught me a number of lessons. I call them “Perfectionist Paradoxes.”
Paradox #1: If you do things well, you will be asked to do more, and more, and more, until you reach the point where you no longer do things well. Or worse, until the point where you can no longer do anything at all.
Lesson #1: You’ve got to know when to say “no.”
Paradox #2: If a hospital or other organization has an outstanding worker, they will keep going to the well until the well runs dry. And they won’t have that outstanding worker any more.
Lesson #2: Don’t expect your organization or your boss to say “no” for you. They’re not looking out for your long-term well-being. They aren’t even looking out for their organization’s long term well-being. They’re only thinking about the next quarterly report. They only care about what they can get from you now. So, you’ve got to say “no” for yourself.
Paradox #3: The same positive qualities that garner praise from your boss, your coworkers, and your patients can and will undermine your relationships with family and friends, and your own health and well-being. In short, everything on the “life” side of the work-life balance equation. Because if you are conscientious to the point of perfectionism, and you always “stay until the work is done,” eventually you won’t have any family, friends, or a “life” to come home to.
Lesson #3: If you want to be healthy and happy, show your family, your friends, and yourself the same care you show your patients and co-workers.
This all sounds easy, but it isn’t. Most doctors and other health care professionals have the “altruism” gene. They get more satisfaction from helping others than from helping themselves. They get more satisfaction from having healthy patients than from being healthy themselves.
Doctors also have the over-achiever gene. Ask them to perform at a certain level, and they’ll go two notches higher.
Meanwhile, health care organizations eat their young for breakfast. They take the best and the brightest—like Dr. B—and they work them to death. They’ve got a fleet of Maseratis, and they treat them like clunkers. They’re only thinking about the next quarterly report, so they don’t take time to change the oil, check the tires, or lube the moving parts. They simply drive them into the ground.
The only thing most health executives know to do is to ask their doctors and nurses to do more. And more. And more. Have you ever heard of productivity quotas being lowered? Have you ever heard of “new normals” being lower than the old normals?
That’s what killed Dr. B. And that’s what kills 400 US physicians every year—by far the highest suicide rate of any profession. They’re too nice or too over-achieving to just say no. So instead they just off themselves. They just say no to their own futures.
Those who end their own lives are the tip of the iceberg. Underneath the surface is a much larger group that is contemplating a different type of suicide: career suicide. One-fourth of US physicians say they are seriously considering quitting the profession they once loved. Not because they are old enough to retire, but because they are burned out and they don’t enjoy being physicians anymore. Ask them why and they’ll say that medicine has lost its soul.
Being a doctor used to be about patient care and quality of care. Now it’s about quantity of care. “Productivity quotas.” “Targets.” And paperwork–tons of paperwork and wasteful, meaningless CYA tests and documentation. Today’s physicians spend more time typing into their laptops than talking with their patients.
Doctors are smart, so they make great data entry specialists. But this isn’t why they gave up 4 years of their life for medical school and another 3 or 4 for internship and residency training. They want to care for sick and suffering humanity. They don’t want to spend their time checking boxes on computer screens or practicing assembly line medicine. Patients don’t want this either.
As my mother never ceased to remind me, it was insanity that killed Dr. B back in 1950. Not his insanity, and not the insanity of the psychiatric patients, but the insanity of the hospital administrators and the health care system. They took the best young doctor they had and worked him to death. They killed the goose who laid the golden egg! Who in their right mind would do such a thing?
If my mom were around today, she’d say we’re doing it again. Except this time it’s on a much more massive scale. We’ve got a physician suicide epidemic, a physician burnout epidemic, and physicians quitting the profession at unprecedented rates. Something horrible is happening, and it’s time we took notice.
I have a modest proposal. I call it “Take An Administrator To Work Day.” One day per month, hospital and clinic administrators should turn off their I-Phones and Blackberries and spend a day following a doctor or nurse. They’ll see how hard these clinicians work, what factors make their work more effective and satisfying, and what values drive their motivation. Once they’ve earned the respect of their medical and nursing staff, they’ll have opportunities to share their own challenges and frustrations, values and priorities as executives and administrators. Once these walls come down, they’ll begin a truly collaborative effort to build health care organizations that provide excellent care for their patients and satisfying work environments for doctors and nurses–without ignoring the bottom line.