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The battery metaphor is one of the great myths of physician burnout. Let’s look at why this common metaphor is completely incorrect when it comes to describing how energy works in a physician.
Imagine I am the Energizer Bunny walking across the room beating my little bass drum. My battery runs out. What do I do? Here’s a hint: the word starts with an “S.” Right, I stop. Simple, right? When the bunny’s batteries run out, he stops cold. He cannot continue to beat the drum until you recharge or replace his batteries.
When was the last time you asked for a break, walked off the job, or failed to show up in medical school, residency, or fellowship? In your current practice, when do you ever take a sick day or unscheduled time off when you are taking care of patients or on call? If the answer is never, then that’s the first clue that the battery metaphor is completely false. You never stop. You never have stopped, and you never will.
We learn to never stop. It is part of the conditioning of our medical education and the second of healthcare’s two prime directives: never show weakness. This commandment is drilled in deep and certainly plays a role in the excess suicide risk in physicians.
Let’s look at the way energy actually works in a well-trained physician and consider the metaphor of an energy account. An energy account is just like an account at the bank that holds your money, but this one holds your personal energy, your life force. The structure is simple: it has a line indicating full and a line indicating empty. A big red area below the empty line where your energy balance is actually below zero. Remember—the Energizer Bunny stops and falls over at the empty line. He remains motionless until you change his batteries. The bunny can’t go into the negative. But doctors are programmed and work-hardened to tolerate working with energy below zero. We are given no option. Doctors never quit.
We continue to show up and do whatever it takes to provide the best patient care we can, even if our energy is below zero at the time. We learn this in medical school and residency. These educational experiences are pure survival. If you quit at any point, you are out on your ear.
In its fullest expression, the “never show weakness” directive expands into all these “little voice” commandments. It suggests you should never do anything to make anyone think you:
- Haven’t got what it takes
- Are not a team player
- Can’t pull your weight
- Are not made of the right stuff
During the course of your medical education, you will be asked to show up when your energy is well below zero time and time again. It will feel like you have no choice. You must keep going, no matter how exhausted, wounded, and traumatized you are at the time.
If you stop or don’t show up, you will be gone. Disappeared. Ghosted. The little voice in your head will shower you with guilt, shame, and “what if they find out?” worry. You will put those scrubs back on and head back in for another shift if you are not kicked out of the program on the spot.
No one does this to residents and fellows on purpose. When asked, “why do you train residents like this?” the universal reply is, “Because that’s the way I was trained.”
This history of “never show weakness” programming starts in Austria in the 1800s and migrates to the US via Halstead and Osler and the rest. It is a sordid origin story for sure.
The end result is simple: We are trained to ignore our energy levels. We are trained to ignore any desire for self-care as dangerous to our career and something we should never request. We are trained to hide any signs of struggling in case it is interpreted as a sign of weakness.
In a future column, I will talk about the three energy bank accounts. That’s right, each of us holds three of these energy accounts. Each one holds a different energy. Each is filled in a different way. A negative balance in each produces a different symptom of burnout.
