The Problem with Altruism

Altruism is killing us. Take a second to let that sink in. Truly think about it. Resist your conditioning to refute this claim and try to apply it to your life. Still having trouble? Let me try to explain.

In order to understand the truly destructive force of altruism on medicine, one must first define altruism. This can be difficult to do in the United States as any “good” or “charitable” act will instantly be defined and praised as altruism but this is incorrect. Altruism is the complete devotion to the welfare of others at the expense and disregard of oneself. Try not to gloss over this last part, it’s important. Altruism is not providing gifts to loved ones because you care about them. It is not volunteering at a soup kitchen during your free time as a resume builder. It is not providing care to patients during working business hours or spending an extra ten minutes on the phone getting their medications approved. It is not performing a task in which you receive some benefit whether it be tangible or intangible. Altruism is the sacrifice of the self in devotion to the other. It is eliminating your vacation to see more patients. It is spending time away from family to answer pages and phone calls when you would otherwise be allowed to rest and relax. It is the uplifting of those that do not care about you to the detriment of those that still do. It is the systematic voiding of the individual that somehow ingrained itself so deeply in the field of medicine that many accept it as a core element to the practice of medicine. This is lethal.

Medicine has changed dramatically over the last thirty years. The Norman Rockwell days are gone and Big Business is here to stay. While the M.B.As have adapted rather nicely to the changing landscape, creating large networks of hospitals, clinics, and administrative overlords, the M.Ds have failed to adapt. We strive to care for our patients despite all else. We try and hold true to the teachings of those that came before us and blindly accept that altruism is essential to our craft as it was to our predecessors. The overlords understand this with complete clarity and are more than happy to walk us down the road to Hell with our good intentions. This is why your clinic roster dictates that you see twenty patients in a day, why you are hounded by “documentation specialist” on whether something is “acute or chronic”, why you are expected to complete CMEs and MOCs, why Press-Ganey demands nines or tens, why your salary goes down while your RVU requirement goes up, and why you spend most of your day interacting with a light bulb trying to figure out how it came to this point. And if there is ever an open disagreement about adhering to “the rules”, altruism is invoked by the phrase “for the patient” to stifle further unrest. Because with altruism, if it’s “for the patient” there can be no valid counter-argument that contains the phrase “for the physician”.

And what effect does all of this have? Is anyone truly perplexed that the suicide rate for physicians is over double the general population? Is anyone truly astonished that physicians are burnt out and desperately seeking the sweet release of retirement or career change? You cannot take a group of highly motivated individuals, set an unachievable goal with unrealistic expectations, and expect a large majority to not fall apart. You cannot expect those highly motivated individuals, who start seeing themselves only in the light of failure, to see much benefit in continuing their existence for decades in such a state. I am not condoning their actions but I am not ignorant to their perception of reality. And I cannot stress enough that this constructed reality has been largely fostered by the core value of altruism.

Altruism does not make you a good person. It does not make you a moral or ethical person. It does not help you take care of patients. Whatever benefit altruism may have provided in the past, it has long since passed and now serves as nothing but the anchor around our necks threatening to drown us. We have to accept that we have value, that we matter, and that we are an end unto ourselves. We have to accept that altruism is a burden and not a blessing and excise it from our core. We can still be physicians without it but we may not be physicians for long with it.

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