The Struggle for Meaning. (Guest Editorial)

Article excerpt

Maintaining physician commitment is one of the most urgent issues facing hospital administrators and medical educators. Unprecedented numbers of doctors are abandoning practice for administration or taking early retirement.

In a recent study by the Sacramento Medical Society of 464 California doctors, 40% of those interviewed were clinically depressed. The majority said that they would not choose the profession again or want their children to be physicians. Another study found that one in three physicians interviewed was planning to leave medicine sometime in the next 3 years.

This is not just a California problem. Doctors nationwide admit the work has lost meaning for them--an unprecedented crisis in the history of medicine.

Not surprisingly, there's a growing interest among policy makers, educators, and the medical community to find ways to remotivate physicians. Because meaning is the antecedent of commitment, there's a growing interest in enabling physicians to reclaim the meaning of their work.

Our training makes us particularly vulnerable to the loss of meaning. The meaning of our work is found in its human relationships, in the quality of its human dimension. Our training actively encourages a disconnect from the human dimension of ourselves and others.

We may need to learn to pursue meaning the way we pursue expertise and knowledge, recognizing it for the resource it is, and protecting it from the erosion of time. Each of us may need to reconnect with the core purpose and underlying framework of values that have motivated physicians since the beginning. The meaning of medicine is not science but service.

Service is not a technique; it is a relationship, and it is more than a relationship between an expert and a problem. Service is a human relationship. It is the most powerful antidote to cynicism, depression, and burnout, which are so widespread in our profession today.

We are not trained to recognize meaning--yet there is a deep river of meaning that runs beneath our daily work. …