Physician and Nurse Burn-Out – Part XVI – Nursing Turn-Over

“If they believe they can sweet-talk us with just a few bucks—they got it coming.”

Norma X. is a very qualified and smart Critical Care nurse that has been seriously considering retiring from the profession after more than twenty years off service due to the physical and mental exhaustion after two long years of pandemic. Management is desperate to keep her, not only to continue taking care of seriously ill patients, but also to guide the young nurses that seem to be entering the career with less knowledge and experience than before to meet the increasing demand. She scoffs at the array of perks they try to entice her with to sign another contract. She confessed to us that she is only dreaming of her retirement in easy Key West with her hubby and two dogs (their grandchildren can visit them but only once a year)

All health care providers know that nursing personnel is the main pillar of a modern Health Care Delivery system, usually more important than the medical corps itself. Most public and private delivery organizations have the strategic imperative of retaining them, and what is more important, to keep them happy in their careers. After the 2008 recession, rates of  unemployment rose in all the economy sectors and some experienced nurses delayed their retirement to account for an increased living cost. At that time retention of nursing personnel was not a problem and institutions were not hiring the new graduates. Now the tide has turned as the new clinical demands of a protracted COVID-19 pandemic has strained the human resources of many hospitals and clinics in the USA. Newly graduated nurses are in high demand but that brings new operational challenges to policymakers and administrators.

Training qualified nursing personnel is very expensive, approximately amounting to double their yearly salaries; institutions cannot afford to have a normal 2-3% staff turnover without suffering the consequences. Their four main reasons to quit are:

  1. Excessive patient workload, worsened during the pandemic,
  2. No scheduling flexibility to accommodate the family life obligations.
  3. Sub-par financial compensation that stresses their family budgets.
  4. Professional frustration due to the lack of continuing education possibilities to advance their careers inside their institutions.

As the exodus rises, the remining nurses inherit heavier workloads, which in turn entices them to follow their colleagues to the exit doors, and so on. A vicious circle. Moreover now large institutions, desperate to cover their many vacancies, are hiring increasingly younger graduates, who have the highest attrition rate in the first year. To meet the market increased demand for nurses, their licensing requirements have been streamlined and the novel nurses get their badges much earlier than before. The rookies are increasingly being deployed in highly critical areas where there is a lot of stress and require clinical knowledge and expertise that they do not yet possess.

Note. This World War II Navy recruiting poster was taken from Wikimedia Commons.

These novel nurses must be paired with an experienced nurse providing emotional support and clinical expertise to the newly entrants; checking on them in a regular basis and simply by “being there for them” will boost the morale of young recruits. Now these “support role” has been systematically developed into protocols by the American Associates of Colleges of Nursing that established the Vizient/AACN Nurse Residency Program to support the entry-level nurses as they transition into clinical practice. The evidence-based curriculum focuses on three critical areas:

a) Leadership Skills and Pathways.

b) Patients’ Good Outcomes.

c) Continuous Professional Development.

A not-so-well-kept-secret-of-the-caring-professions is the mendacious role played by some old-timers in the nursing profession that systematically harass and demean the rookies, perhaps trying to make them pay for “sins” committed by physicians, in a classical example of what Sigmund Freud described as a displacement mechanism that we fully discuss in our new book Emotional Frustration – the Hushed Plague. The horizontal abuse of colleagues must stop, and senior staff must be vigilant. Because most of these recent nursing graduates are young ladies a little bit too shy for their own good, who prefer to quit their jobs in silence rather than complain. The formal mechanisms to report labor abuse must be operational and easy to access.

Of course the salaries and perks of Nursing personnel must be raised to make them closer to what physicians actually earn in the public and private institutions. But more importantly the feminization of the Health Care workforce has given new impetus to the longstanding demand of nurses that management should consider the family life of their employees by offering more flexible scheduling and coverage. Promoting a healthy, inclusive, respectful environment will certainly impress nurses.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.


Physician and Nurse Burn-out – Part XV Group Therapy

-“We are watching so much horror —and we must take it with a stiff upper lip?”

That complaint from one of our medical colleagues recently summarizes the sorry spiritual state of most of the health care practitioners that have been taking care of very sick patients in all these interminable months of the COVID 19-pandemic. Most of us are physically exhausted and emotionally depleted with no relief in sight. There are manifold signs that as the non-stop clinical burden takes a heavy tool on us, many are experiencing serious signs of stress overload and emotional/ mental surmenage.

In a great paper, Dr. Clare Gerada stated that the same personality traits that allow us physicians to bear so many clinical responsibilities in grueling work schedules are the same ones that might predispose us to sickness and prevent us from seeking specialized help early on in the process. According to Gwen Adshead, we are:

  1. Perfectionists
  2. Narcissists
  3. Compulsives
  4. Denigrators of Vulnerability
  5. Martyrs

Most physicians can easily recognize a few or all of these traits in our personalities because we have a good esprit de corps that makes us feel “different from others.” We all have a deep-rooted sense of “being special” and our professional identity gets consolidated as we plow through the study-intensive Medical School and the ridiculously demanding work schedules of Post-Graduate Training. It is our armor for survival. In fact all our personal lives get subsumed by the demands of clinical work and the hospital demands replace the ones from family and home; akin to a secret cult we create our own jargon and a new way to see things: the medical gaze.

When we physicians get sick there are external and internal defense mechanisms that usually make us hide the reality and waste precious time to get the needed professional help. You got sick? How come? It can’t be. We , doctors, do not get sick. The others do… Moreover, in all these long months of  pandemic horror and the associated Social Isolation prodded us to necessarily acquire two tricky psychological defense mechanisms: depersonalization and denial of feelings. In order for us to slog through our tasks and still remain operational, we had to “take distance” from the encroaching Death and Despair. The farther apart we moved form the daily horror, the more we duped ourselves into believing that we were somehow “invincible”, which is usually a hallmark of the younger Docs. As we are now used to work in clinical groups with different specialties,  we tend to abhor the idea of “being sick ourselves” as it is like a treason to our healer’s oath to always be ready for big service.  Moreover, if we get sick, someone else will have to pick up the slack with our patients.

Note. Considering that our two references are British authors, we decided to put as featured image this Royal Navy World War II recruiting poster, which was taken from Wikimedia Commons.

Humans need to live in groups and feel a “sense of belonging” to feel fine. For us physicians the primary belonging is to our clinical work and when it is destroyed, then we need a secondary group, preferably with the company of our peers. In another great article, Dr. Gerada discusses the NHS Practitioner Health Program,  which is a very confidential service to discuss and treat the Mental Health disorders of physicians. Finally freed from their masks of empathy, health care practitioners can “spill the beans” in the comforting company of their peers sharing their angst. In the 2008 sample she studied at the time she found that three fourth of cases had Depression/ Anxiety and only a fourth had Substance Abuse problems. She claimed that this represented only a stopover solution and that eventually most of them responded to psychological therapies and later joined other non-medical groups. As the exclusivity of physicians’ privileges have been steadily contested by a more egalitarian approach to health delivery services, there are hardly any physicians’ meeting points like reading and discussion lounges, lunch spaces, etc. We lost the intimate contact with our peers.

She wrote: “it is important that, as health professionals, we engage as patients, participants, and as providers in group work. Part of any strategy to improve retention of doctors must involve creating spaces for doctors to reflect together, support each other and share techniques for remaining mentally healthy.”

In order to get some well-deserved relief from the stress and angst we suffer now, we. physicians, must first take the step of getting rid of our guild-identifying lab coats. Below them, we are simple human beings, notwithstanding all our knowledge. In the re-assuring company of colleagues, including nurses, and devoid of our silly theatrics pour la gallery, we can finally begin to heal.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

Physician and Nurse Burn-out. Part XIV – Wearing Two Hats

What do physicians and nurses have in common with Canadian truckers? Plenty.

Rous Dhouhat, Opinion writer of The New York Times, wrote an article where he explained how the much-vaunted meritocratic system of our modern societies has degenerated into a binary caste system dividing us in two separate camps. He wrote: “A great and mostly unknown prophet of our times Michael Young, whose book ‘The Rise of the Meritocracy’, published back in 1958, both coined the term in its title and predicted, in its fictional vision of the 21st century, meritocracy’s unhappy destination: not the severe rue of the deserving and talented, but a society where a ruling class selected for intelligence but defined by arrogance and insularity faces a railing populism where grievances shift but whose anger at the new class order is constant.”

Michael Dunlop Young, British sociologist and politician, coined the term meritocracy by fusing the Lain verb “mereor” or “demereor”, which means “to deserve”, and the Greek suffix “cracy”. He was in fact ridiculing a planned transformation of the Educational System in the United Kingdom, which destroyed the traditionally egalitarian role of  their Public System by creating a schism in society at large. He rightly foretold that intelligence and merit would become the central pillars of the new British society, replacing the traditional class warfare envisioned by Karl Marx. He predicted that on one hand, there would be a merited, powerful intellectual mandarinate and on the other hand a less merited, alienated lumpen proletariat. His manuscript was roundly rejected by 11 publishers until Thames and Hudson agreed to publish it.

After this terrible pandemic, there has been a stark differentiation between those that gawk at the symbols in a screen all day long and those that use their hands to work. Young wrote his book before the advent of the computer and could not have fathomed the extent of his visionary conception of the world we are now living. Watching the rebellious truckers’ protests in Canada, N.S. Lyons alerted about the clash between those that work by manipulating data and those that have daily contact with the physical world. He divided workers into The Virtuals and The Practicals.

Note. This image of a First World War Navy recruiting poster was taken from Wikimedia Commons.

What does all the above have to do with our daily tasks as physicians and nurses? Fortunately, most of us are working in a hybrid environment where we have daily physical contact with our patients with their raw realities but at the same time, we sit for hours on end in front of computer screens to gawk at the Electronic Medical Records (EMR) to decide on virtual pathways that only exist in the digital world. As a result we receive the input of both worlds and share their unique challenges.

In this challenging Post-Pandemic World, physicians and nurses must daily juggle the obligations of wearing two hats. The Mandarin’s button spheres that separates us from commoners. And the Proletariat’s flat cloth cap that gets us closer to them.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.



Physician and Nurse Burn-out . Part XIII  – Split Second Decisions.

Where lies the oversized professional and social power of, us, physicians?

Financial recourses? No. Political power? No. Social Influencing? No.

It resides in the fact that we can make split-second Life or Death decisions.

When we were doing our internship in a large New York City hospital, we had to do a 24 hours-On Call stint every three days, which meant that we spent a large amount of time in the facility, working side by side with dozens of residents from across all the specialties and training levels. When our duty was done, we liked to meet in the large On Call room to have a snack and watch TV together. Yes, those were the times when we all participated in the same viewing. No nasty arguments.

One day I showed up with a tuna sandwich and saw a black and white TV program where there was a smiling fat bus driver fighting with his blonde wife in their living room.

-“Mario,” Steve, a fellow intern said to me, “have you ever watched this program?”

-“No, “ I replied. “What is it?”

-“The Honeymooners. Sit down. You’ll love it, buddy.”

From that moment on we got hooked on the funny episodes of a sitcom featuring ralph and his wife Alice, which had made its debut in 1951, before we were born. It was comforting to share a meal and distraction with other Young Turks…Until.

-“CODE BLEU IN THE ICU,” the loudspeakers blared. And all our beepers (small digital devices that we had to carry with us, even to the bathroom) started ringing.

We all dropped whatever we had in our hands and stampeded out to the exit door. There was no time to wait for the elevators , so we ran up the stairs to the third floor where the ICU was located. Usually there were other interns and residents already there, working on the Cardio-Pulmonary Resuscitation of the compromised patient.

However, we all just stood in silence, waiting for any instructions or orders. Just like in the Military. Once the loudspeakers called the Code off (either because the patient had survived or , much more commonly, because he/she had died) we all left.

This drill was repeated once or twice every time we were On Call. Again. And again…Until one day what we , the rookies, secretly dreaded did happen….When we arrived at the ICU or the wardroom where the Code was called for, we were met by the Head Nurse, who summarily told us: “Get ready. The nurse started. Go.”

We were ushered into the room where the nurse was pumping oxygen into the patient’s mouth with an Ambou bag; another one was trying to get an intravenous line. Often the anesthesiologist On Call was there, getting ready to intubate the patient. But on that occasion, he was busy in an emergency surgery in the operating room; we, the interns, or residents, had to intubate the patient. No delay.

Note. This image of a World War II poster for Nurse recruitment  in the Navy was taken from

The first time a nurse handed us the intubation kit, we almost fainted to the floor. We managed to grab it and we went behind the patient’s back. We opened his mouth; we slid the apparatus down the left side of his mouth and then pulled our hard upwards. The first orifice that you see belongs to the  Digestive tract. You have to pull the handle up to see another orifice, exactly in front of the other one, belonging to the Respiratory tract. We slid the previously lubricated tube in a diagonally upwards direction. We asked the nurse to check the positioning of the tube. “Good. Doctor.”

Before we came to the USA to do our Post Graduate training, we worked for two years at two small countryside hospitals in Buenos Aires province, where we usually covered all the Emergencies for the whole weekend, assisted by the attending physicians. They often responded but sometimes, they were MIA; it usually occurred when the philandering docs put the excuse of “I am On Call” to their wives in order to meet their lovers  in a love shack by the Riverside. We kept mum.

One night we had just taken the On Call service in the public hospital in San Miguel del Monte and their top clinician stopped by at dinnertime to duly warn me:

-“Hey, my new sweetheart wants to see a play in La Plata, and we are leaving now.”

-“La Plata?” we shot back. “”That is almost one hour away in the fastest car!”

-“Don’t worry, you are doing fine here with us. When we’re back, I’ll stop by…”

A little anxious, we nonetheless made the final rounds and went to bed at midnight.

At 2 AM, the Chief Nurse barged into our On Call room and turned the lights on.

-“Doctor, Mrs. X came to the ER…She’s due in these days…Hurry up.”

Of course she was referring to a term pregnancy attended by the Lothario.

The nurse escorted us to the Obstetrics section of the ER where a young woman was already in the exam chair with her legs wide open. Next to her stood the anesthesiologist who was slowly dripping some pain medication into her spine and the midwife, ready to take care of the newborn.


-“Hurry Doctor, the baby wants to come out…Here, give your hand and I’ll show you, ” she said before taking over the motricity of our two Upper Extremities to go through the motions. She handed us the cutting knife and took a big piece of the patient’s vulva. “Cut here, “ she said showing us how to do an Episiotomy.

-“Push, push,” the midwife ordered. Exhausted, the patient made a last muscular effort. And in a few seconds, we could grab the amniotic fluid- covered head of a boy. With her help, we could deliver a healthy boy and we gave him to the mother so she could feel him; the midwife cleared his nostrils and enveloped him with a blanket.

-“What’s his name?” I asked the mother.

-“Federico,” she replied.

Smiling with pride, we went back to our On Call room to write a letter to our dear grandmother Yolanda in Montevideo, to tell her the whole story. She was henceforth very proud.

These clinical events marked by critical split-second decisions can only be handled by highly educated and trained physicians and nurses. It is our earned prerogative. It is the basis of our professional reputation and social standing. It is the largest feather on our cap. WE EARNED IT.

No bean counter that seems to enjoy harassing us with their micromanagement BS, will ever be able to match us. Let us continue to study and train intensively to continue being quasi-indispensable.

We love our Medical Profession and will practice it until the end of our lives.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.






Physician and Nurse Burn-out. Part XII – Losing Oneself

“The greatest hazard of all, losing oneself, can occur very quickly in the world, as if it were nothing at all.” Søren Kierkegaard

Søren Aabye Kierkegaard was born on May 5th, 1813, and passed away on November 11, 1855, in Denmark, and has been considered as the Father of Existentialism. In a great Wikipedia article they defined him as: “he wrote critical texts on organized religion, Christendom, Morality, Ethics, Psychology and the Philosophy of Religion, displaying a fondness for metaphor, irony and parables.” In his times there was a big emphasis on the Cartesian evaluation of Religion, highlighting its rational and communal aspects to better Mankind in general. But Kierkegaard was interested in a much smaller dimension, the one that traverses the daily lives of each and every one of us making choices that may lead to significant future changes of the same.

Last week we discussed in earnest how it was so critically important for Health Care practitioners of all genders to choose very wisely their life companion and partner. We have borne his protracted SARS-CoV-2 pandemic and the calamitous effects of so many months of Social Distancing, which we are only starting to see at the social, political, economic levels and public health seared an indelible scar on our minds. Imagine that each and every citizen of the planet has been methodically herded into an alley abutting to a cattle chute, where we have been all marked by Death itself. We pray for the Salvation of all those relatives and friends that succumbed but, above all, we pray for all of us who were left around for the next Walking Dead’s casting.

Note. This image form of Dublin’s Famine Memorial was taken from Wikimedia Commons.

The other day we came across in a Miami street with a colleague of ours from Columbia University that went into Intensive Care Medicine as a sub-specialty. He looked like he had put on, not 10 years since we last casually met, but rather some 40 years. He noticed our indiscreet staring and asked us: “So I look that bad to you, eh? And how about you? When was the last time you faced the mirror?” He was absolutely right as we, physicians, and nurses, do not dare to gaze into it lately.

However, we can make our sorry state of affairs even worse, much worse. How? For starters if the Health Care authorities continue to negate or minimize the existence of an extremely serious Mental Health epidemic in our ranks, especially for female colleagues. And if those deadbeat politicians in Washington D.C, continue their disgraceful pandering in search of votes by endorsing any wacky conspiracy theory.

As our Pope Francis said: “Either we come together out of this one or we do not.”

Brothers and sisters, let us not lose ourselves. We still got much more Life Ahead.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Do not leave me alone.


Physician and Nurse Burn-out – Part XI. Our beloved Spouse

“On ne devient pas un fou si on ne le veut pas » Jacques Lacan

(We do not become crazy if we do not want to)

-“Mario is very special…Not any girl can become his girlfriend and companion.”

You know how girls love to meet and speak of us, innocent men, behind our backs. A few months before our graduating as physicians in La Plata, Argentina in 1981, a large group of girls convened a meeting in a restaurant to “rate us all for good.” Yes, naïve men out there , we are being scrutinized by these girls at all times.

Rarely did they ever allowed a boy in their meetings but my lifelong buddy Jorge, with whom we shared all the up and downs of the Medical School studies and is the godfather of our son Gian Luca, happened to stop by that resto and was let in. Most likely because he had the reputation of being the “super-nerd” of our class and he was deemed harmless enough to sit in the midst of all that feminine cacophony.

-“The first half , they rated each and every one of us,” he told me when he returned to our shared dorm. “And the other half ?” I dared ask. “About you and only you.” He was amazed that each one of our feminine colleagues took turns to, besides extolling my brilliant mind and savoir faire with the ladies (false modesty apart), they would opinionatedly select which one of them could be my fit Life Companion.

Note. This reproduction of a US Navy Recruitment poster was taken from Wikimedia Commons.

The Selection of Your Spouse is the single most important personal decision that a practicing physician must decisively make in his/her/ihr life. The very critical one. The aspiring candidates must all carefully be vetted with a hawk’s eye. No less.

So, fair damsel of catwalk looks, will you be expecting your hubby to arrive every day at 5 PM to share hors d’oeuvres and cocktails? No good. Get yourself a banker.

So, fabulous stud with those big muscles, will you be expecting your wife from the hospital to do the laundry, fix dinner and make love? No good. Go back to Mommy.

So, great fun of all parties, will you be expecting your exhausted wife to put a friendly face when you parade her in your yard gathering? No good. Join the clergy (any)

So, inflexible enforcer of Feminism, will you be expecting your man to drop  the CPR team busy in the ICU to listen to your harangue? No good. Join the Communists.

These are only a few examples of the hard scenarios that physicians and nurses must ponder before making that critical decision. AND ONLY YOU CAN MAKE IT.

You must be aware that when your spouse waves goodbye every morning to you, he/she/sie is in fact slowly lowering a high tensile steel cable of your harness to lay you in PURE HELL. She will then tie the cable to the strongest oak of the park. Loyally, she and the children will show up at a re-arranged hour to pull you back up. And do not commit the silly mistake of lingering around for a drink or chat, as you mind will be slowly eroded until you end up mad ( we saw several of these cases)  When your family rings the bell above, skedaddle out of that dark hole to preserve your sanity.

Down in the entrails of Sickness and Frailties, you and your colleagues will be fiercely battling all kind of demons and monsters, including some of your own making. Whomever gets distracted for a single second, runs the risk of being eaten. One of the most silly and dangerous mistakes of us, male physicians, is to get a Trophy Wife to brag to all our colleagues, patients, family. There is only a problem. As the knucklehead is more interested in finishing her bridge game with the girls at the country club, you arrive at an impossibly cold and chaotic house with no dinner.

What do most of us, stupid men, do? When the cute OR assistant gives us a wink in the middle of surgery, we arrange for a discreet date, to avoid our horrible hearth. So goes the cutie Med student, then the cutie in Admissions, then the cutie….Until one day you find yourself in the doghouse in the middle of a terribly cold night, madly trying to make Fido share his blanket. Fat chance. Fido knows you are a Sorry Loser.

Forty years ago I had to make that terribly decision and I think I made the right one. Now I am standing at that critical junction of my career path for a second time before deciding which one.

Will I be so lucky as to win the Lottery twice? Stay tuned. More to come soon. 

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

Physician and Nurse Burn-out – Part X Crying is not just for Sissies

Another day of grim statistics of rising new cases in the USA and elsewhere has swiftly passed.  The social media is awash with alarming reports of the Omicron variant that has arose in South Africa. The governments are clumsily trying to contain the spread of the Covid-19 to avoid another peak. In the meantime all the Health Care providers are exhausted of the efforts of the past few months. They are tired, demoralized, disgusted at the silly games that the D.C. politicians and sycophantic voices in the media, from almost every corner of the ideological spectrum, repeat like tragic clowns. And the families of physicians,, nurses, technicians, etc., are watching them slowly crumble away…

In this scenario, crying should be a natural human reaction…Why aren’t we welling up more?

There are troubling reports that the incidence of Mental Health disorders in Health Care personnel after the sacrifices they have made during the past year and a half is steadily rising to serious levels, with only palliative measures that concern financial benefits, and ignore the needed psycotherapy.

There are several factors that block physicians, and other medical personnel, to seek the needed counselling. The crazy work schedule of physicians and residents, the confidentiality issues that might affect the licensing status of practitioners, the personal issue of loneliness and divorce, all might contribute to it. We, the Health Care providers, are watching this drama unfolding before our eyes.

Note. This World War II poster of the Cadet Nurse Corps was taken from Wikimedia Commons.

It is always advisable to repeat, again and again, the major clinical signs of Professional Burn- Out. We transcribe a section of our book Emotional Frustration – the Hushed Plague. Here they are:

Professional burn-out is characterized by a most evident but ignored tragic triad:

  1. High emotional exhaustion
  2. High depersonalization
  3. Low sense of personal accomplishment

A – High emotional exhaustion

The increasing demands of payors, administrators and patients on the time and resources of the health care personnel produces a generalized dissatisfaction with the perceived quality of their delivered care services. The level of resilient frustration is so pervasively high in our system that physicians, nurses, technicians, receptionists, and other ancillary personnel are literally “counting the days” until the end of their silent martyrdom eventually comes—their retirement date.

B – High depersonalization

The negative feelings and bad vibes will inevitably foster the emergence of cynicism and sarcasm in the ranks of providers, with the resultant degradation of their rapport with the patients and families. It is a self-sustaining vicious circle. Patients complain that they are being ignored and/or mistreated, which triggers more negativity and disdain for the staff. As a result, the latter continue to react negatively without the possibility of pausing for a moment and reflect calmly.

C – Low sense of personal accomplishment

For the majority of us who have chosen the medical career, profit and social standing are secondary considerations. What we most value is the possibility of helping our fellow human beings and at the same time enjoy the unique standing conferred by possessing a voice of authority. With the landing of the abominable “bean counters”  in both the public and the private payor system, our maneuvering room has been drastically curtailed. Our decreasing satisfaction not only pushes us into early retirement but also into all kinds of drug and alcohol abuse in our ranks, plus the possibility of one day to casually start mulling about “the unthinkable.”

We will continue this discussion as the honest approach of all institutional parties and professional associations to the pressing issue of Mental Health Disorders in our battered professional ranks is of paramount importance to stem the steady exodus of colleagues to the Elysium of Retirement.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.





Physician and Nurse Burn-out – Part IX Meeting at the Metaverse

“Il faut s’éloigner des ânes, sinon vous pourriez braire comme eux »

(You have to keep your distance from asses, if not you might bray like them)

One of the most dramatic post-pandemic developments, which we are paradoxically experiencing in a society like the USA with quasi-herd immunity protection, is the growing and unstoppable escape of physicians, nurses, and patients to what we will daringly dub as “anything but our frustratingly obnoxious present physical reality.”

After so many months of exhausting work, incredible suffering, lost relatives and friends, lack of basic humanly contact, socio-economic repercussions, etc., we, the Health Care Providers have an extremely short fuse. Whenever we come across  someone in our offices that repeats parrot-like the utter nonsense that the reactionary social media outlets vent about the lifesaving vaccines, we just tune them out. At the same time, those patients that are not satisfied with our clinical advice, do exactly the same, taking refuge in a virtual world of our own making, where we feel safe.

The recent announcement of Facebook, which is rightly taking tons of public and congressional flak for its irresponsible corporate behavior, that it will change its name to Meta is a harbinger of the big changes that are inexorable coming our way. The business-savvy executives of that company are engaging in a fuite en avant. Whatever the public watchdogs and the regulatory authorities are planning to do to tame that monster amounts to a ridiculously futile chase riding an old donkey. In a uber-capitalist society like the USA, there will be no substantial  atonement for it. As Josh Brown, the smart commentator in the Closing Bell of CNBC, said: “Facebook will survive this storm of bad publicity because it has simply become too important for commerce. There is no better way for businesses to efficiently target their coveted segments. And its stock price does not swivel much.” Moreover, it has learned how to outsmart all its foes in Washington D.C. and way beyond.

In this crucial month of November, when we celebrate our birth a few decades ago, we seriously pondered the possibility of retiring from the arduous clinical practice and dedicating our full attention to the demands of Consulting and a Writing career. However, we decided to carry on as we still do have a passion for Medicine, fully enjoying its practice and the contact with patients and colleagues. However, we are  training ourselves to escape to the Metaverse anytime someone gets under our skin.

If you visit us in Miami, you might catch us with dreamy eyes and a beatific smile on our tired face.

Our body might be there, but our mind is in a far-away beach, cuddling with a sweet red-haired girl.

Note. This reproduction of a U.S. Navy World War II poster was taken from Wikimedia Commons.

Putain les femmes!

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.



Physician and Nurse Burn-out – Part VIII Stampeding Out

Why would we be surprised that so many Health Care workers are skedaddling?

In an article in the CNBC Business portal, Karen Gilchrist wrote: “According to recent studies, between 20 and 30% of frontline U.S. health care workers say they are now considering leaving the profession. Notably, one April 2021 study by health carte jobs marketplace Vivian found that four in 10 (43%) nurses are considering leaving their role in 2021 – a figure that is higher among ICU workers (48%)”

For all of us who work in the Health Care Arena, it does not come as any surprise that so many of our colleagues are toying with the idea of leaving the profession for good, or at least to find a parallel track with limited clinical duties. On the contrary. More than twenty years ago, we were shocked how the failed attempt by the Clinton administration to reform the Health Care coverage of Americans, literally wiped out the profitability and sustainability of many solo practices, including ours. At the time, we sat down with our wife to discuss options to assure our future employment; we decided to study, with humongous financial and personal sacrifices, both Master and Doctoral degrees in Health Policy and Management at Columbia University.

Note. The reproduction of this U.S. Navy recruiting poster was taken from Wikimedia Commons.

Unfortunately many of our colleagues did not take any similar preventive steps and are now confronted with the stark reality that, even after the sacrifices they have made during the pandemic, they are back in the same exploitative work parameters of yore, with the added caveat that they might be dragooned for the next pandemic. The obnoxious understaffing of hospital wards, the relatively low pay, the long hours of an insensitive scheduling process that messes family life plus the rising incidence of Mental Health problems, worsened after the pandemic, with no foreseeable relief. A few of them are close to the retirement age and their plight will be brief indeed. But what happens to the thousands upon thousands of middle age-professionals? From our personal experience, we know that it takes a long time to efficiently re-engineer your career and stir it to more predictable and pleasant working waterways , compared to the always stormy clinical sea lanes.

A recent Department of Labor statistical study showed that almost half a million health care workers have quit since the start of the pandemic. When will it end? For starters, our politicians in D.C. and the statehouses should stop playing dummies. This is an ongoing tragedy that will have severe repercussions for the health of our children and grandchildren. And it will not be solved by just throwing money at it. Secondly, we , the health care professionals, should participate more in the associations that defend our interests, be at the national, state or local levels. It makes a difference. We confess that for may years we ignored these organizations but for the past few years we have tried to participate in the varied activities of the outstanding Florida Medical Association.

We will make our humble contribution by writing articles on these issues, which will constitute the needed scaffolding for our upcoming book Physician and Nurse Burn-out – Roots and Remedies.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

Has the C.D.C shamefully failed us?

We have all eagerly watched, and anxiously awaited, the critical communications of the prestigious Center for Diseases Control and Prevention (CDC) during the pandemic’s peak. However, the failure to make an accurate epidemiological assessment at the beginning of the COVID-19 pandemic, the initial failure to develop an efficient test and the surprisingly contradictory guidelines on Social Distancing for the citizenry eager to receive the experts’ guidance, have certainly baffled us.

In a review article of The New York Times Magazine, Jeneen Interlandi analyzed the core causes of those system failures in what was, and still is, considered the premier infection surveillance in the world, whose guidelines are respected by all countries. She begun by informing us that last November a group of academics and Public Health experts created, via regular Zoom meetings, the Covid Rapid Response Working Group to analyze the guidelines to open schools for physical interactions. The local communities were bitterly divided over whether to allow the access of students to their classrooms, even though the latter had not been sources of infection.

She said: “So far there was no national plan for how to move forward, The Centers for Disease Control and Prevention was advising everyone to wear masks and remain six feet apart at all times. But that guidance was a significant impediment to any full-bore reopening, because most schools could not maintain that kind of distance and still accommodate all their students and teachers. It also has left many questions unanswered: How did masks and distancing and other strategies like opening windows fit together? Which were essential? Could some measures be skipped if others were followed faithfully?”

Interlandi attributed this inertia and contradictions to a dangerous phenomenon that had plagued the agency for years already: extreme politicization. Not only the agency has shown baffling clumsiness in their public dealings but, what was much worse, it was immobilized by the meddling of the Trump administration; some reports were altered at the last minute to “comply” with the false mantra that “the epidemic was under control” and that we should trust that “Daddy knows best.” At the state and local levels, the draconian powers of Quarantine were used for blatant demagoguery by unscrupulous pundits of all stripes. In order to conceal their utter ineptitude, the authorities shifted the burden of guidelines’ design to the local authorities, so they could “take the rap” if anything went wrong. As one of our Neurology professors used to say: “the worst policy is no policy.”

The Covid Rapid Response Working Group, located at the University of Harvard, stepped into the public plate to design “actionable intelligence” based on humongous amount of raw data—on infectivity and hospitalization rates, morbidity and mortality rates, etc.—that they had collected and analyzed from multiple sources across the USA; they devised county-by-county risk assessment tools, national testing strategies and contact tracing protocols that fast filled the knowledge void. In particular cases, like the operational guidelines for hospitals, this nimble group moved much faster that the pachydermilian CDC, struggling to catch up with them.

Since its creation in 1946, the agency has had to walk a “fine line” when dealing with the states and local communities where most of their authorities and administrators have always been wary of having “too much federal interference” in a turf they always considered as their own. Moreover, even after great successes, once the light of the public attention was turned off ( and it always does as the limelight depends on our fickle attention span) the mendacious politicians took advantage of it by slashing its funds and cutting staff. The scarcity of funds triggered many vicious internal fights for their apportionment. Some insiders have confided that everybody was fending off for only their interests, compounded by the reality that agency chiefs were unwilling or unable to cooperate.

Interlandi paints a bleak picture of the constraining corset that this sprawling organization (with scientific teams and field offices all over the USA and the World) must forcibly wear at present. “Despite that scope, the agency has little authority. Its officers can’t compel individual states to participate in its initiatives, for example, nor to include CDC scientists in local outbreak investigations, nor to share much data with the agency—even in the middle of a pandemic. It can’t force people to wear masks, or force local leaders to close (or open) schools…Aside from a few quarantine powers, the most that the CDC can do is issue guidance, which is unenforceable and –as the past year has repeatedly shown—just as likely to be weaponized as meaningfully employed.”

The atomization of the institutional arrangements with the states and the extreme focus on foodborne-pathogens (rather than the airborne ones like the coronaviruses) hampered its ability to conduct the necessary genomic surveillance for the threat. There is a great variation in the surveillance capabilities of jurisdictions, sometimes focusing on different parameters that suit their public and political interests. In the beginning of the pandemic the CDC was notoriously absent from the scientific discussions carried out by many teams all over the globe. A sorry shadow of it past.

The Biden administration has already taken bold steps to modernize the bureaucratic structure of the CDC, starting with the demise of a few honchos blocking reform. It has proposed increased federal funding in the budget and allocated some surplus Covid 19 funds to it.

Will that be enough to modernize it?

When we needed them the most, the CDC’s opinions were notoriously absent from the public sphere. They have certainly shamelessly failed us, the citizens of the USA, and the rest of the World.

Stay distant. Stay safe. Stay beautiful.

What do you think ? Please tell us.

Don’t leave me alone.