Life is not primarily a quest for pleasure, as [Sigmund] Freud believed, or a quest for power, as Alfred Adler taught, but a quest for meaning. The greatest task for any person is to find meaning in his or her life.1
Viktor E. Frankl
As acute care physicians, by definition, we are routinely entrusted with the lives of others.2 Given that medical achievements have increased tremendously over the past decades, we have great opportunities for effective patient care.
Such increased professional effectiveness could also be expected to enable intensified personal self-development. Yet, more and more of us are burning out, given ever-increasing pressures in a constantly changing and ever more complex and demanding world. These dynamics include diverse dimensions, ranging from evidence-based treatment options and patient expectations to legal requirements, economic pressures, and self-management. Ultimately, the psychological syndrome of burnout can emerge, leading us to experience detachment from the job, feelings of cynicism, a sense of ineffectiveness, a lack of accomplishment, and overwhelming exhaustion.2,3
While international guidelines, personalized medicine, interdisciplinary collaboration, and departmental mission statements can offer professionals some guidance, ultimately, they are extrinsic demands as well, and thus could potentially reinforce personal exhaustion. Intrinsic motivation to perform our daily duties becomes the utmost importance, not just for us as individuals, but for our patients and our coworkers in acute care departments and health care systems worldwide.
As we learn from Frankl,4 “the will to meaning” that is, our ability to endure challenges by focusing on a continuing purpose to create a positive future, is a powerful tool for sustainable resilience. While the topic is complex, and understanding it requires a long-term commitment to personal self-development, it is possible to understand the concept through storytelling, an effective way of conveying information.
Therefore, I want my teams to understand Leo Tolstoy’s short story “The King’s Three Questions.” It offers guidance for caring professionally for the lives of others and personally for our own lives (besides Tolstoy’s book,5 the short story is available on PubMed6 and several other webpages). The simplified version in brief:
There once lived a powerful king who was, when honestly reflecting, somehow unhappy. He believed that the key to happiness might lie in knowing what the most important time was, who the most important person was, and what the most important task was. To find an answer, he called many scholars to his court. All of them gave different answers and none of them was able to convince the king. Finally, he set out into the world and, after a dangerous and adventurous journey, met a hermit. From the hermit the king learned that the most important time is “now,” because it is the only moment we have. The most important person is the one who is with us right now, in this moment. And the most important task is to take care (Table).5
|The questions||The answers|
|What is the most important time?||The most important time is now.|
|Who is the most important person?||The most important person is the one who is with us right now.|
|What is the most important task?||The most important task is to take care.|
Taking care of a patient is at the very core of clinical medicine. Yet, the complex dynamics of daily work often distract us. The vast majority of mishaps in acute care medicine derive from deficiencies in nontechnical skills.7,8 By focusing on taking care of the person who is with us right now, we likely increase the quality of care and decrease mistakes in our clinical work. Although the interplay between unrestricted attention and performance may often not be obvious, focusing the mind reduces distractions by simultaneously getting one in touch with inner feelings and impulses.9
While departmental mission and vision statements can provide professional context and guidance for success, they often fail to address ambivalence and the search for meaning.
When evaluating and empowering talent, academic skills are only one aspect to be considered. We must strive to develop the courage and the willingness to focus our attention on the very moment and the person and the task at hand.9
Frankl1,4 described three possible sources of meaning in our lives: being courageous in difficult times, working on something significant, and taking care of another person. In Tolstoy’s short story, I have found an effective way to formulate my core values and to share them with my teams. I am convinced that such values enhance patient care and can help us avoid burnout by providing meaningful context and connection. When telling Tolstoy’s short story to your teams, make sure they understand Frankl’s1 wisdom that “doing good again and again finally becomes being good.”
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