Give Us This Day...
The research literature on burnout in healthcare has exploded over the last forty years. It is fuelled by a growing awareness that changes in the way healthcare is delivered is marginalising perhaps the most important part of quality healthcare: a caring healthcare professional.
Much of this is felt to be a by-product of the way healthcare has changed in the latter half of the 20th century, with the gradual shift from personal relationships and public service to a business and efficiency model. “Complex, intimate caregiving relationships have been reduced to a series of transactional demanding tasks, with a focus on productivity and efficiency, fuelled by the pressures of decreasing reimbursement. These forces have led to an environment with lack of teamwork, disrespect between colleagues and lack of workforce engagement.” Yet I wonder if the problem of burnout, though new in form, is really quite old.
In “safety net” programs like mine where the gap between system expectations, patient need, and available resources can tear wide open at any moment, we are never far from falling through the cracks. It happened most recently when our healthcare for the homeless clinic decided we would turn no one away. It was a shiny and admirable idea to accept everyone who comes to the door, but one that quickly lost its lustre as it descended from the ivory tower where it was made to the trenches where it was supposed to be carried out. On the battlefield there were casualties everywhere: people were calling in sick at a much higher rate, others complained with increasing negativity, and the head nurse admitted he was burned out and going to quit. After five years of building a resilient staff and three years of minimal turnover compared to the previous three years of losing someone every month, we were about to reduce it all to rubble.
One of the best stories about inadequate resources in the face of overwhelming need is the multiplication of the loaves and fishes in the Bible. A familiar story, not surprising since it appears in all four gospels, even occurring twice in Matthew and Mark. With thousands of hungry people, a bit of bread, a few fish, and a tired group of disciples, we have all the ingredients for compassion fatigue and burnout. Yet instead everyone eats with plenty of leftovers. A wonderful story, isn’t it? But what does it have to do with us? Is anyone going to miraculously multiply our resources in the face of overwhelming need? Maybe, or maybe not - yet the story is about much more than an airdrop of abundant provisions in the middle of a famine.
Unique to the gospel of John we get a glimpse of what happens next. The following day the people catch up with Jesus on the other side of the lake. Naturally they are hungry again and want more of the same. But Jesus sees their needs - and ours - far better. Yes, he knows we need food, for we are physical beings with daily requirements for nourishment and rest. We also need miracles - how else will we persevere in our feeble efforts if we don’t believe God is still at work in this broken world to mend it. But along with physical and emotional needs, we have spiritual longings requiring another kind of nourishment. When Jesus tells the people, “Feed on me,” how confused they were! Yet Jesus knew it is the essential truth that sustains life: “I am the bread of life. He who comes to me will never be hungry, and he who believes in me will never be thirsty” (John 6:35).
So the simple prayer: “Give us this day our daily bread” goes far deeper and asks much more than we may realise. Unconstrained by our limited perspective, God hears our deepest groanings, our whole person crying out in all its needs - the physical need for food, the mental and emotional need for hope, and the spiritual need for a living relationship with God. And herein God gives in unfailing love what sustains in all circumstances.
Bob Cutillo
1 Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ Qual Saf 2015;24:608-610.
