“So what are you smoking for Christmas, Doc?” Those were the first words out of the mouth of one of my patients this morning. John (not his real name) has been my patient for more than 20 years, and he and I both have a shared love for smoking meat. I talked about my Thanksgiving smoked turkey; he talked about his smoked chuck-roast tacos. Back and forth we went for a few minutes until finally we moved on to his office visit.

I walked out of the exam room some 30 minutes later with what could best be described as an internal smile — a sense of satisfaction and accomplishment, an honoring of my commitment to medicine. It’s the exact opposite of what one physician recently described in an online family medicine forum: “I dread coming to work most mornings. I put on an act all day for patients and seem interested in how they are doing, but inside I really could not care less.”

This online stranger made my heart sink. They were experiencing burnout to a major degree.

THE REALITIES OF PRIMARY CARE: ESSENTIAL BUT STRAINED

In 2022, the American Heart Association (AHA) updated their concept of the eight things necessary for cardiovascular health (CVH), called Life’s Essential 8 (LE8).¹ It’s a great foundation for keeping patients healthy, and it’s the same stuff we as primary care physicians talk to our patients about every day: eat healthier, get more exercise, stop smoking, manage weight, control cholesterol, manage blood sugar, manage blood pressure, and get healthy sleep. So it wasn’t surprising that in 2024 the AHA specifically called out the essential role of primary care: “Because of its central role in patient care and health care delivery, primary care is ideally positioned to help people achieve optimal CVH through LE8.”²

What was surprising was that the AHA identified burnout in primary care as a major challenge, saying “the complexity of disease, alongside technological and administrative burdens and pressure to see more patients in less time, has strained the primary care workforce.” They went on to point out that the solution requires system-level and policy-level changes.

If I put myself in the shoes of my burned-out internet colleague, the idea that things can only get better when politicians and administrators fix the system could feel disheartening. But I would encourage my fellow physician to flip that framework around and realize that burnout is an organizational problem, not a personal failing.³ There is an interplay between moral injury and burnout⁴ when our incredible desire to take care of our patients grinds against the friction of “The System.”

SO WHAT CAN WE DO?

One strategy for avoiding burnout is to get very granular and focus on building relationships with individual patients. Meaningful interactions with patients, which often are based on non-medical topics, have been shown to help with burnout.⁵ That conversation I had with John about smoking meat, while innocuous, was a powerful part of my burnout shield. To my colleagues who are feeling burned out, my advice is to find a connection to your patient. Figure out a way to bond with them, even if it’s just for a few moments a few times a year. The secret sauce to all of this comes back to the reason we all entered this profession: our patients.