The Elegant Cousin of Burnout (and How to Outsmart Her)
It started last week when I learned about a new feature being added to our EMR. Even while admitting to myself that I have absolutely no idea what it means to “turn on a function in an EMR,” I clutched my metaphorical pearls when I heard it was going to cost our institution $27,000 to start using a feature that other hospitals of our size already use. Clutching my metaphorical pearls morphed into seeing metaphorical red when I then heard it wasn’t just $27,000 to turn the function on, but $27,000 per year to keep said function turned on. I unmuted myself for the first and only time on that meeting to lament that the cost seemed completely insane and that I was obviously on the wrong end of the business of medicine. (Yes, this is what I contribute to meetings. Why do I get invited to so many?!)
And then today I was on my fifth, yes, FIFTH, iteration of our schedule when I felt it creeping in. “Gah! This still isn’t working!” I complained. “Uuuugggggghhhh, why doesn’t this super-expensive system work the way it’s supposed to?!” I whined. Sending my ump-teenth email to our system’s help desk (excuse me, our “Customer Portal”), my hissy fit transitioned to frank rage. Punching each key much harder than necessary as I typed, I thought, “These. People. Are. Completely. Inept. And. Have. No. Idea. How. Medicine. Works!” Between “those people” who are behind our EMR and “those other people” who are behind our scheduling software, I started to curse the entire medical enterprise, all the medicine-adjacent people who purport to make our jobs easier but, in reality, just screw everything up.
Cynicism, according to Oxford Languages via Google, is “an inclination that people are motivated purely by self-interest.” Still, it is also used more casually to convey distrust, skepticism, suspicion, and disbelief. And perhaps the most recognizable in medicine? Pessimism. Think back to your last clinic day or shift. How many times do you remember feeling pessimistic? About patients being on time? About medical learners being interested in, well, learning? About charting not being a pain in the neck? I wasn’t even in the unit today, and felt cynicism permeating most of my to-dos.
Cynicism feels safe. If I reject something before it goes badly, then maybe I won’t get so upset when things go sideways. “I knew it!” seems like it will feel a lot better than “Uuuugggggghhhh!” But the problem with cynicism is that it robs us of agency and turns us into victims. It says, “This system is broken, and there’s nothing I can do about it.” Which, let’s be honest, is occasionally true. But it’s also deeply corrosive when applied too liberally.
Here’s the paradox: cynicism feels intellectually superior but emotionally lazy. It lets us posture as savvy insiders who “see through the nonsense” while quietly surrendering our hope that anything can get better. It’s burnout’s elegant cousin: sharp-tongued, well-educated, and perpetually exhausted.
But underneath that sophistication is something tender. Disappointment. We wanted medicine to be noble, purposeful, maybe even a little sacred. When it turns out to be bureaucratic, glitchy, and expensive, cynicism rushes in to cover the bruise. It’s armor against heartbreak.
The antidote isn’t naïveté. It’s gratitude.
Gratitude doesn’t deny the absurdity of modern medicine. It simply insists on holding appreciation and frustration at the same time. It’s saying, “This EMR function situation is ridiculous… and also, I’m grateful to have a team of people figuring out the schedule with me, and very patient colleagues who aren’t giving me a hard time about how long it’s taking.” Gratitude doesn’t gaslight us into pretending the hard stuff isn’t hard. It just keeps the hard stuff from swallowing the rest whole.
I’m not talking about performative gratitude, the kind that lives on a Post-it note or in a PowerPoint slide during Wellness Week. I mean the quiet, daily practice of noticing something that still works. The nurse who saw a patient’s subtle decline before I did. The family who brought snacks for the night shift. The resident who kept trying even after a demoralizing sign-out. These small recognitions don’t fix the structural dysfunctions, but they do fix me. Or at least keep me from calcifying into someone I don’t want to be.
When cynicism creeps in (and it always will), try this:
1. Name it. “Ah, there’s my inner cynic again, trying to keep me safe by convincing me not to care.”
2. Find one thing that still feels good. Something absurdly small counts: your coffee temperature, the teamwork during rounds, the kid who waved goodbye on the way out of the unit.
3. Say thank you. Out loud if possible. Gratitude interrupts the feedback loop of frustration. It’s hard to mutter “thank you” and “you people are the worst” in the same breath.
Gratitude won’t make the EMR less expensive or the scheduling software less maddening. But it does something far more subversive: it keeps us human in systems that too often treat us like interchangeable parts.
And that, my friends, is how gratitude becomes the antidote to cynicism, not because it changes the system, but because it changes us enough to keep showing up.
When you notice cynicism creeping in this week, pause and ask yourself, what disappointment is it protecting me from? And what small thing is also true that I can be grateful for?