Finding Resiliency in Healthcare

Fortunately, the topics of burnout, wellness, and resiliency have been popping up more and more frequently over the past 1-2 years across the media, social media, and even professional conferences. I welcome the increased transparency and willingness people have to open up about their experiences, concerns, and struggles, but most importantly, what we all are currently and will soon do about it.

Burnout is not a new problem. In the research journals the topic has been discussed and analyzed for decades. I searched Pubmed for “burnout healthcare” and the earliest indexed articles there were from the late 1970’s. In fact, the earliest article was from the Journal of Nursing, entitled “Burnout: the professional hazard you face in nursing,” by Seymour Shubin.

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I’ve read through at least 30 articles on the topic ranging from the 70s to earlier in 2017, and what’s encouraging is that we are finally starting to see a shift from describing the issues involved to how we can address them. As of the past 5-10 years, studies have emerged that actually analyze how effective or ineffective specific interventions have been on the issues of burnout, wellness, and resiliency. Even more hopeful, the large medical journals which historically are last to catch onto new waves and new ideas, are also publishing more on these issues.

I am glad for this change. Over the coming weeks and months I’m planning to discuss a couple of studies per week on related issues. Consider it my first #FOAMed contribution.

But in all honesty, personally I feel that the keys to addressing this issue are so broad, multifactorial, and involve both systems issues and individual professional level issues, that it will require much more than just discussing the issues and publishing about them to create real changes.

One of the things I want to focus on here is discussing and creating dialogue about the individual level options that can make a difference for us all.

Here are some thoughts from the above mentioned article which I thought were important to highlight.

I can’t stress this enough.

IT IS NOT SELFISH TO TAKE CARE OF YOURSELF.

Let that sink in.

The more you take care of yourself, the more you have to give at work. The more caring a professional you can be. The more reliable and dependable a colleague you can be.

Contrary to what you may feel is expressed by supervisors, managers, administrators, colleagues, coworkers, etc, your longevity in the career you chose is important. Your longevity in your chosen work (physician, nurse, nurse practitioner, physician assistant, social worker, respiratory therapist, etc), is directly related to your “wellness factor.”

If you work with a negative wellness factor, meaning your experiences are multiplied by an overall negative sense of self image, self worth, and self care, means you are ultimately cutting career satisfaction and your own wellbeing down.

If you work with a positive wellness factor, meaning your experiences are multiplied by an overall positive sense of the above, your experience in general is going to be augmented. It helps set you on a trajectory for success, career satisfaction, and personal wellbeing.

As the Thanksgiving holiday has come and gone, I challenge you to think about how your current wellness factor is. What is your current state of affairs? What are the things that you struggle with? What’s causing you stress right now? Identifying issues is the first step toward improvement. Let’s get well.

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Light Among Darkness, Part 1

Photo Credit: Nimit Patel (www.inimitable.io)
There is a culture of machismo still prominent in medicine. Locker rooms, physician lounges, clinics, and hospital hallways are full of doctors of all kinds, both men and women, who place unnecessary and unfair expectations on one another to “suck it up” and “just deal with it” without showing a single sign of emotion. In the absence of formal training on how to manage our emotions and what we feel, doctors historically just did not show emotion. You hear stories from decades ago, of people who never cried and never discussed emotional challenges, and yet they are baffled as to how so many people whose primary goals are to help those dealing with medical illness could help foster a culture of pent up emotion and practice such poor mental health hygiene. It also is no surprise that so many physicians struggle with depression, marital difficulties, substance abuse, and more.

This is, thankfully, changing.

I contributed to this by standing up in front of 60 people and telling them that I had struggled with burnout in residency. It was, though not a big deal, a big deal. I was squeezed between a lecture on the life-saving use of ultrasound in critical care patients and a discussion of the latest and greatest in the management of respiratory distress. It’s still considered “edgy” and maybe even “taboo” in 2017 to teach doctors to discuss their emotional experiences and struggles. It’s still considered unusual for a doctor or nurse to tell their colleagues about their struggles. That culture still exists – but the wall is coming down.

Day by day, one person at a time, one hug at a time, one moment of beautiful vulnerability at a time, we are working to change this. I realized when I was recovering from burnout that we spend much of our time in medicine finding ways to take care of others, but we constantly neglect our own health. Worst of all, the culture of medicine is that this is how it SHOULD be. When I started medical school in 2011, it was obvious the expectation was I would show up, do whatever it takes to get the job done, and simply never discuss what’s hard about the job or what keeps me up at night.

In a typical day at work, I take care of anywhere from 15-20 individuals and help them with a large range of medical problems. Most are minor issues, like an ache or a pain that is not serious. Some are dealing with severe infection, heart attacks, strokes, or other emergencies that will require admission to an ICU or even emergent surgery. If all goes well, I will help most of these people and they will have good outcomes. It often doesn’t go well.

One of the weaknesses in medical training is that I get ample preparation on how to handle good outcomes and facilitate them – but I get no training on how to handle bad outcomes. The patients, and their loved ones, who suffer the poor outcomes, are the ones I feel for the most. But not far behind them, I worry about those that devoted the hours, days, weeks, months, and even years to care for them. Second victim syndrome is real, and I have felt the pain it can cause.

If a physician or medical professional is involved in caring for a patient, and the patient has a poor outcome, it does not matter whether it was simply the course of the disease or illness, or if there was some error or problem with the care delivered. Truthfully, the medical professionals involved always feel some responsibility for what happens. Even when it may not have been their fault. No one wants to have a bad outcome on their watch. No one wants a patient to die. The problem is that they do, and often it has, unfortunately, little to do with the decisions we as medical professionals make. This is hard to understand unless you yourself are a medical professional. It contributes to the emotional and spiritual burden medical professionals carry with them.

You see a doctor intubating a patient to save their life, but I see a physician weighed down by the patients he has witnessed suffering incredible pain and hardship that she could do nothing about.

You see a nurse who is quickly drawing up a medication to help treat a sick patient, but I see a nurse who has seen so much death and hardship he doesn’t even know where to start to process it.

We all carry baggage. Medical professionals carry graveyards.
Stay tuned for part 2.