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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Doctor, It’s Okay to Cry, Part 1

Preface: I am planning on starting a series for young trainees of all kinds, including physicians, nurses, physician assistants, nurse practitioners, Emergency Medical Technicians, patient care technicians, and Paramedics. The purpose of this series is to share what I have learned along my journey so far, and what I continue to learn for the rest of my career in Medicine and Emergency Medicine. Please be patient with me as I work out the formatting, organization, and schedule for these posts. I felt this was an important topic and decided to start with a post addressing mental health among trainees, and those who deliver medical care. This is the start of my blog post contributions to #TipsForNewDocs. I welcome any and all comments, feedback, and hope that you may be inspired to share your experiences and join in allowing the medical community to feel empowered to share and process their experiences and emotions.

Note: Please be aware that the contents of this blog post contain descriptions of patients and their health conditions which may be graphic or upsetting to certain readers. In order to protect patient privacy I have kept things as general as possible, changed some of the situations around to protect those involved, and I hope you all understand the purpose for this post and do not dwell on the specifics. The specific patient situations are simply what I have observed, but all in health care will have their own stories.

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Many of you will recognize the photo above. It went viral last year after it was posted on social media by a friend of the physician posted in the photo, by permission. For those of you who are unfamiliar with the photograph and the story behind it, I encourage you to review this post which synthesizes the events that transpired and the background of this quite well.

This photo, and the story behind it, resonated with me so much when I learned about it. All my life, I had been known by family and friends to be emotional and attached to those around me. I knew going into medicine what was in store for me. That being said, it hasn’t and doesn’t make it any easier for me to deal with bearing witness to the suffering and loss that I do on a daily basis in my line of work.

I wanted to share some personal patient encounters that troubled me and caused me grief and emotional suffering afterward, because I think it is important we allow physicians, nurses, physician assistants, nurse practitioners, patient care technicians, and all those who participate in patient care, to experience, process, and truly be open about how they feel.

The first time I really cried after starting medical school was when I was a fourth year medical student. During one of my away rotations in an Emergency Department, I helped in the care of a police officer who was shot in the line of duty. I had assisted with and observed innumerable trauma resuscitations by this stage of my training, so the actual events transpiring in front of me were not unfamiliar to me. However, what was different about this situation, the first time I was directly involved in caring for an officer who was injured, was the sheer emotion of the situation. The officer’s colleagues flooded the Emergency Department. There was a complete different tone of urgency among the supervising attending physicians and trauma surgeons. I could see in the eyes of the nurses, technicians, physicians, and officers around me, that this was hurting them. The pain and suffering the policeman was enduring, the treatment that he was receiving, it was causing a tidal wave of many emotions throughout the facility.

There must have been 15 police cruisers that showed up outside of the department within moments of the officer’s arrival. Several of his lawmen had brought him to the department in their cruiser, since there was concern that by the time an ambulance arrived, the officer would be too sick to save. This was one of the first times I learned that in some situations police officers, because of the environment they served in, had to transport patients with trauma to Emergency Departments in their own cruisers. Not many people know this about police officers, and with the recent negative publicity that surrounds law enforcement all over America, I wish it to be known that police officers do so much that the news media never shares. They are, in many ways, endangering themselves day in and day out, for the general benefit of the citizens they serve. Bad apples always exist, and create negative publicity, but please do not forget what the men and women of America’s law enforcement agencies signed up to do for us – protect us.

The officer was rushed to the operating room, and there was silence in the Emergency Department. For anyone who has ever worked or been in any ED for any period of time, even as brief as 30 seconds, there is never silence. If an ED is quiet, you should worry. It took a good 30 minutes for the entire department to shake the effects of the trauma resuscitation. Staff, patients, officers who lingered behind for a time, appeared dazed. You could see some were emotional, but most looked stoic.

I went about the rest of my shift as usual and went home. It wasn’t until several days later that I realized how much this had affected me. I was watching The Wire with my wife (SPOILER ALERT) and watched an episode in which an officer was shot. In the make believe show, the officer was transported to Shock Trauma for resuscitation. I immediately and suddenly burst into some of the most awful crying I have ever done in my life. It rivaled how much I cried when I was kneeling besides my dying grandfather at home, who was on home hospice for his bad lung cancer, and whose hand I held as the last glimmers of life left his eyes. As I write this, I am fighting back the desire to again cry, because I happen to be writing this in a public space.

My wife held me close, and comforted me. She was patient, she did not judge, and she was everything I love her for. She waited for me to speak first, and then proceeded to very calmly and compassionately try and find out what was wrong. I explained to her, not mentioning specifics, what I had observed in the Emergency Department with the police officer. She immediately understood without much explanation why the events that transpired in The Wire affected me so much. I continued to cry and bawl my eyes out, until finally I regained my composure. I felt a lot better having shared my emotion with my wife, and for allowing myself to feel the raw emotion I was dealing with. This was an important moment for me because I realized that this needed to happen for me.

(To Be Continued)