I'm always reading about strategies and measures that doctors and other medical professionals are taking to reduce, reduce, or immunize themselves from burnout, emotional distress, and empathic strain. We've been talking about this for decades, and “burnout” has increased as a result. It seems time for a paradigm shift to allow for more productive discussions, acceptance, and strategies. Instead of talking about burnout, resilience, and self-care (I can see you rolling!), let's talk about how to realistically manage this challenging and rewarding work.
Distress is a natural reaction to working in the medical field, and the reasons are all people already know. It means facing pain, high patient volumes, and a broken health care system, and quickly connecting with patients and families to best meet and understand their needs. In essence, this is not a transaction. It's relational work. For many of us in the medical profession, this reaction can be exacerbated by years of clinical practice. Vacation has a short half-life.
Yet, how do we take personal responsibility for our own well-being without recognizing the acceptable natural consequences of working with people who are understandably stressed and in difficult situations? (which is true enough). If we 1) accept the fact that, as providers, we are understandably emotionally affected by this work we do, and 2) stop accepting that only individuals are responsible, can open a window of opportunity to help and transform ourselves. Improve systems, improve institutions. And our patients too.
Changing the paradigm to include a universal acceptance of this normal outcome of human interaction holds organizations and systems equally, if not more, responsible for this natural outcome. It invites and perhaps demands. As suggested by NEJM Catalyst (Insights Report, 2018), we cannot (and should not) immunize ourselves against burnout. Assuming that pain can somehow be avoided, this invalidates the work itself and paints the individual as robot-like. We certainly know that our approach to medicine is not appreciated by the public. And without connection, we won't find much meaning in our work. I recognize the need to compartmentalize and wall off in response to overwhelming stress. It can be an effective coping mechanism, but not in the long run.
Continue doing yoga, painting, singing, walking in the forest, and meditating. they will help. If we don't explicitly acknowledge the humanity of our healthcare workers, we'll only continue to blame ourselves for things that will rightly affect us all.
Let's change our paradigm and add it to our list of strategies.
1. Push back against institutions that don't provide the social support you need to do your job (i.e., provider debriefing, time off, no overtime recognition, etc.). Isn't this their moral responsibility?
2. Oppose the use of the word “hero” to describe the lengths health care workers go to to help patients. This only underestimates the stressful nature of medical work. It also puts providers in a position where they don't have time for themselves. (Last I heard, heroes don't take days off).
3. Resist the organizational resilience narrative. Bouncing back from challenges requires resilience, but it also requires a realistic recognition that challenges exist. A “resilient personality” does not avoid or erase the effects of the work we do, nor does it prevent burnout or guarantee that we will not experience psychological distress. .
4. To better describe the lifelong efforts of health care providers, including physicians, to continue working and find meaning, solace, and fulfillment while accepting the nature of their work, resilience can be translated into the term sustainability. It should be replaced. It’s hard, and it will always be hard (pandemic or no pandemic).
Efforts to help health care providers do this work over the long term include recognizing that some things (i.e., distress) are inherent to this job and profession, as individuals, as institutions, and as a system. , we need to honestly admit. Rather than pretending to be unaffected by the best and most difficult aspects of medical work, we must work to find ways to sustain ourselves and each other.
Vicky Leff I am a palliative social worker.
