Culture of Medicine, Part II

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NaBloPoMo 2018:  What I’m Learning

So, what did you think of how trainees described the Culture of Medicine?  If you’re in medicine, how much did you resonate?  If you’re not in medicine, how much were you surprised, or not?  How do you think this affects our relationships with you, our patients?

Do you wonder how we get through any given day?

I asked the group:  What are characteristics or traits of Culture of Wellness (COW) Leaders?  Once again, I present their responses here, in order of discussion.

  1. “They ask how people are doing.” They are proactive about it, opening the door, making it safe to talk honestly about how we really are doing.  They exhibit the ‘body language of listening.’  It’s still hard to talk about it, one student pointed out.  The best leaders explicitly carve out time to talk, to invite feedback.  It also matters what they do with the information once they get it—empathizing and acting on it if needed, rather than dismissing.
  2. Mentor. This is someone who knows you and whose role it is to help you ‘unconditionally,’ different from any of your evaluators—maybe an advisor.  It can be an informal relationship, maybe just someone you want to emulate.  Trainees agreed that it often happens organically, and they seek it actively.  One resident identified her program director as ‘absolutely a COW leader.’
  3. Walk the Talk. Examples: work/life balance/integration, acceptance of mistakes, admitting when you don’t know something.  NO DEFLECTING; OWN YOUR SHIT.  This one hit home with me—this is Integrity.  As Brené Brown says, integrity is “choosing what’s right instead of what’s fun, fast, or easy.  It is living your values rather than simply professing them.”

The next several descriptors emerged in a flurry.  The atmosphere in the room swelled with positive energy as one label after another of what we admire about our teachers and colleagues overtook the downtrodden mood just moments before:

  • Consistency
  • Proactivity
  • Openness
  • Empathy
  • Personally engaged
  • Curiosity
  • Caring
  • Kindness
  • Vulnerability—willing to share
  • Positivity—seeing mistakes as learning opportunities. Encouraging—“We’ got this!”
  • (Understand the importance of) Food: attending to physical needs
  • Humor—acknowledging the challenge and weight of the work and also holding it loosely
  • Validating
  • Appreciative
  • Grateful

The last one triggered a story.  One student rotated on an inpatient service.  Critically ill patients poured into the hospital; all work hour restrictions were necessarily violated.  Nerves were more than frayed, and people were at their worst.  He witnessed open hostility by senior residents toward interns, backstabbing, undermining.  The attending, present only minimally, was oblivious.  And, “They never said thank you.”  The student, who had planned to enter this field, considered switching.  It was that bad.  But somehow, he was able to get perspective and remind himself that this one bad experience did not represent the whole of this specialty.  It had been an unusually busy month at the end of a long, hard year.  Maybe the cumulative exposure to some of his COWL role model traits had rubbed off, and buoyed him when he stepped onto a leaky boat.

A senior student admitted that when she started medical school she had heard of burnout.  “I initially didn’t believe it could happen to me…  Then later I realized it can happen to anybody—it could absolutely be me, if I don’t take care of myself.”  I asked what that means, taking care of yourself?  They answered:

  • Sleep
  • Nutrition: “Any food your intern year; choices matter more when you’re PGY (post graduate year) 3!”
  • Outside interests
  • Finding a practice situation that fits: eg caring for the underserved, women’s health, hospital medicine, etc.
  • Find Your Tribe. The trainees did not use these words, but this is what I wrote in my notes—they expressed a need for belonging.
  • People at work: truly collegial relationships, especially across specialties
  • Confidants: safe people to share with, your emotional support network
  • Physician-Patient relationships: mutually vulnerable and open

I asked them what they needed to take care of themselves.

  1. Purpose
  2. Time—to be given by the system, and also to be responsible and efficient with themselves.
  3. Habits—established and also adaptible

Overall the discussion felt productive and successful in the end.  We had just mapped out the way(s) to Be The Change we seek in our profession.  Some of them took pictures of my notes (so Millennial), which made me feel gratifyingly connected.  I had tried to question more than lecture, to explore and facilitate more than ‘teach.’  I wanted each of them to own their own path to leading from any chair, now and forever.  I proposed that they could start the moment they walked out of the conference room door—no elevated status or title necessary.

This is why the calling still resounds compellingly, why our enthusiasm for the work persists resolutely, despite the hardships.  It’s Hope.  And at its foundation lies the bedrock of our best relationships—with ourselves, with one another, and with our patients.  On the march toward a true Culture of Wellness, real leaders go in front and set the example.  The rest of us learn by mimicking.  Thus we all have leadership potential and, dare I say, responsibility.  We are the system; we make the culture—each and every one of us makes a unique contribution.  Nothing we do is too small to matter.

Onward.

Culture of Medicine, Part I

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NaBloPoMo 2018:  What I’m Learning

Recently I met with a group of medical trainees from different institutions, ranging from pre-med to senior resident.  The topic was leadership in medicine and culture.  My objective was to lead a discussion on how we see leadership, and to encourage physicians at all levels of training to see themselves as leaders, regardless of designated status.  I often invoke Benjamin Zander’s invitation to ‘lead from any chair.’

We started out discussing the current state of medical culture.  My summary of the labels, in the order we discussed them, follows here.  I strive to hold these observations with minimal judgment, and to practice radical acceptance.  This is simply the way things are, not good or bad, it just is.  That includes how we feel about it all, and that we want to change the parts we don’t like.  Tomorrow I will continue with Part II, characteristics of Culture of Wellness leaders.  For now I invite you, especially my friends in medicine and healthcare, to review the list dispassionately, objectively, from a distance.  See how it lands.  How do you feel reading this list?

  1. Intense
  2. High stakes—we hold people’s lives in our hands.
  3. Imbalanced. When asked to say more, this trainees explained, “It encourages a lack of balance—we are not supposed to mind the long hours.  Our priorities are skewed—we say patients first (but it feels like patients above all else, at any cost?).  There’s the paperwork, the burnout.  You can’t go home if the patient needs you (internal medicine), and in some fields there is no such thing as a shift.  It never ends. (surgery)”  These trainees felt no work-life balance.
  4. Resistant to change. It’s an attitude—“When I was your age…”  Anything different and new in terms of work hours, work load, etc. is deemed bad or inferior before it’s even considered.
  5. Hostile. Between staff members, between doctors and nurses, between doctors themselves, nurses themselves.  The trainees saw this as a key contributor to everybody’s burnout.
  6. Hierarchical—especially surgery (they pointed this out explicitly). For example, walking in the halls, there is an order in which people enter patient or operating rooms.  One student reported entering before her team, because she knew the patient, and making small talk.  Later, she reported, “the senior resident yelled at me, said to go in order, and do not talk to the patient.  In 2017.”  In the OR, when students cut sutures, they must always cut the attending’s suture first.  One medical student was admonished loudly in the OR for this.
  7. “You’re expected to know everything already, even though you’re supposed to be learning on the job.” Trainees agreed that they expect to have to prepare for each day at work.  But as trainees, they cannot always know how to prioritize information as they study in advance for what feels like daily examination.  And they are belittled and shamed for not reading their instructors’ minds and knowing exactly what the teacher is asking for (‘pimping’ the students, as it’s known).  “I never feel like enough.”

At this point you may suspect that I somehow planted the seeds of negativity in these trainees’ minds, goaded them on to blast our profession and everybody who had ever said something mean to them in the hospital.  I assure you I did not, and I marveled myself at how easily these labels flew onto the table.  I hurried to take notes.

Thankfully the vibe circled, as it often does.  One woman commented:

  1. “Family medicine seems actually anti-hierarchy.” Attendings, she observed, often defer to students, who usually know the patients the best, when discussing patient history and data.  Team members may all address one another by first names.  Another student piped in:
  2. Pediatrics is similar. Attendings cover for the team during signout, answering pages and signing orders—everybody pitches in.    On rounds students are allowed to be students—to make mistakes, to show gaps in knowledge.  And a resident pointed out:
  3. In anesthesia, team members take breaks, and she felt a sense of autonomy and support of residents—no shaming. “Maybe it’s the nature of the work,” she said, “it’s easier to tag team.”

Fascinating.  I was practically trembling with excitement—here were ten strangers, from different specialties and at various levels of training, men, women, people of diverse colors and cultures.  And we all had the same experience of our chosen profession, much of it negative.  Yet here we all were, committed and still excited to be doing this work—we all still hear the call.  Whatever keeps us going?  How do we get up every morning and come to work in this ‘toxic’ environment?

I’ll tell you tomorrow.

Frass, Trauma, and Other Stuff

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NaBloPoMo 2018:  What I’m Learning

Can’t think of anything useful to write today…  Or rather, I’m too tired to make any half useful thoughts into enough coherently connected sentences to be worth publishing.

So I’ll share some small things I have learned recently, which I find interesting.

Frass

Noun.  Fine powdery refuse or fragile perforated wood produced by the activity of boring insects.  The excrement of insect larvae.

I have a wonderfully smart and kind friend who conserves paper for a living.  Do you know any expert paper conservators up close and personal?  If so then you know the exquisite mind and temperament it takes to do this work.  She must possess the exacting scientific leanings that comprehend both biology and advanced chemistry (inorganic and organic).  She holds the vast sweep of art history, especially as it applies to paper and ink as media, at her fingertips.  And her appreciation for the uniqueness and intrinsic value of every piece drives her pursuit of the end product.  She must command all of this knowledge in an integrated fashion, bringing to each new project confidence, curiosity, and love.  And when she works on an old map in the library archives caked with dust and soot, and tells her friend about the project, she teaches her friend the word frass.

Getting out tree sap and other cool tips

You probably already know about using Coca-Cola to clean toilets, and salsa or ketchup to shine pennies and silver.  But did you know that olive oil and butter get out tree sap, and mayonnaise gets off glue residue?  Unbrewed coffee grounds absorb mildew if you leave them in an open container at the bottom of a closet for several days.  Vodka works well for getting smells out of clothes.  And rubbing your hands with salt can get out the smell of onion or garlic.

Toxic gaslighting

I only learned the word ‘gaslighting’ after the 2016 election.  *sigh*

The word was among the final contenders, apparently, for the Oxford English Dictionary’s 2018 Word of the Year.  But ‘toxic’ won.  Says the head of the company’s US dictionaries, “the word was chosen less for statistical reasons, she said, than for the sheer variety of contexts in which it has proliferated, from conversations about environmental poisons to laments about today’s poisonous political discourse to the #MeToo movement, with its calling out of ‘toxic masculinity.’”  Last year’s WotY was ‘youthquake.’

Trauma

Last weekend I spent time with a wonderful residency classmate and her amazing family.  She is the Chief Medical Officer a large health system that serves a population with a high prevalence of mental illness and substance abuse.  I got to hear about her passionate and profoundly important work educating and advocating for trauma-informed care, which I am only starting to learn about.  Interestingly, NPR had just posted an article detailing findings of a study published in the Journal of the American Medical Association (JAMA) showing that childhood trauma is strongly associated with poor adult function outcomes, such as mental illness, failure to hold a job, and social isolation.  By age 16, 31% of children in the study had had one traumatic exposure, 22.5% had had two, and 14.8% had had three.  What does that look like at the doctor’s office?  Read the Harvard story of the two kids and their vaccines here.  What can we do about it, as physicians and society?  First, recognize the prevalence.  NPR asked, “Should childhood trauma be treated as a public health crisis?”  The answer, unequivocally, is yes.  Second and always, practice curiosity and empathy. Every day.  All the time.  Again and again.  If someone is acting out, before judging them for being difficult and ruining your day on purpose, ask what could lie behind the behavior.  Everybody deserves and benefits from a little concern and gentleness. And if you’re a healthcare professional, start with the Harvard article, and then read this one from the National Council for Behavioral Health.  We all need to treat each other better.  So much better.  Please.

So, what interesting thing(s) have you learned lately?

What The Best Teachers Do

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NaBloPoMo 2018:  What I’m Learning

The post last night was a long time coming, maybe.  It took longer than I thought it would to actually write, edit, and publish, but it poured out in a flurry of energy that has built up over several months.  I received immediate feedback from members of my Counsel of Wisdom, supportive and encouraging, gratifying.

As I thought more, I realized that my best teachers growing up practiced emergent design and strategy.  Imagine you teach the same subject, the same skill, the same content, year after year.  Your approach is to do it the same way, expecting the same result.  Would you not get bored?  And if you’re bored, no question your students may want to gore their eyeballs out with their writing implements.  In medical school my classmate and I met a physician in his office for a lecture on his area of expertise.  We sat across from him in his big armchair behind a mahogany desk piled high with papers in disarray, the sun shining through the window at his back.  He spoke in a slow, bass monotone.  The words that dribbled forth practically fused together, such that I strained to distinguish and make sense of them.  And I kid you not, he literally put his elbow on the desk and rested his face in his palm while he spoke, as if he may have a near death experience from the sheer dullness of it all. That was not his best teaching moment, I’m sure he would agree.

My best instructors, on the other hand, engaged us learners in real time, with rapt energy.  They asked us what we knew about the topic, encouraged us to consider and describe how core principles applied in real life situations.  In classrooms, my best teachers were both goal-oriented and open-minded.  They had a clear learning objective but held the map only loosely. They allowed space for the learning journey and path to unfold before the class, always with an eye on the destination. We learners all got to choose the way, and we still ended up where we needed to be.  And every time I bet it was a little different for the teachers, so it was fun for them and they always learned, too.  I know that’s how it feels for me.  That’s what keeps any of us engaged and improving, I think—the confidence of knowing we hold the reigns coupled with the excitement of not knowing which new trail our class will blaze to apprehend the learning.

My Counselor friend described it as, “The map becomes a new and storied journey with each iteration of participant-cartographers.”  Is she not eloquent?  I have invited her to write a post with me soon.

Coach Christine reminded me, “What you describe is coaching at its best – the fundamental philosophy of the coaching I’m trained in is, the client is naturally creative, resourceful and whole. Not broken, doesn’t need fixing.  Capable of digging deep to find the answers within themselves, and /or where to find the help they need.”  Creative, resourceful, and whole.  I had not heard or seen those words in this context in a long time.  So grateful for the reminder—Thanks, Christine!

What are you teaching these days?  How might you hold your leadership map more loosely and allow those you lead to point to a new or different way?  What might you all gain in the process?

Less Phone, More BOOKS!

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books 11-3-2018

NaBloPoMo 2018: What I’m Learning

Hi, I’m Cathy, and I’m addicted to my phone.

Last month I finally decided to do something about it, mostly so I could be more present to the kids.  It’s been a fascinating journey so far, and I’m proud to say I’ve already made progress.  First I banned Facebook after 6pm.  That went well until I traveled.  Then I took the Facebook app off of my phone.  The withdrawl continues to spike at times.  I also notice that I use other things to substitute—New York Times, email, Washington Post, email, WordPress Reader, email.  I notice an anxiety, a frustration, a kind of crazed, darting hankering– I crave that dopamine hit.

The awareness of it all, however, and the commitment to get disentangled from my screen, has cleared space for a recently dormant impulse to surface afresh:

READ!

* * *

At the conference last month I was turned on to the idea of complexity (or chaos) theory and how it relates to fixing physician burnout and turning our whole medical system around.  It was positively mind-blowing (for me—most others did not seem quite as lit).  The speaker was Anthony Suchman, my newest hero.  Some highlight ideas:

  • Every system is perfectly designed to get exactly the results it gets. Our current healthcare system evolved to this point precisely from serial and cumulative decisions made over years, even though the current state was never the intent.
  • We think of organizations as machines, with predictable, linear consequences of adjustments in one part or another. This is rarely how organizations (of people) actually work.  Rather, we can think of organizations as conversations, and let go our expectations of particular outcomes, the illusion of total control.  We can let things unfold and go where the outcomes lead us, all while holding to core values and goals.
  • Patterns are (re)created in each moment, and also self-organizing. So at the same time that a pattern (eg culture) seems inevitable and self-propagating, sometimes small, almost imperceptible perturbations can create new and dramatic cascades that lead to transformation (the butterfly effect).
  • Emergent Design thus embraces the approach of “finding answers we are willing to not know,” trusting that we will get where we need to go simply because we are paying attention (or that’s how I interpret it today).

This theory that everything within a system both results from and also contributes to the whole system (a fractal) validates an idea I have been advocating to my patients for years, and that I continue to personally relearn ad nauseam: It’s all connected.  The most concrete examples are Sleep, Exercise, Nutrition, Stress Management, and Relationships—I used to call them the 5 Realms of Health; now I call them the 5 Reciprocal Domains.  Each one is inextricably connected to every other one, and they all move in concert, with subtle or dramatic dynamics.

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I browsed around my local bookstore a couple weeks ago and came across a colorful title on the shelf: Emergent Strategy by Adrienne Maree Brown.  So of course I snatched it up.  The blurb says:

Inspired by Octavia Butler’s explorations of our human relationship to change, Emergent Strategy is radical self-help, society-help, and planet-help designed to shape the futures we want to live.  Change is constant.  The world is in a continual state of flux.  It is a stream of ever-mutating, emergent patterns.  Rather than steel ourselves against such change, this book invites us to feel, map, assess, and learn from the swirling patterns around us in order to better understand and influence them as they happen.  This is a resolutely materialist “spirituality” based equally on science and science fiction, a visionary incantation to transform that which ultimately transforms us.

Holy cow, YAAAAS!!  I could not wait to read it!  So I bought it, along with Make Trouble by Cecile Richards, What If This Were Enough? By Heather Havrilesky, and The Dharma of “The Princess Bride” by Ethan Nichtern.  I had also ordered Leading Change in Healthcare, coauthored by Dr. Suchman and two others.  That copy arrived last week.

Suchman 1

I feel this as all part of a slow turn, getting off my phone and diving into books again.  I’m so excited.  I have done this before—buy a bunch of books and never read them.  They occupy whole shelves in my bedroom.  But I honestly feel a transformation coming on.  Yesterday I spent a couple hours reading, researching, and writing the blog post, then I turned off the computer and opened Brown’s book.  I read through the long introduction and resonated with sentences like, “Emergence is the way complex systems and patterns arise out of a multiplicity of relatively simple interactions.”  This is a quote from Complex Adaptive Leadership: Embracing Paradox and Uncertainty by Nick Obolensky (which I have also now ordered).  I also love (ha!), “Perhaps humans’ core function is love.  Love leads us to observe in a much deeper way than any other emotion.”  Also:

all that you touch

you change

all that you change

changes you

the only lasting truth

is change

god is change

That is a quote from Parable of the Sower by Octavia Butler.

Then before bed I opened Suchman et al’s book and found these words, also in the introduction:

Complexity theory here is enriched by the focus on relationships [Hallelujah!], rather than the more traditional reference to science.  “Relationship-Centered Care” is a way of thinking that brings love and all that is personal into a world, the world of healthcare, that is mostly interested in more control and more data-based, evidence-based practices.

The point is made throughout that administrators cannot bring real change into their healthcare institutions without going through change themselves.

(The book describes) the relationship-centered social dynamics that are at the heart of Lean and a major source of this method’s success.  Unfortunately, these social dynamics are overshadowed or even displaced by the analytic technique in some Lean implementations, compromising results.

Suchman 2

So I’m learning about new ways to think on change.   It’s changing how I approach trying to change my patterns, how I see my relationship to them, how I see all relationships.  Wow.

All of this to say, I feel a deeply personal, yet global and cosmic impulse for growth, for transformation—a shift into more mindful and intentional use of my time and energy, and how I manifest it outward.  Less distraction, more focus.  Less incidental information consumption, more integrated learning and coordinated application.  Less phone, more BOOKS.

What will be the outcome?  I have no idea, that’s what makes it so exciting and wonderful!  Onward!

 

It Must Be True Because…

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NaBloPoMo 2018:  What I’m Learning

Funny how fear crops up sometimes.  It’s especially distressing when you fear your own ‘team.’  But we are here to learn and grow, so we step forward. My point in this post is to practice critical appraisal of research data before accepting or integrating it; especially if I am biased toward it.

BI fox news worse 2012

A fellow progressive Facebook group member posted this photo with a message of glee and encouraging everybody to disseminate.  I admit I also initially felt justified and righteous when I saw it.  But something kept me from sharing on my own page.  I should do this more often, perhaps—let something marinate for 24 hours before sharing, just to make sure it’s really something I want to engage with.  I ended up commenting that I think we should be careful about disseminating this kind of oversimplified graphic, as the data may not justify the claim.  I await the angry backlash.

After reading the article in Business Insider from whence the figure came, I had more questions than answers.  What are  Farleigh Dickinson University and Public Mind, anyway?  “Researchers asked 1,185 random nationwide respondents what news sources they had consumed in the past week and then asked them questions about events in the U.S. and abroad.”  What were the questions?  How were they chosen, and how do we know they represent broader knowledge of current events?  “With all else being equal, people who watched no news were expected to answer 1.28 [out of 5] correctly; those watching only Sunday morning shows figured at 1.52; those watching only ‘The Daily Show’ figured at 1.60; and those just listening to NPR were expected to correctly answer 1.97 [out of 4—why the ask one less for this?] international questions.”  Are these differences statistically significant?  And regardless, if the best we can do is answer less than 40% of domestic questions correctly, yikes.  How do we know this actually represents the population?  How does this data compare to similar research findings, maybe ones published in higher caliber, peer-reviewed journals?

The Business Insider article did link to the study report it referenced. I consider this to be a sign of responsible journalism—I look for it in the publications I read—access to the primary literature, so I can dissect and interpret ‘data’ for myself.  Turns out the study was a follow up in 2012 of an initial survey done in 2011 that reported similar findings.  The specific questions and statistical methods are included, as well as discussion of the results.  And while it’s not as rigorous as I am used to reading in peer-reviewed scientific journals, with sections for abstract, background, hypothesis, methods, results, discussion, and conclusion, I could follow the language and rationale of the authors, for the most part. I think they could have done a better job making a distinction between correlation and causation.  I also wished for a discussion addressing implications of the data and recommendations for further study.

Interestingly, I found a Forbes article entitled, “A Rigorous Scientific Look Into the ‘Fox News Effect.’”  I thought it was going to answer all of the questions I asked above.  It started out appropriately skeptical:

In 2012, a Fairleigh Dickinson University survey reported that Fox News viewers were less informed about current events than people who didn’t follow the news at all. The survey had asked current events questions like “Which party has the most seats in the House of Representatives?” and also asked what source of news people followed. The Fox viewers’ current events scores were in the basement. This finding was immediately trumpeted by the liberal media—by Fox, not so much—and has since become known as the Fox News effect. It conjures the image of Fox News as a black hole that sucks facts out of viewers’ heads.

I got excited when I read:

I have done similar surveys, both of current events and more general knowledge. In my research too, Fox News viewers scored the lowest of over 30 popular news sources (though Fox viewers did at least score better than those saying they didn’t follow the news). The chart’s horizontal black lines with tick marks indicate the margins of statistical error. Last Week Tonight with John Oliver, a news satire, had the best-informed viewers.

Turns out the rigor of this scientific look at the FDU data amounted to not much more than pointing out that correlation does not prove causation.  The author, William Poundstone, is a prolific non-fiction author and biographer of Carl Sagan, so I imagine he has formidable expertise parsing research data, though I don’t see any published research or surveys of his own.

In the end I’m satisfied, because I have done my homework on this topic.  I feel righteous again because, this time, I extricated myself from ‘liberal lemming’ (is that a thing? If not then I just coined it) mindset…  But it took some time.  And writing about it has cost me some psychic energy for organization and expression.

As I write this it occurs to me that it would be much more time efficient to just not believe anything I see or hear on any media platform—just be skeptical about everything and leave it at that.  Huh…  Nope.  That feels too much like willful blindness, which does not align with my core values.  It’s worth taking several minutes sometimes and disengagement, to verify the quality of what I take in on a daily basis.  I hereby commit to making this a regular practice.  I’ll let you know when I find anything really worthy of integration and dissemination.

 

How Not to Engage

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NaBloPoMo 2018: What I’m Learning

My friend Alex* posted about being a nurse and how she loves it despite having to always hold her pee, skip lunch, and get bled on, puked on, peed on, and yelled at, all while missing her family and taking care of yours.  One of her friends, we will call him Greg, commented that until nurses unionize and demand professional respect ‘just like physicians,’ nothing will change.

My impulsive (GRRR!) response:  “Trust me, physicians are struggling, too. I propose that we stand up for one another. Then we’d really be a strong force. And in the end it benefits us all–doctors, nurses, patients, the whole care team and, most importantly, patients. Also, I don’t know of any unions that physicians can join, but there are ones that nurses can: https://nurse.org/articles/pros-and-cons-nursing-unions/”  Okay, I know, saying, “Trust me,” is not a good way to get someone to trust or listen to you.  And my reply was defensive in its origin.  I sincerely believe what I wrote, though, that allied advocacy is an untapped force for good in medicine.  Physicians, patients, nurses, all healthcare professionals—why should we not actively support one another in all of our efforts to achieve a more cohesive, efficient, fair, and collaborative system, one that works better for all of us?  Why can we not embrace our connections and combine our voices to call for change?

Greg replied that basically he does not believe that physicians are “struggling,” and he does not see how we would stand up for one another.  After Alex described that I’m a physician “who will always help the nurses,” he wrote that doctors “can’t be in the business of supporting nurses.”  That we should “be in the business of supporting” ourselves, and “from all the research I’ve ever seen, they’ve continued to do a pretty good job of it.  Good for them.”  He expressed support for physicians’ right to advocate for ourselves.  In each reply, he continued to make his point that nurses should unionize.

I find this thread fascinating.  There are so many ways Greg and I could interpret each other’s replies.  When he talks about demanding respect ‘like physicians’ through unions, what benefits and outcomes does he imagine will follow?  When I say “struggling,” I wonder what he thinks I mean?  Actually he asks me, “How exactly are physicians struggling?”  He goes on to write, “Nurses are nurses and should be for nurses.”  All of his comments and the tone I inferred from them caused me to beg off of the thread.  Too bad, it might have been an interesting conversation—if we could have it in person.  Maybe we can later.

But it motivated me to look up some information to post here, in case anybody wonders ‘how physicians are struggling.’  The answer is burnout, depression, suicide, and leaving work that we love because it simply costs us too much—and I mean costs other than money.

Physician burnout is well described and referenced.

Doctors suffer from burnout in especially high numbers, according to the study, which was designed to offer a representative snapshot of doctors and the general U.S. working population. Nearly half of U.S. physicians – 49 percent – meet the definition for overall burnout, compared with 28 percent of other U.S. workers. More than 54 percent of doctors have at least one symptom of burnout, a more detailed analysis found.

Doctors also register more than one and a half times the general working public’s rates of emotional exhaustion and depersonalization. Working a median 50 hours per week, their satisfaction with work-life balance is far lower than that of others: 36 percent versus 61 percent.

medscape burnout causes 2018

Medscape Survey 2018

There are myriad causes for physician burnout, and most of them lie in the system, not in our inherent lack of resilience or because of some intrinsic defect in our collective character.  The electronic health record has accelerated our dissatisfaction with work.  It does so by creating innumerable clicks to accomplish menial tasks, burdening us with data entry that detracts from actual medical decision making and patient care, and putting a physical barrier between us and our patients, further separating us in relationship.  Burned out and dissatisfied doctors are distracted, less empathetic, and aloof, and we may even make more mistakes.  And when we aren’t well, our patients aren’t well.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. But they are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity, as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether — an ominous trend as the U.S. experiences a growing doctor shortage.

 

I have not addressed here the challenges that nurses face every day.  My mom is a nurse, and I have worked with nurses my whole career.  I see how they are treated by the system and by patients, and also by us physicians.  And yes, my extracurricular activities focus solely on advocating for physician health and well-being.  Maybe I should learn more about nurse burnout and job satisfaction, and figure out ways to advocate for my nursing friends and colleagues better.

Or maybe it’s too much to ask for groups to stick up for one another.  Maybe Greg is right, and it should be every tribe for itself, let others take care of their own.  Maybe it doesn’t do any good for people to know how and how much doctors “struggle.”  I don’t know.  But I have learned now not to instigate such debates on my friends’ pages on social media.

*Not her real name