Tag Archives: physican

Hippie Zealout Conference High! Notes from CENTILE 2015

Posted on by
4

Hello again, friends, I have missed you!  It’s been an exciting and exhausting month of travel, nature, speaking, and learning.  My brain and heart are both so full I can hardly stand it, and all I want to do is write and talk about it!  Last week I attended yet another phenomenal meeting!  I feel another quantum leap coming on, both professionally and personally.  Below is the spontaneous post I wrote over lunch on Tuesday, and I wish I had published at the time.  I would have made my own deadline and… well whatever, it’s all about learning to put myself out there with less fear and judgment.  *sigh*

Now I have some time to synthesize and process…  Here’s hoping I can articulate and share effectively! 🙂  Thank you for reading, and please share your thoughts! –Cathy

~

Tuesday, October 20, 2015

Hello from Washington, DC! I submit this report from Day 2 of the CENTILE Conference, 2015, the International Conference to Promote Resilience, Empathy, and Well-Being in Health Care Professions.  I am in symposium heaven—it’s a veritable love fest of like-minded and like-souled physicians, nurses, educators, scientists and others, all here to share what we’re doing to make medical practice and practitioners healthier!

In the spirit of sharing and collaboration, I present in this post the highlights of the conference so far, and invite you all to reply and share how they resonate with you. Let’s explore how we can make not only medicine more humane, but life on Earth, and all of our relationships, too!

Caveat: My own thoughts will appear in [brackets]. The other ideas come from my handwritten notes, and I make no claims of content accuracy.  They are what resonate with me personally, experienced through my existing filters…  I hope they move you, as well.

  • ‘Burnout’ may be an obsolete term, fixing our gaze on what’s wrong. It may benefit us all more, rather, to shift our attention to wellness, in all its forms and layers. [“Energy flows where attention goes.”]
  • Six areas of job-person fit or mismatch:
    • Workload
    • Control (choice, discretion, voice)
    • Reward (compensation, recognition, acknowledgement –[“I see you.”])
    • Community (workplace RELATIONSHIPS!!!)
    • Fairness (promotions, etc. [!gender bias])
    • Values ([Your WHY—does it align with the organization? Does the organization walk its talk? Does it allow or hinder you to walk yours?])
  • There are mountains of burnout data, and only molehills for interventions and their outcomes—now we know what to study!
  • Individual strategies are not enough, the system/context also needs to change in order for providers to be well and do their best work—the data is sparse, but that which exists suggests that this is the more effective approach—we need BOTH.
  • Workplace civility: Our words and body language matter, more than we know! When we act meanly or kindly, it does not just affect the other person, it affects everybody. Thus we can choose, in everything we say and do, to contribute to a more loving or a more toxic work environment.
  • We need to change our culture. This will not happen overnight—”there is no antibiotic!” We need to think of it more as sustained lifestyle change—[diet and] exercise!
  • There is now a growing consortium of pediatrics residencies, all collecting data on baseline wellness, innovating and implementing strategies for improvement, and reporting outcomes! Wooooooooo hooooooooooo!!
  • More and more medical schools are changing the traditional teaching models and including resilience training, with amazing results. At St. Louis University School of medicine, by making the first two years pass/fail, decreasing curriculum time by 10%, and offering longitudinal electives, the depression rates among first and second year medical students dropped from 25-35% to 8-21%, and for anxiety from 54-61% to 14-47%, respectively. Holy cow!
  • [I’ve been saying this for a while:] Physicians are [tribal] leaders, like it or not. But they should not be compared to the captain of the ship; rather, they are the coach of a high school soccer team from which no player gets cut and all must participate.
  • You can calculate fiscal ROI for wellness interventions! At one large academic institution, Resilience training for faculty and staff decreased employee healthcare costs by $450 per person for year over 5 years [I’m pretty sure I got that number right…].
  • Partnering health sciences students with a peer health coach during their training improves their subjective well-being, their biometric measurements, as well as their own confidence in advising patients on lifestyle change.  In addition, the peer coaches also benefited similarly.  [ IT’S ALWAYS A WIN-WIN WHEN WE HELP ONE ANOTHER, HOOOOOORRAAAAAAAAYYY!!]
  • Stress is not all bad!
    • “Threat” stress can be—fight or flight—cortisol, vasoconstriction
    • “Challenge” stress can be good—rise to the occasion—DHEA, testosterone, vasodilation
    • “Tend to a friend” stress can be very good—evokes caring behaviors that help the tribe thrive—increases oxytocin, the hormone of love.
    • Generally we see that people with increased stress die earlier, but it’s actually the subset of those who believe that stress is all bad who do this; those who believe that stress is not all bad actually live longer!

Resilience can be learned. It’s proven!  Let’s get started now!!

The Burnout Crucible

Posted on by
25

For the past three years, I have had the privilege every month of meeting with a remarkable group of medical students. I precept a group of about ten, discussing topics that range from death and dying to social media. The class meets regularly during the students’ third and fourth years. Through blog posts and discussion, they share stories from their clinical rotations and personal lives, things they witness and how they think and feel on the wards. We talk about culture, technology, and work-life balance, among other things. These students consistently inspire me with their passion, insight, and honesty.

My last group, members of the Class of 2015, set the bar very high for their underclassmen. Over the two years we met monthly, we shared myriad stories and loads of food. They came to my house and knew my children. We slogged through residency applications and interviews, and celebrated engagements, weddings, Match Day and graduation. I loved them. Being with them fed my soul and I could not imagine another group feeling quite the same.

In that time I was also growing my own interest in physician wellness and resilience. In 2014 I had the honor of presenting on physician burnout to the primary care providers at the Cook County Jail, one of the largest correctional facilities in the nation, with an average daily census of 9900 detainees. Can you imagine? I learned infinitely more that day than anyone in my audience—God bless each and every one of them!  Since then I have presented similar talks to members of the Chicago Medical Society, the American College of Physicians, and at the University of New Mexico. I have connected with other physicians similarly interested in helping our profession uphold its principal call to heal, starting with ourselves.

I can joyfully report that I am already in love with my new group of third years. They had me from, “This is why I came to medical school,” when they wrote about their first impressions of clinical rotations.  I could palpate their exhilaration and glee at finally getting to help take care of patients, rather than just reading about it and practicing on actors. In July I found myself practically commanding them to, “Print these essays out and hang them all over your apartment for later, when you hit the inevitable wall!” As if it were a foregone conclusion that the fire of passion in their training would dwindle and burn out.

Since the summer I have wondered, is it necessarily better to enjoy an ever-roaring fire? Or could there be greater value in the flagging smolder, and the attention and work required to re-ignite the flame? As the students progress in their training, we talk about behaviors that they witness—many inspiring, some not so much. We examine the potential origins of the latter. I ask them to assume that all of us, physicians, nurses, therapists, and other clinical staff, come to medicine to help people, and that we are all kind and compassionate people at heart.

What then, drives people like us to behave in such unloving, unkind, dismissive, and undermining ways? Emergency room doctors and nurses crack jokes and exchange snarky remarks about trauma patients, teams rounding on wards refer to patients by their diagnoses rather than their names. The students know the causes—they are the defining markers of burnout: emotional exhaustion, depersonalization, and low sense of accomplishment. It’s not intentional, it’s insidious. It’s toxic, and the medical community is waking up to the costs, both personal and institutional, of burned out physicians. It resembles a plague, infectious and potentially life-threatening, with few reliable treatments.

While I would never wish burnout on anyone, I also think that the process of rising from its depths to a new mesa of joy in medicine can be a good thing. For my students who articulate so clearly their Why for being here, maybe all it will take is reading their class blogs or med school application essays over again. Or maybe it will take deeper soul searching and acquisition of new skills, in mindfulness and stress management, prioritization and boundary-setting, to get them out of a burnout funk. Will those surviving this crucible be better physicians, better people, than those for whom the fire never dwindles? I don’t know.

I’m reminded of a TED talk by Ester Perel on infidelity. As a researcher, she’s often asked if she recommends that people have affairs, because she studies the personal growth that can result from the experience. She says she would no more recommend having an affair than having cancer. And, that cancer survivors will often tell you that they now live more fully and authentically because of their illness. Maybe burnout is the same? We don’t want it, it’s painful and destructive, but if we can come through it, we may be better for it.

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out. In my last session with the students, we ended by asking ourselves:

  1. What do I need (to take care of myself)?
  2. How will I get it (without harming someone else)?
  3. How will I be a contribution?

Maybe this is a good place to start.

I Am A Lone Nut!

Posted on by
34

At the end of my recent physician burnout/resilience presentation, I stood wondering if it meant anything to anybody. I did my best to follow Nancy Duarte’s structure in her book, Resonate: Make the audience the hero, contrast what is and what could be in story with texture and emotion, sound the call to action and describe the blissful future! Every time I give this talk I feel energized and passionate by the end, but most of the audience looks positively neutral. Thankfully, a few usually approach me afterward with words of praise and I feel somewhat validated. I remind myself, if only one person is moved, then I have made a difference and it was worth presenting.

When I spoke to editors, writers, and instructors at the Harvard writing conference, they said I should not write for both patients and physicians, I had to pick one. They told me to identify my audience (but keep it broad), and then differentiate myself from all the other authors writing for that audience. It feels like opening a retail shop. What will I sell? Who do I want to shop here? What is my purpose? It’s not to make money; it’s to make a positive impact on the community, to fill a need. Some people will walk in, look around, and walk out without buying anything. That’s okay. If I stay open long enough, they may wonder, ‘What’s so great about her store that she’s still in business? Maybe I should look again.’ They may eventually make a purchase, if they see something of value.

Others will enter, feel immediately at home, and linger in the aisles, soaking up the aesthetics, wishing they had more time to spend. One shiny piece will catch an eye, they’ll snatch it up, and come back as soon as they can, looking for more treasures. They belong here, and so do I. Now I know, I’m not simply writing for patients and physicians; I’m writing for those patients and physicians who, like me, believe that our healthcare system can thrive again only if we all work to reclaim our relationships.

I aim to start a movement.

But one does not accomplish this by barking a generic message to everybody who walks by. Doctors come to noon conference as a routine, a social and academic ritual. We earn one hour of continuing education credit for showing up, staying to the end, and completing the requisite evaluation forms, regardless of how much we actually engage with the presentation content. It occurred to me this time, that there are always a few in the audience primed to receive and respond to my message—they are my tribe. While some parts of my talk may resonate with some people, the whole talk will resonate deeply with those few. They are my target audience. Why? Because they are the ones who will take up the torch, hail the call to action, and participate in the movement now. They feel, like I do, a visceral agitation for this change.

To the attendees who don’t feel it (yet), I must seem like some lone nut, roaming the room and flailing my arms about. They may remember something I say and apply it for a short time, and forget me in a few days. But for my fellow tribe members, my waving and shouting (I don’t really shout) stirs something kindred and profound. They want to wave and shout back, “I get it, I get it! Hallelujah!” They will carry my message with them and share it with anyone who will listen, because it is their message, too. I know because I get this way when I hear someone speak who believes what I believe. It happens at professional meetings; I call it the Hippie-Zealot Conference High.

I get the idea of the ‘lone nut’ from Derek Sivers’ TED talk, “How to Start A Movement.” Sometimes I feel like the one on the amphitheater lawn, dancing unabashedly, provoking expressions of ‘weirdo’ from others. But there will be tribe members there, the townspeople who love my shop. They will get up and dance with me, if only I can connect with them. Maybe all it takes is eye contact, a welcoming smile, or an exuberant gesture to join in. Once they stand up and start dancing, pretty soon the gawkers may feel our collective energy, shuffle cautiously at first, then let loose and get down with abandon. We will all be in relationship for the better.

Derek Sivers calls those tribe members ‘the first followers.’ I prefer to think of them as fellow lone nuts. Lone nut status, especially with a microphone (or megaphone) can feel special, and it also gets lonely. I would much rather live and work among mixed nuts, with complementary and mutually enhancing, yet unique, contributions to the jar.

From now on, when I present on physician resilience, patient-physician relationship, or any other passion, I will make a concerted effort to acknowledge my fellow lone nuts. I will call out to them especially loudly, and invite them personally to join the movement. Then we will all feel empowered to rally the masses, one small circle at a time, until everybody’s up and dancing, happy, strong, and together.