One of the most extensive studies to look at trauma in the U.S., the ACE study (Adverse Childhood Events), showed that more than 60 percent of adults surveyed had experienced one traumatic event during childhood, including enduring physical, emotional, or sexual abuse — 25 percent of women had experienced sexual abuse. This shows how prevalent abuse is in childhood and how most of us carry trauma. It does not escape physicians or any demographic.
Whether we saw, experienced abuse or were emotionally neglected, those experiences leave an imprint in our brains. They can shape our responses and actions and be triggers that can lead to the future activation of our stress response. These triggers can later resurface subconsciously.
If we analyze this further, we can then think about the fact that many physicians came to medicine due to an experience while growing up in which maybe they did not feel control, respect or their needs were not being met.
Perhaps it was an illness they experienced, or they were a caretaker for an ill family member, or they endured some trauma growing up. This could have led them to pursue a profession in which they envisioned they would have control (with their expertise and knowledge) and respect or admiration (which they craved if they grew up with emotional neglect).
As we continue in the practice of medicine, it has become clear that we have many challenges in our profession. This includes our ability to have control of all the tasks piled on us and to control our free or busy time. Respect given to our profession has dwindled, which are the top causes of burnout.
We are also faced with sexism, racism, and implicit bias, which not only chips away at our enthusiasm, but it is also a trigger or alarm that begins to ring within us when we experience it.
This puts us back subconsciously in the situations we thought we were “fixing, escaping, or overcoming,” which may have propelled us to choose a career in medicine.
When we are triggered unconsciously, we are then brought back to a familiar and stress-provoking place where we are not in control, where we are not respected or listened to. Our stress response unknowingly begins to wreak havoc on our internal well-being. Our stress hormones begin to flood us unknowingly until we are faced with the chronic and end-stage symptoms of stress, which is burnout.
The hormones released in our brain from the stressful stimuli begin to impair the executive function of planning and diminish our capacity for compassion and empathy. It also turns down an area in the brain that deals with our expressive language (Broca’s area), and therefore it is challenging to express what we are feeling or why we are feeling it.
At some point, we no longer recognize why we are angry, reactive and overwhelmed as we cannot verbalize it. We have no time to stop and pause to reflect on this since our workload and tasks continue to pile up. There are always more demands, meetings or charts to close with dwindling personal time to rest and recover. There is no time to think about what feels right, what we need, but we are now just in survival mode. Trying to get through the day and weeks begins to blend into a wake-, work-, sleep-, rinse- and repeat-cycle.
Our capacity to create and envision begins to dwindle as those creative parts of our brain are shut down during chronic stress. What would we do if we could pause and listen to our needs, bodies and intuition? It would tell us that continuing this path in which our basic needs to rest, eat and have time to take care of our own health are neglected. It will be personally destructive, which has amplified the health care burnout toll.
As physicians in the U.S., we continue to be in a crisis in which burnout, anxiety, depression, suicidal ideation and more than 400 suicides per year plague our profession. The data show more than 40 percent of all physicians are experiencing burnout but affecting more than 50 percent of all women physicians. More worrisome are the rates showing 13 percent have suicidal ideations and 26 percent drink alcohol to cope with burnout.
The consequences of burnout are the cost of making medical errors as well as having the health care workforce leave, which has been significantly augmented during the pandemic with #thegreatresignation.
A subconscious, yet present sensation, tells us something is wrong, to listen to our bodies, to our intuition. Yet we deny our inner voice as we cannot see it. We cannot prove it exists. We have been conditioned that only what is factual or linear is what we can trust and believe.
What will be the outcome if we continue to deny what we are feeling and experiencing? Who or what will save the wounded healers who are left?
To begin recovery, we must continue to speak up and change the narrative of wellness for physicians. All of us make up the culture of medicine. It is not an external force without a name or a face. We all have a voice that can start change.
We must speak up and set boundaries for self-care, which is essential care. Continuing to deny basic needs or self-care that is not prioritized will continue to deplete us and not allow the much-needed time for resetting and introspection.
When we quiet our mind, rest and recover and have time to exercise and take care of our health, we can counter the flood of stress hormones.
It is under a state of mental calm that we can be creative, compassionate, and empathize with others, which are many of the qualities and attributes that brought us to medicine. We cannot continue the path we are on. The change in culture to recover the wounded healers must start today.
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