There are highs and lows in doing any job and throughout one’s career. The highs, and the possibility of highs, can often overpower the effect that the low moments have on well-being and professional satisfaction.
The health care context is no different. But unlike most professions, physicians, nurses and other health care workers are exposed to a higher frequency of distress, pain, suffering, death and trauma and all the accumulated personal and professional highs don’t always neutralize their effects.
Without a balanced overview of a patient’s circumstances and situation, exposure to distress can cause a physician (and anyone!) to feel distressed. With repeated exposure and an absence of practices that attenuate their negative effects, emotional distress can accumulate and become imprinted in the physician’s and the collective health care workforce’s psyche.
Over the years, I’ve asked hundreds of health professionals about how they go about processing the effects of being exposed to distress and suffering. Most of the time they answered with a blank look. After some prompting, many shared they release pent-up energy through regular physical activity, have lots of socializing time, family time, numb out with tv/drugs/alcohol/pain meds and lots of holidays. Relatively few mentioned the word self-care, going to therapy, meditation, self-inquiry, reflection, restorative or spiritual practices.
I haven’t gone to medical school, but I’m pretty sure there isn’t an evidence-based ceremony or ritual involving the transmission of healing, bionic intuition and emotional resilience superpowers from teacher to student that makes the newly minted or experienced doctor impervious to human suffering.
Last time I inquired, everyone involved in medical training and education are extraordinarily ordinary humans who need to eat, sleep, create, feel joy and the broad range of human emotion like everyone else. So if that’s case, why are psychotherapists, psychologists, social workers and counselors expected to have regular, frequent and consistent reflective practice and debriefing sessions while physicians, surgeons, nurses and other frontline workers are not? Am I missing something?
Considering the frequency that health care workers are exposed to pain and suffering, or treat patients with procedures that cause pain, it’s surprising that physicians and many other health practitioners don’t debrief frequently, as in daily to once per week minimum, about the distressing things they witness with a professional facilitator. Even when the pain caused benefits the patient, what’s the impact on the doctor who injects vaccines in children? The nurse who has to draw blood from hard to access veins? The pediatrician who has to call social services with suspicion of child abuse? Or the surgeon with a teenage daughter who had to remove a teenager’s ovaries?
I totally get the necessity to squash those negative feelings down because they can feel overwhelming and can get in the way of doing a job well. On the other hand, holding onto those feelings without giving them a healthy outlet can also be a barrier to doing a job well.
While knowledge, evidence-based protocols and logic are used to justify causing pain, emotions don’t work that way. Emotions can’t be coaxed or placated using rational thinking because they’re not rational —they just are. Emotions can be acknowledged and felt or numbed and repressed. Even if it’s accepted that painful procedures, breaking bad news and experiencing patient death are part of the job, these events can still negatively impact professional satisfaction if there isn’t a positive outlet to give a voice to feelings emerging from distress.
What about those times when patients open up to their trusted doctor about their cares and concerns that they haven’t been able to share with anyone else? Consider the courage and strength it takes for someone to bare their soul about what’s going on inside them and how powerful it is for this vulnerability to be witnessed by a caring professional, especially if the patient is used to soldiering on and being ‘strong’ for everyone else. It’s likely that opening up to a professional support that shows warmth, openness and interest helps them feel relief, accepted, courageous and less anxious. Why would the experience be any different for a doctor?
As soon as we give a voice to our concerns, feelings, fears, near misses, mistakes, doubts, and desire for insight in a safe, confidential setting with someone who wants to explore our experiences with us, relief is felt, and our feelings become our allies in understanding and trusting ourselves more. We need someone who can express unconditional positive regard, non-judgement, empathically listen and won’t jump in to fix, offer well-intended advice or rescue us from our own distress (because of their distress with our distress — what a feedback loop!) while also gaining new ways of perceiving experiences and strategies to implement into practice to align better with best practice principles, insights come. This can help develop self-confidence, assertive communication, humility, kindness, compassion and other qualities that research evidence says benefits practitioners, patients and pretty much all participants in the health care system.
Reflective practice, self-inquiry, and regular debriefings are vital for doctors to develop self-awareness so they can easily detect the internal signals that more self-care and support is needed. These practices also reveal the highs in what might have been perceived as lows and provide an opportunity to discover ways to increase the satisfying ways of working with patients and colleagues. And this can help doctors restore a balanced outlook on patient care so that they’re less likely to feel distressed and more likely to feel calm, leaning toward compassionate when exposed to human suffering.
This has effects on professional satisfaction, burnout and compassion fatigue prevention, reduced staff turnover and absenteeism, strengthened connection among health care teams, increased patient satisfaction and eventually a healthier health care system that no longer stigmatizes doctors and patients having any extraordinarily ordinary human experiences.
Nathalie Martinek is a health care researcher in Australia.
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