I know you don’t know me, but I feel like I know you from your transparency and radical honesty in all of your public communications. I know that you speak truth to bullsh*t while remaining civil. I know that you are more than aware of the lack of adequate mental health services across the nation. I know you see the catastrophic toll medicine takes on the mental health needs of health care providers specifically. I know that you are worried about the future of medicine because the PTSD that results from COVID-19 will be catastrophic and exceed the capacity of the system to care for its own.
You are passionate about fixing the massive problems of the current health care system. You speak about the utmost importance of re-humanizing medicine and returning the clinician-led, deep human-human relationships of old-school models to the top of the priority list. I am on-board with all of this, 100 percent.
But how is this change going to happen exactly?
You advocate for ways that providers could care for themselves in the future. Mindfulness, meditation, empathy, and self-compassion are all extremely useful tools. I am so grateful that you endorse their value because so many are quick to dismiss such things as malarkey.
My concern is not that these practices aren’t worthwhile, but that they are all performed in isolation. Given that humans are wired for connection, are these solo practices going to be enough to sustain the mental stability of burned-out, over-taxed health care professionals?
You see the value of holding multi-disciplinary rounds with pharmacists, nurses, and other important players involved in caring for the patient. But we also need to gather momentum, and take a multi-pronged approach to ways health care providers can care for themselves.
My experience leaning on colleagues has been sorely inadequate. How can one drowning victim rescue another drowning victim? And if you have just pulled yourself out of the ocean, do you really have the strength to dive back in and save another? The insufficient skills of my colleagues actually damaged me many times in my career, leaving me with more shame and a sense of inadequacy than if I had kept my traumatic experiences to myself. Ironically, most star-performing medical professionals are notably deficient in emotional intelligence. Having spent their adult lives honing their intellectual skills, they don’t know much at all about their own feelings, needs, or how to meet them, much less how to meet the needs of colleagues.
According to psychologist Dacher Keltner, people are born inherently compassionate. But power erodes compassion and undermines people’s ability to truly love and show concern for others. Power is a destructive force.
Now that health care providers are universally dis-empowered, where will they regain their compassion skills? Who will teach them to have compassion for themselves? Who will grant them permission to care for themselves and meet their deepest needs?
I don’t believe more exhaustion, self-denial, or delayed gratification are going to deliver the level of satisfaction, meaning, and positive self-worth health care providers need so badly.
In order to be “anti-fragile” and still feel safe to take off our robot armor, ask for help, and connect with other humans, we need professional facilitators. We need physician coaches at every level of medical training and beyond. We need guidance, tools, and skills to actually learn ways to recover from the daily trauma that life in medicine brings; cognitive-behavioral and positive psychology skills with tangible action steps to deal with overwhelm, workaholism, over-spending, over-eating, imposter syndrome, perfectionism, burnout, work-life balance, poor patient outcomes, financial crisis, work, and personal relationships, etc. You get the picture.
We can’t only sit in lotus position and drink more protein powder. We need actual personal trainers to build the emotional muscle, strength, and strategies to keep showing up at work, not only in body, but also in mind and spirit. Full presence.
I strongly believe that traditional therapy and psychiatry are vital and valuable disciplines. (I might not be here without them.) But not everyone who needs help living adult life or surviving a life in medicine should have to meet the DSM criteria for mental illness or suicide risk in order to qualify for emotional support. No one should have to go through life alone, literally or metaphorically. No one should see quitting or even suicide as the only ways to end the suffering.
I highly recommend that you incorporate physician coaching into your revolutionary health care vision. Coaching by health care workers, for health care workers, who are trained and certified to be coaches, is the untapped and underutilized resource for providing the skills to heal our broken culture. By first and foremost healing ourselves, coaching has the potential to radically transform medical training and all of our experiences in health care. The only way to eliminate the negative stigma around self-care, physician well-being, mental health, and the universal need for help, is to have such professionals integrated into all aspects of medical training and careers.
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