It’s time to reframe second victim syndrome [PODCAST]

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“Taking control of distress is done by embracing the concept of ‘mental fitness.’ Being mentally fit enables one to overcome the negative emotions that have traditionally sabotaged our lives, both personally and professionally. Similar to physical fitness optimizing our bodily strength, mental fitness promotes achievement in our performance, relationships, and sense of well-being. Much research has been done in neuroscience, cognitive and positive psychology, and performance science, showing the true benefit of mental fitness. In particular, the concept of neuroplasticity suggests that with the continued strengthening of certain neural pathways in the brain, modifications in brain architecture can be achieved. These changes have been shown with functional MRI, demonstrating increased density of grey matter in areas that correspond to certain thought processes.”

Susan Wilson is an emergency physician and physician coach.

She shares her story and discusses her KevinMD article, “It’s time to reframe second victim syndrome.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Susan Wilson. She’s an emergency physician and physician coach, and she wrote the KevinMD article “It’s time to reframe second victim syndrome.” Susan, welcome back to the show.

Susan Wilson: Thanks, Kevin. I’m so excited to be back with you after just a few months.

Kevin Pho: So we’ll get into the article in a little bit, but for those who didn’t get a chance to listen to our first conversation, can you briefly share your story and journey to where you are today?

Susan Wilson: Sure. I actually practiced emergency medicine for about 25 years in the Milwaukee area and had to retire in June of 2019. I actually have this progressive retinopathy, so I just couldn’t see well enough anymore to work clinically, but I still really wanted to be involved in medicine and interacting with colleagues. So I thought coaching would be a perfect thing to do. As a result, I got my coaching certification, and now I’m really focusing on assisting and supporting health care professionals with job satisfaction, work-life balance, and anything that really can help them make their careers more successful.

Kevin Pho: Now, over the past year during the pandemic, from a coaching standpoint, what do you think are the biggest issues right now facing health care professionals that you see in your practice?

Susan Wilson: Well, I’ve heard a lot of people specifically talking about the exhaustion piece, so certainly both physical and emotional exhaustion. And as we all know, emotional exhaustion is one of the primary features of burnout. So I think those seem to be the primary concerns for people.

And then certainly, with things that have changed in medicine, telehealth is becoming much more prominent. I know a lot of people in different specialties have been furloughed, and there have been cuts in salaries, so those are also concerns for people. As a result, those have become much more important to people in terms of how to deal with those in their career and still feel satisfied.

Kevin Pho: So I know each individual case is different, of course, but in general, when you talk to health care professionals and you talk about burnout, what are some actionable tips that you typically give to them?

Susan Wilson: Well, one thing I love to tell people is to really think about your mantra, like, what is your why? Why are you in medicine? Why is this important to you? It sounds probably a little corny, but the idea of actually writing your mantra on paper and reminding yourself of that every day before you go to work, I think, is really helpful. I mean, I kind of did that throughout my career, and it really made turning around from a tough shift and going back into the emergency department the next day much more doable and palatable. So I love that idea of the mantra.

Certainly, the whole concept of self-care and really doing things for yourself is so important, and finding things that really bring you joy, so that you at least have something to look forward to when you’re not working.

Kevin Pho: And when you talk to a lot of your clinician clients, do a lot of them talk about leaving medicine altogether?

Susan Wilson: You know, some of them do. A lot of them I’ve talked to think about what else they could do in medicine. I mean, they’re in a certain specialty. Certainly a lot of my clients are in emergency medicine, and a lot of them have talked about, “Well, maybe there’s something else I can do. I don’t think I can do this anymore.” And so yes, that’s definitely something that I think is important for people.

Kevin Pho: All right, let’s transition now into your KevinMD article. It was written back in April. It’s titled “It’s time to reframe second victim syndrome.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and again share the story of why you decided to write it?

Susan Wilson: Yeah. So as you know, and maybe some of your audience knows, I’ve been really passionate about this whole concept of second victim syndrome and peer support. At the very beginning of my coaching career, I really did a lot of work around that and thought a lot about it. And recently, just in the past few months, I’ve really had an epiphany about this concept that we’re not victims. So I think the time has really come to sort of reframe that.

Instead of the word “victim,” which suggests that we’re helpless, we have no power, we have no control, we’ve been injured, instead of that word, I’m really now drawn to being more discerning about the concept. So I love the idea of recalling this, or renaming it, “clinician distress syndrome.” I feel like just changing it that way suggests, yes, there’s still distress. I’m not minimizing the impact of these events, but just the idea that, no, we’re not victims.

And then I go on in the article to describe where a lot of this thought comes from for me personally. I’ve been doing a lot of work now around mental fitness, and I’ve actually subsequently been using mental fitness as the framework for my coaching. The whole concept is clinicians really taking control. Just like you build up physical fitness and you become stronger physically, the whole concept is building up your mental muscle and becoming stronger mentally. And I do see that as something that can really help us get through these sorts of scenarios.

Kevin Pho: Now, there’s the psychological concept of learned helplessness, and I think it applies to a lot of physicians, in that they feel like a lot of things are being done to them, whether it’s pre-authorizations or electronic medical records and bureaucracy. And I think that there’s that lack of empowerment that physicians have. No, give an example of how a typical clinician can kind of reframe that, perhaps, and take a more proactive approach that you suggest.

Susan Wilson: Well, the work I’m doing, and actually I’ve done this both for myself personally and am now sharing this with my clients, is based on the work of Shirzad Chamine, and the whole program is called Positive Intelligence. The concept is that we just have three core mental muscles, and the whole idea is you’re building up those muscles. This is done actually through mindfulness exercises.

Basically, what you do is we’re recognizing saboteur voices, which are negative, and sage voices, which are positive. These are basically personifications of thoughts, thought patterns that we’ve all had through the years. And so you think about it: In medicine, there are so many negative thoughts out there, or negative concepts that have just kind of been ingrained in us. So the idea is, instead of thinking of everything, having your saboteur kind of dominate your thought and how you’re approaching something, by practicing mindfulness you are ultimately able to switch over to seeing things through the sage perspective and being much more positive.

So for example, let’s say a physician is encountering a struggle with pre-authorization, and it’s super frustrating. Well, that anger, frustration, and upset is all coming from a saboteur voice in your head, so that’s a thought pattern, right? And so the idea is being able to switch over into the sage, which is the positive, calm, clear-headed, big-picture kind of thought. So maybe you can use this opportunity to try and modify the system that you find has been so dissatisfying.

So it’s just a change in mindset. It’s a change in how we approach things. And so then maybe, if you find that pre-authorization has become an issue, then get involved in helping to change that or modifying it in some way so that it does work for you and for your patients.

Kevin Pho: Now, a lot of times physicians or other clinicians have just gone through their entire medical training with one particular mindset. Now, in your experience, how long does it normally take for a typical clinician to reframe or change their mindset into something that you’re talking about?

Susan Wilson: Well, certainly this is a process. I mean, if you think about it, our entire lives we’ve had these certain thought patterns that we’ve been using to try to get us to where we are today. These saboteurs, as they are described, are kind of identified in the left part of the brain, so we think of that as the rational, analytical part, the survival brain, the fight or flight. And so that’s kind of what has been dominating our thoughts. And you think of physicians, or anybody in medicine in particular, and you think of them being hyper-achievers. They’re hyper-rational, they’re perfectionists, and those are all those negative kinds of thoughts, or characters, that have really gotten us where we are right now.

And so being able to switch over and gradually build up this stronger muscle, so that you can switch over to your sage and get back in touch with your positive emotions, that’s a process. It’s not going to happen overnight. I will use myself as an example. I started doing this work personally just a few months ago, actually really after I think we first talked in January, and I have already noticed, just in eight to 12 weeks, a significant change in how I approach things, both professionally and personally. It’s kind of funny: My husband’s totally noticed. “Oh, you are much more positive about things.”

And so I just see this as such a great application for people in medicine, and really being able to just work on this, just like you work on your physical fitness. When you go to the gym, you don’t expect in a week that, “Oh, I’m going to be able to bench press a couple hundred pounds,” or whatever. It’s just a process, but I think it’s a great goal to have and something that, over time, will definitely make a difference.

Kevin Pho: We’re talking to Susan Wilson. She’s an emergency physician and physician coach. She wrote the KevinMD article “It’s time to reframe second victim syndrome.” Susan, you talk about mental fitness, and you talk about switching from the saboteur voice to the sage voice. Are there any other exercises that clinicians can do to improve their mental fitness?

Susan Wilson: Well, I think so. The beauty, I think, of this program specifically that I am doing and that I’m teaching my clients is that it is a very simple process that you really can apply to all situations, whether you’re at work or whether you’re at home.

So basically, the idea is, let’s say I’m in the emergency department, and I’m about to walk into the room of a patient that just brings up this very negative connotation to me, whatever the chief complaint is. And so I stop, and just in the moment, even just 10 seconds of doing some kind of a mindfulness, which is basically any intense focus on a sensory phenomenon. So for example, if you rub your two fingers together and you’re intensely focused just for 10 seconds on that, or you’re washing your hands and you intensely focus on the running water on your hands. So you do that, and that process in and of itself builds up, you know, you’re commanding your muscles. You’re self-commanding yourself to focus, and then you’re able to say, “OK, I’m going to switch into this more positive mindset. I’m going to switch into my sage.” And then, moving forward, you can approach the rest of the interaction, whether it’s with a patient or with a colleague, in a much more positive manner.

And so it’s doing that same process over and over and over, the same basic process. It’s a simple process, and I think the beauty of it is that you don’t have to remember a bunch of different things to do. And the other thing that I think is really, really beneficial about this particular system is that you really can choose any kind of a mindfulness, any kind of a sensory perception thing that speaks to you, that is convenient for you. So for example, even if you’re not at work, like when I’m out for a run, I’m feeling my feet on the ground, I’m really being mindful of that, and then I’m switching to listening to the birds outside. And so you can really apply this whether you’re at work or whether you’re at home, and you can adjust the mindfulness exercises to what fits your life, and you can adapt it.

Kevin Pho: Any resources that my listeners can research in case they want to find out more about the approach that you’re describing?

Susan Wilson: Yeah, so actually, as I mentioned earlier, the founder of this whole concept, his name’s Shirzad Chamine, and he actually has a very robust website, PositiveIntelligence.com, and there’s a lot more information there. As I said, I’m using this concept as the framework for my coaching, and I will say, so far, the clients that have been exposed to this really just love this idea.

And I think the one thing that’s really interesting for people with a scientific background, or people in medicine, is that all of the research that this program is based on comes from different areas: psychology, performance science, but neuroscience, I think, is the thing that really probably speaks to us so much as clinicians, and specifically this idea of neuroplasticity. So I think that really gives this more legitimacy to people in science, instead of thinking, “Oh, well, this is just some made-up thing.” It’s really not, and it’s really based on definitely some scientific study that’s been done. So yes, that’s, I think, a great place to start to get more information. I think he’s written a book, and so if people want to read a book and get more information. Certainly, as I said, I’m doing this with my coaching, so anyone can certainly reach out to me on my website or connect with me on LinkedIn.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Susan Wilson: Well, I think the biggest message I really want to leave with the audience is that we are not victims and that we have the ability to take control. Not only our physical fitness, but our mental fitness is so important, and there are steps that people can take to really change their mindset and really start thinking in a new way. And I think that brings a lot of satisfaction and will really help them to reclaim the joy that they once had in medicine.

Kevin Pho: Susan, thanks again for sharing your time and insight, and thanks again for being on the show.

Susan Wilson: Thanks so much, Kevin. It was great to be here.

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