“Careful, if you tell the wrong physician they need resiliency training, they may punch you.”

Can’t you just see the scenario? ED physician is covering whole department early in the AM because everyone else is at faculty meeting. Guy in suit looking shell shocked gets roomed by RN. Fresh blood from his nose has dripped on his super nice tie. ED doc introduces himself and recognizes name on patient’s hospital badge as CEO of their healthcare organization.

Physician: “Tell me what happened? Were you assaulted? Do you have any other injuries?”

CEO: “No, just my nose. Guy hit me in the face.”

Physician: “Why? Were you in an argument? Where were you?”

CEO: “Faculty meeting. I introduced our physician burnout 2 yoga plan. You know, like couch 2 5K? This doc came to ask me a question, something about paperwork and schedules, but I don’t really remember ’cause he punched me just then.”

Now, by no means do I advocate this approach to interaction with our administrative teams. However, can’t we all think of at least one physician we work with who is so frustrated with medicine right now that they are just angry? Like all the time grumpy? Would you ever go up to this person you are imagining and suggest that they do yoga to address their anger? Yeah, me neither.

grumpy-cat-8-22 image credit: www.grumpycats.com

I realize the title of this post seems contrary to my recent post about my experience with EMDR therapy increasing my resilience. But it’s not. You’ll see.

Resiliency training is the new thing in physician “support” right now. Big systems offering physician assistance, suggesting stress reduction methods, mindfulness techniques, resiliency training. Let’s be clear. We (physicians) ARE resilient. We have gone through the rigors of medical school, residency, even fellowship, and boards. We handle stress like its our job. Wait, it is. Anyway.

Yes, there are times when we need help. And it’s ok to ask for it.

There are times that the stress of caring for patients, the trauma of the hard cases, the pain and guilt of losing a patient breaks down our reserves, hurts our hearts and psyches. And we need a way to process these times in order to keep moving forward and caring for the next patient, the next difficult case. Based on my own experience, I highly recommend counseling (and therapy as indicated). But find whatever works for you. Just acknowledge it needs to be addressed. Now, if administration offers you this sort of assistance, by all means take it, even if you think you don’t need it.

The key to the above advocated counseling and therapy increasing resiliency is that the treatment is aimed at the root cause.  The problem with resiliency training comes when it is offered as a way to combat “physician burnout” and it is not addressing the root cause of said “burnout.” Resiliency training, mindfulness, and yoga are NOT going to fix physician demoralization from what some would call abuse, or as coined by Dr. Heather Hammerstedt, “systemic professional disempowerment.” What does that mean? It means resiliency training won’t fix physician frustration with lack of autonomy, inability to control daily office schedules, unreasonable requests for on call services and treatment decisions being trumped by non-clinicians at insurance companies bullying physicians and patients with endless paperwork. Giving physicians autonomy, assisting them in the fight with insurance companies, and listening when they say that a workload is no longer safe will improve physician morale and decrease “burnout.” Because those changes stop the abuse and disempowerment.

Pamela Wimble calls “physician burnout” a victim blaming term used by an abuser to the abused. Some physicians, including residents and fellows (and medical students too), are in programs or organizations that literally abuse them. Physicians in these situations are asked to do more than one doctor can physically do, they are criticized on their clinical management but not offered acceptable back up or assistance, they are asked to see more patients in less time. They are belittled and called weak when vulnerable enough to suggest the workload is not safe for themselves and their patients. Or they are told that it is simply not true (gas lighting- classic abusive behavior). And then these physicians are told they are “burned out” and should just make time for some more yoga or something. Some physicians in that situation just slump further over, too deep in the abuse to recognize it for what it is, and go on believing this is one more thing they have failed at (victim blaming at work again). Some get angry, punch the yoga teacher who came to faculty meeting, and then get sent to anger management class. (This too is a real entity in domestic violence, the abuser manipulates the abused into a negative appearance in public, then there is no sympathy for the abused and their story when it is reported or comes to light at a later date).

Now, do these healthcare organizations intend to abuse? Some may. Some may be playing the game of wearing down the opposing party until they are too exhausted to counter and rather acquiesce all control and answer yes to every unreasonable request. Because these disempowered, abused physicians don’t believe they have any choice.

But my idealistic self would still like to argue that most healthcare organizations do not intentionally participate in the systemic professional disempowerment of physicians. Because if we are helpless victims and they are the villains, then what is there to do? Maybe there is a part of the story missing in our interaction. I would argue these perceived or real negative actions result from disconnectedness rather than malicious intent. Administration of medicine is often very disconnected from the practice of medicine. Physician leaders in administration help decrease this disconnectedness. But even then, their clinical activity is limited or simply outdated if they are no longer practicing, and eventually it feels that some become too intertwined in the business discussions to remember the original mission of care being about patients and physicians.

Due to the nature of their jobs, administrators aren’t on the floor with you or in the clinic with you day by day. They don’t know how your eyeballs hurt from completing insurance or other seemingly asinine paperwork. But they do hear rumblings of physician dissatisfaction and the word “burnout” being thrown around. And they don’t want that kind of negativity in their organization.  So they hire a guy to come in and give a talk. Or they start a whole physician wellness program. They are trying to help, they just don’t realize that in all relationships, before your try and help solve a problem, you must first empathize. (I’m not some relationship guru, but I have learned more about relationships through parenting than just about anything else. John Gottman’s book, Raising an Emotionally Intelligent Child, speaks to the empathy first technique.) If I feel listened to, man does it decrease my animosity. (Ask my husband. He has listened to his share of rants.) Shockingly, listening also increases one’s understanding of the actual problem. It allows both sides to tell the real story.

Do mindfulness, yoga, breathing, etc. help me deal with foolish paperwork, schedule snafus, aimless meetings, etc. without popping my cork? Yes. Do those practices keep me calm so that I can make an important point with administration in a measured, non-emotional, way? Yes. Are they valuable? Absolutely. Will they fix the disconnect between (what feels to me to be) those governing medicine (CMS, insurance payors, administration) and those of us trying to DO medicine? No. As another colleague, Dr. Genevieve Henry once said, “mindfulness isn’t much use in a burning house.” Being clear on that point should prevent some broken CEO noses.

Namaste y’all.

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Yes, that’s me. Trying to be a tree at work. I am not a yogi. Yet. I’m sorry I don’t have a picture of me eating yogurt. That’s what my kids call yoga. Yogurt. I even have a yogurt mat.

 

Disclaimer #1: I really do respect and admire the administrators I currently work with. I am treated like an adult. I am listened to and respected for my experience and medical expertise. I do not claim any of my above examples or hyperboles as actual instances or my own complaints. They are a summary of frustrations heard from other physicians in many other specialties.

Disclaimer #2: I am not writing this to be negative. I am writing to give voice to physicians too mired down in the system to do it themselves. I am writing to seek understanding and start discussion. Because I really do love medicine, and I want to be a part of fixing what’s breaking the pillars of our system, the physicians. More to come on effectively telling our story and listening to theirs. So physicians and admin can win, together.

Disclaimer #3: My attorney husband says absolutely no nose punching in response to this post.