The Key to Physician Resilience

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I was sitting in the resident room when I overheard a co-resident reliving a recent experience running her first “Code Blue.” In her retelling of the dramatic event, the end was rather bleak. The patient unfortunately did not survive. She was ruminating on how sad and disappointed she was in that outcome. She was focusing on and reliving the pain and anguish of losing that life and the personal responsibility she felt in failing to bring about a different outcome.

But that’s the nature of the job. We, as medical providers, on a daily basis come face-to-face with human suffering and are challenged to rectify it. And because of our vocation’s objective, we sometimes see the natural process of death and dying as a personal and professional failure. Our focus sometimes gets stuck on the negative. The people we didn’t save. The orders we put in wrong. The syndrome we recognized too late. The addict we couldn’t convince to quit before their fatal overdose. Thanks to the wise words of a mentor of mine, I’ve started to shift my focus: “It’s not a personal failure. Sometimes bad things happen, and most of the time it’s not your fault. It’s inevitable.”

It is understandable that medical providers feel overwhelmingly connected to our patients and the suffering they endure. We are innately compassionate people with a special role in society obligated to alleviating human suffering. But in that effort to keep our oath to the people we serve, we will unfortunately also be faced with situations where a positive outcome is impossible. In order to help prepare for that inescapable future, we have to learn to become more resilient. Interestingly, science supports the idea that our innate compassion will be our reprieve.

The brain child of Into the Magic Shop author and Stanford neurosurgeon, Dr. James Doty, The Stanford Center for Compassion and Altruism Research and Education (CCARE) has been researching and cultivating the human quality of compassion. Through CCARE, neuroscientist, behavioral scientist, and other researchers have examined the human mind as it specifically relates to compassion, altruism, and empathy. Their research helps to shine a much needed light on our interesting predicament.

Medical providers have an inherently compassionate nature. It is this motivation to reduce someone else’s suffering, this “other oriented” as opposed to “self oriented” mentality, that drives us in our occupation. We focus our actions and emotions in a way that allow us to not only feel what others are feeling but to care about that feeling. This leads us to act in a way that alleviates that suffering. Unfortunately, as E. Simon-Thomas et al discovered, the same areas of our brain that are activated during our feelings of compassion are also activated during our perception of pain. So, as we cognitively understand what our patients are feeling in their time of need, we go beyond that to mirror and absorb those feeling into our own psyche. And in doing so, we not only motivate ourselves to provide the care to alleviate that suffering, but also open ourselves up to emphatic distress. And it is this empathic distress, when unchecked, that can lead to burnout.

In a paper by Scarlet et al., the authors explain that when we experience emphatic distress instead of giving into compassion we withdraw. This pain makes it difficult to give and receive compassion to others and ourselves. We get overwhelmed by taking on other’s suffering and become emotionally exhausted and overwhelmed by caring for others. In a similar way, it is well accepted that burnout is hinged on a feeling of isolation. It is an oxymoron for loneliness, as we somehow withdraw internally in a job where we are forced to interact and connect with others and (given the high burnout rate) feel this loneliness together.

Fortunately, our downfall is also our salvation. We are hardwired to be compassionate. Through mindfulness and re-focusing on gaining an understanding of the experiences we all share, we can feel less alienated and improve practices of self-compassion. This in turn can increase our job satisfaction, allow more flexibility in accepting the curveballs that our strenuous job and life throw at us, and possibly reduce the risk of burnout. CCARE has developed an 8-week compassion training program using mindfulness, self-compassion, and loving kindness meditation (meditation involving mindfulness and sending kind wishes to oneself). It has many implications and studies show reduced emotion suppression, worry, mind-wandering to unpleasant subjects, pain, depression, anxiety, stress, and empathic distress.

I’m not asking us all to take time out of our already busy schedules to enroll in this 8-week course. But I am hoping that as we embark on the new academic year for medical house staff, we rededicate ourselves to being compassionate providers. May this new year serve as a hallmark for refocusing on the renowned quote “do no harm” and apply that to our own well-being. And in melding science and psyche, let us be more compassionate as we give in to our innate desire to take on the suffering of others. Last and most importantly, should we discover that in our attempt to embrace and alleviate human suffering that our patient’s fate cannot be changed, let us forgive ourselves. Doing so will promote resilience, ensuring that we continue to provide compassionate care to all and long experience the joy of healing those who seek our help.

Chioma Udemgba is in Medicine/Pediatrics and is a 2018-2019 Doximity Author.

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