Foolish Compassion and Physician Burnout

One of the biggest problems I've been trying to solve is the idea of "compassion". To some, people think that compassion encompasses simply doing everything that you can to empathize with a person and then doing all you can to help them. However, we need to take a self-check sometimes and understand that wisdom must go along with compassion for it to be effective.

For example, if one is compassionate towards a drug addict, and gives him drugs to alleviate his withdrawal symptoms, simply because you are empathetic, then this is absolutely foolish. But if someone never had medical knowledge, then they wouldn't understand the implications of their actions. Therefore, one of the most powerful things that any compassionate act must have is wisdom.

To be wise, one must understand what the consequences are, or at least what direction such an action will lead to. To put it in metaphor of parenting, one cannot be too indulgent a parent, nor too authoritarian. Instead, one must be able to balance emotion and logic, so that the compassionate act becomes one that truly helps the person. In the same way, a good doctor must be able to learn how to exercise true compassion.

One of the biggest things I've seen and heard from doctors, is the question of physician burnout. It's not an easy thing. In fact, it's been proven statistically that 33% of all physicians in the world, regardless of location or specialty, experience burnout (That's every ONE out of three!)

For one, the stress comes from the huge responsibility of directing the course of a person's life and health, while managing the emotions that arise from it, and also within physical restraints such as the lack of time, overloading pressure as well as the shortage of staff.

Add to that the hectic call-days, the short recovery periods, and nearly a decade of working through the lower ranks of being an MO and HO - and you get a burnt-out physician, with what we call "compassion fatigue". It's even normal to hear phrases like "working like a dog", "a slave's life", "my biggest regret", etc.

And you can't blame them at all! Because it really is true. The medical life isn't as smooth-sailing as anyone might think. It's only for those who have chosen to dedicate their life towards serving suffering patients.

But I feel that like all problems, there is always a root behind it. While we cannot change the tides and waves of the ocean, a skilled boatman can certainly navigate his way through the storms. What exactly would help a doctor retain his compassion, while working with vibrance & expectation, looking everyday forward to serving the medical field?

We can't change what we can't name.

-- Dr Bliss 

 If we are not aware and cannot see it, then we will miss it. There are many ways to look at how someone moves towards burn-out, and the very first thing is to take a look at its symptoms, as recorded by the Maslach Burnout Inventory (MBI):

1. Physical Exhaustion: Working long-hours end-to-end, or having somatic stress. 
2. Depersonalization & Emotional Venting: This includes a form of distancing away from the patients and situation, erecting an emotional barrier between doctors and patients, also known as compassion fatigue. It happens when doctors start to use sarcasm and non-compassionate terms to describe patients, usually as a group-venting session. They say things like "My patient is a bunch of *&^%*&".
3. Loss of Purpose: Doctors start to question if their work even makes a difference (more prevalent for females statistically).

In other words, we could also summarize them as Physical, Emotional and Driving Needs. But the red-alert is usually Cynicism, Blaming Behavior and Venting, along with a drop in both physical and emotional energy.

I read about this very useful analogy, which is to treat our energy levels as a Bank Account, instead of a Battery, because batteries die when they run flat. However, we are definitely able to function even at 0% - we just continue to accumulate charges. 

We can't give what we don't have - so we need to exercise wisdom to build up our own physical, emotional and driving balances. 

The causes of burnout are as follows:

1. Patient Care: This can range from simple things to very traumatic events, which may need narrative medicine (which I will do on this blog). It can be really crazy and tragic things that you see in your workplace, which can leave a scar on you. Let's face it - Nobody wants a health problem, neither do their families.
2. Career Stresses: Relationship with your colleagues, superiors, etc. Job-related stresses like 
3. Life Outside Medicine: This comprises relationship problems, financial issues, family issues, or things that can happen outside, catching you off-guard. Sometimes things can happen at home which make it difficult to "recharge" at home.
4. Unhealthy Conditioning: We learn these conditioning archetypes in the training of medicine, being conditioned to be like that...
   1. The Patient cannot always come first - When you are not with the patient, doctors must focus on their own lives - Don't be a workaholic.
   2. By trying not to show weaknesses, it forces people to ignore them, making them unaware of pain.

I also feel that doctors should take care of their own kind - not just patients. It's a collaborative effort, and we need to look out for everyone else on the same mission to help others - nurses or medical assistants, etc. By helping everyone out, it generates a helping and supportive culture, which is a far healthier working environment than one where doctors are constantly thinking that burning out is part of the work - it shouldn't be! 

In fact I'm starting to think we actually need doctors for our doctors. Who's going to take care of doctors if they cannot take care of themselves? Doctors think they are superheroes just because they can save others. But I find that a reckless thing - More will suffer if a doctor goes down.

True compassion is taking care of yourself FIRST, then allowing yourself to be a good presence to the patients. In the same way, the Buddha said that one should focus on enlightening oneself, then enlightening others naturally as a consequence. You can't save a poisoned victim if you're already ticking with poison in your blood.

Insanity is doing the same thing over and over and expecting a different result.

-- Albert Einstein

Doctors know that they are being burnt out. But by using short-term strategies like patient venting is not a good way - in fact, it exacerbates the contrast when they move away from venting into serving the patients. The burning out shows.

Some of the strategies to prevent burnout are as follows for doctors:

1. Become aware of your emotions. Lower your stress at work, increase your recharge at home. 
   1. Stress comes as a consequence from the inability to manage the physical, emotional and spiritual. You cannot directly manage stress. Therefore, learn how to be aware of the physical, emotional and spiritual, then apply strategies to relieve them.
   2. All suffering comes from a form of attachment, stress is this friction. One must become aware and be a witness, and understand that all bliss comes from within us.
2. Make yourself and family a priority. Again, it is not about selfishness, but seeing the larger picture. A happier doctor makes for better healthcare. We are humans, not robots. 
3. Ask for help when you need it. It's not weakness, it's recognizing that you are human and the needs of your human body. Conversely, ask your co-workers: "What's going on at home?" and let them know that you are there, even if they resist it.
4. Have an ideal job description. Always know what you want. What are the overlaps between an Ideal Job description and the current Job? What are the things you can work towards? What would I change to increase the overlap?
5. Differentiate Dilemmas from Problems. Problems have solutions, but dilemmas don't necessarily do. You can't find a one-step solution for a dilemma, it is about finding the balance point. A strategy is multi-stepped. Also, a tracking system is required, where there is tweaking so that we can move towards the ideal point.
6. EMR (Electronic Medical Record). Learn how to be a Power-user. Only put something in the chart if they fall within these 3 categories:
   1. Continuity: Can someone else pick up the chart and take over where you left it?
   2. Billing: Did you put enough in the chart to charge to the insurance
   3. Cover your legal part: For malpractice coverage
   4. Make Templates for "repetitive things": Take half an hour to make a template, once a week.
7. Optimum Time Management. Keeping a form of structure will allow you to meet commitments and have more time to yourself.
1. Paper Calendar. Every week, put your workouts, date nights (twice a month) and destress sessions. Ask your family/loved ones to put them in as well. Then scan them into the phone.
2. Say "No" when appropriate. Use the Paper Calendar as a reason. Practice a phrase to say "no". 
8. Compartmentalize Home vs Work. Take off the 'white coat' when you go home. Do boundary rituals: Visualize pulling out the key to "work" while exhaling when you step out of your car. 
9. BID Huddle: You're never too busy to huddle. Grab a schedule, pre-plan the day together with everyone else. Know which patients need pre-planning - troubleshoot them before they break out. How to schedule empty slots? Use the opportunity to build the team and show gratefulness (Check in: How are you doing?). Talk about something outside of work and make it a supportive culture.

[Work in progress...]