Dec 6, 2019
In this podcast, Dr. Laurie Drill-Mellum, an emergency medicine provider and a strong advocate for breaking down the communication barriers that are all too abundant today in medicine. Dr. Drill-Mellum also addresses the challenging issue of "burnout" in healthcare. This is part one of a two-part podcast.
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The ability to see each other in general, is lacking, according to Dr. Laurie Drill-Mellum. We have stressful jobs in medicine, regardless of the role we take on as physicians, PAs, NPs, nurses, EMTs, and all other caregiver roles. What is the effect on our psyches after the cumulative caregiving we provide our patient over the years? As human beings, we are self-centered, and we are compelled to think about how we perform as caregivers. But if our reaction to a perceived poor performance is one of negativity and even aggression, then we not only harm the other person, but we are ultimately harming ourselves.
Empathy versus sympathy. Empathy, in general, fuels connection. Really trying to understand what it's like to be in someone's shoes. As Dr. Drill-Mellum says, if you reply to someone with the phrase, "I can't imagine...", it is inviting the affected person to go into detail and talk about their issue. As opposed to a closing statement, like "Well, at least he's in a better place now." or "Well, her suffering is over now." This is a means of staying out of judgement of the feelings and issues people are experiencing.
Connecting with others is a deliberate act. Intentional effort is sometimes needed here. Studying facial expressions, as noted by the work of Paul Eckman, helps people understand better the mood one is in. Anger, surprise, sadness, happiness, fear and disgust. It's actually easy enough for most to pick up on these, but it also require a deliberate act and thought on the part of the clinician. When it comes to being motivated to remedy a problem, whether it's lack of communication skills with each other and our patients, there can be significant barriers, and many of them have to do with learned behaviors over many years of training and practice. As physicians and health care providers, we tend to put ourselves on a pedestal of excellence or at least the pursuit of it. And when something bad happens, such as a poor patient outcome or lawsuit, (and the ability to cope and reconcile when faced with this), there is shame and blame, and we struggle with how this could have happened, especially when our expectations of ourselves and (false) sense of perfection are suddenly not felt to have been lived up to. Tait Shanafelt, who was a t Mayo, studies burnout in the physician population. Back in 2015, in Mayo Clinic Proceedings, some of his findings were published. In particular, asymmetric rewards in medicine. While we, for instance, may do very complex procedures in our practices and deliver excellent care, our world is very transactional now. The awe and reverence of medical care in some ways has been removed a bit. And right or wrong, our patients feel entitled to this care, and this entitlement is deemed justified by the price they pay for that care. At the same time, gratitude for that care may not be as evident, due to the whole experience being a transaction in the mind of the patient. And the disproportionate criticism and criticism of the occasional undesirable outcome then tends to cause tremendous self-blame and guilt on the part of the practitioner. Cynicism, diminishing confidence, depersonalization and ultimately burnout can ensue.
So how do we approach this in ourselves and our own practice? Stay tuned as Dr. Drill-Mellum continues to discuss these important concepts and the Tragic Gap in the medical world.
Parker Palmer has written a lot about this "tragic gap", which is the gap that exists between the hard realities around us and what we know is possible, not because we wish it were so, but because we have actually seen and felt what it is like. Real connection. Something that is actually woven into your very being.
There are obvious swings in our profession. We feel joy and disgust with our jobs at times. Well...that's normal. First we must recognize the normalcy and appreciate it. But how do you know when you're spent?! When you are actually burnt out? The three main components as measured by many experts, but originated in the 1980s by Dr. Christina Maslach are: 1.) Depersonalization, or treating people as a problem/disease or body part. "The ankle in room 3"! 2.) Emotional exhaustion. You can't take one more complain, whine or gripe. 3.) Low sense of personal accomplishment. When we are not doing the stuff we were trained to do. The majority of burnout is driven by workload and workflow.
Dr. Drill-Mellum poses questions regarding connecting to others and connecting to ourselves. Number one is intention. In other words, what is most important to us? The next is attention. That to which attention grows. There is science that confirms actual physiologic change that happens in our brain when we pay attention to what we see and feel. It has the power to change out brain and ultimately how we establish new patterns of thought and practice.
Dr. Drill-Mellum discusses her feelings and opinions on what makes a great physician or practitioner. Is it merely technical skill? Or course that is what our patients expect and deserve. But do they deserve more? Compassion and a human touch. Yes, they do. And it's okay for those of us to explore our ability to provide this as well, to improve this aspect of our practice. There are a lot of lessons learned as one progresses through their career and we should consider leveraging their experience. Not only technical, but to also consider gleaning from them, "What would you do differently? What would you have done more of?". We need this guidance.
Dr. Laurie Drill-Mellum, continues her discussion in a second part of this podcast. Please download and listen to Dr. Laurie Drill-Mellum's continued discussion in part 2 of "Joy Empathy, and Provider Burnout".