Thursday, March 26, 2015

Coping Skills for the Clinician

A question asked of me on twitter by a medical student and the recent Germanwings plane crush lead me to write this. All clinicians, at the front line of medical care, at some time in their career, some more often than others, feel overwhelmed. This is accompanied by a thoughts of incompetence, helplessness  which if left unattended, can lead to misery, burnout and self harm. I have seen this in myself after residency and had to take a career detour to sit and ponder and attend to the rest of my life. I am grateful to have had an opportunity to be able to afford to take a break, and not see patients for nearly two years. Afterwords, as I eased into practice, first a volunteer position looking after the uninsured and then locum tenens hospital positions- I felt able to cope with all the troubles and the chaos that clinical practice, especially that of a primary care, brings along with it.

These are the methods I used to foster resilience in my life and I hope these will be generalizable to others, as well.

1. This too shall pass
Events happen and sometimes, we just need to bear witness and not respond too quickly in a knee jerk manner. The nature of life is transience, and events can be beyond your control. If a patient is upset on rounds or in clinic, often it is nothing personal- it could be something as trivial as a bad cup of coffee (or, lack thereof). I have trouble with practising this consistently - most of us see ourselves as problem solvers and if something does not go right than we can surely, make it better. I am practising this - it is not always about me, I can bear witness without actively responding to something and possibly escalating arguments needlessly.

2. There is a larger world
There are bigger things than you- the patient comes first. There is a story behind every illness and life experience- finding it often unearths empathy which helps both you and your patient to cope better with the illness. This is not a panacea but looking for a bigger picture helps me in gaining perspective and looking forward.

3. Focus on the moment
Now, I sound just like my yoga instructor this morning. And I am aware that some may think I am contradicting my earlier advice. It is important that we consciously try to focus on what is happening in the moment. Anxiety about the future mars our interactions now. Mindfulness raises awareness and helps us respond better to situations as we are less distracted. This, I find helps anxiety and makes our patients respond better to us- because if we are mindful, they realize that they have our full attention so their anxiety about not being listened to, also decreases.

How does all this relate to the recent plane crash? This morning when I heard on the news that it maybe that the co-pilot of the German plane had crashed the airplane knowingly, it made me very sad to realize that this was a preventable accident and so many young students' family and friends would not be mourning now. The comparisons of health care, patient safety and airline safety are commonplace and sometimes, I find them odious. I find it challenging to think of health care episodes, the way I think of a flight, although there are some similarities for example, checklists have been shown to help with safety in both airline and health care systems. It is possible that overwhelming depression, suicidality was responsible for the airline tragedy and I see some parallels of this sort of despair in health care, too. Recent studies have shown that half of US doctors show signs of burnout and in my humble opinion ( some data to back this up ) my fairly commonplace advice to re-focus, be mindful and sometimes, take the long view has helped me keep burnout at bay.

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