Grief Episodes, Sustaining Empathy and Physician Wellness
“Jim, you know our terrific ER Director, Alex, right? The one everyone loves – nurses, doctors, patients, families…, he urgently needs help. I don’t know if it’s depression or burnout or something else, but he has this very visible, chronic heaviness these days…and he wants to quit. Can you talk with him?”
Dr. Lewis, the president of this physician group, contacted me many times in the past to work with his physicians on leadership development, patient satisfaction, emotional intelligence and yes, burnout, resilience and wellness. This time, one of his top physician leaders was experiencing more and more fatigue and couldn’t shake it. The fascinating thing is that this particular leader, Dr. Alex, had himself often taught colleagues, medical students, residents about the signs and symptoms of burnout.
Dr. Alex was a 45 year-old, male emergency medicine director, who’d been in his role for at least 8 years. He and his supervisor, Dr. Lewis, have a great relationship, which is fortunate for Alex, because he was not able to recognize the signs in himself and/or unable to step outside of his current routine to turn things around.
When Alex and I began our coaching dialogues, one of the first things he mentioned was that his grief episodes were happening more frequently. He noticed his own lethargy, weight gain, lack of contact with family and friends…and crying.
Three years earlier I interviewed him since he was typically a high scorer on HCAHPS surveys. I asked him, “What’s the secret sauce in creating a great patient experience?” Part of his response then was, “assuming we have a robust enough organizational infrastructure, a key piece to a great experience for the provider is to be able to make a connection with patients.”
Almost in the same breath, he added, “AND one of the challenges to be aware of is that being empathetic can also wear you out. So, being self-aware as well as emotionally and socially intelligent is important. These are things we’re not taught in med school.”
Alex continued. “For example, for me to be the best doctor that I can be and want to be, I try to do a mini-emotional assessment (when possible) of where the patients are when they come to me. I ask them about their fears and/or goals. Yes, this might take a few extra minutes up front during the patient encounter. However, it often pays dividends toward the end of the encounter because it puts patients at ease and helps me be a better diagnostician, for them.
“On the other hand, I’ve noticed in myself, there have been days that I just shut down to people and patients, for whatever reason: my fatigue, frustration, confusion, grief. On those days, I recognize myself to be more of a robot in my transactions. I don’t mean it, but it happens when I get emotionally saturated or overwhelmed. In one case, I couldn’t remove the image of our team’s failed attempts to resuscitate a two-year old who arrested, out of my head. It got to the point that I needed to step away and formally grieve that. Especially since my daughter was three years old at the time.
“When I get into robot mode, I know that FOR ME, that’s a huge red flag. I need to get out of that environment and re-assess because, I don’t want to be that robotic doctor. In fact, each year I re-evaluate this role with my wife. I tell her, ‘the year I stop crying over some of these difficult scenarios that we see, is the year I’ll need to resign, because I will have become too numb and too distant to be healthy and safe for my patients and for myself.”
Three years ago, Alex was more centered in himself. He was more fragile now. By beginning the coaching process, he allowed himself to be still, long enough, to recognize how things were out of balance for him now. One of the hardest things for many great physicians who can run ‘long distance adrenalin shifts’ is that, at some point, they have to slow down and rest, in order to rejuvenate. Even the Olympic gold medalist has to get rest.
Alex recognized that a few big-ticket work items had landed on his plate and that his old medical school mantra (when he was a younger man) of “well, I’ll just push through it,” had come out again, and he had been working longer hours, putting off family events and caring less for his own physical and mental health. He had gotten into the habit of sacrificing his critical ‘rejuvenation’ time to catch up on work tasks, even though his boss, Dr. Lewis, said, “It’s OK for you to take a break.” Alex had to stop some behaviors and re-start others.
We discussed topics that helped him slow down and get perspective, to see if he wanted to continue his medical career. One thing that worked for him was to review a ‘balance’ model. There are many out there. The one we used comes from Bob Rosen’s book, “Grounded”. It’s called “the healthy leader” model. It allowed Alex to remember what’s most important to him at his core: his family (his wife and daughter). Also, community was important and he realized he hadn’t been part of his faith community for a long while. He realized that he hadn’t been to his daughter’s school with her in a while. His weight increased. They needed to get back to their fun morning, “elliptical sessions” together before and after school whenever possible. Alex also got back into the monthly dinners with his sister’s family who lives 5 miles away.
These changes didn’t happen overnight, but thanks to the coaching process which can take months, Alex carved out some time to be reflective or ‘mindful’ and now hardwires that into most of his days.
Alex isn’t waving a victory flag yet per se. He knows these ‘balance’ and ‘mindful’ behaviors need to be baked into a regular routine. He continues to practice them…and practice medicine and we check-in on an as-needed basis. Today, he’s smiling with his daughter and wife.