Thompson

This quote from a leading pharmaceutical company describes the experience of a doctor in fighting to prevent the ravages of mental disorders from destroying his patients’ relationships, families and careers. The enemy is not confined to mental illness however.

Physicians do battle to save patient’s lives. They “declare war” on diseases. They “fight” illnesses that are resistant to current therapies or defy conventional diagnostic methodologies. They “battle” managed care companies to extend necessary treatment and services. They become embroiled in skirmishes with administrators, colleagues, supervisors and other health care providers over quality of service delivery, access to care, financial viability or interpersonal differences.

In the latter instance, the stress created has been facetiously defined by Chuck Swindoll, a radio minister, as “the confusion created when one's mind overrides the body's desire to choke the living daylights out of some jerk who desperately needs it."

In addition to the immediate assaults that impact physicians, there is the context. Change occurs rapidly, forcing one to be increasingly adaptable and resilient. For example, biomedical advances create information overload. A total of 8.1 million journal articles were published in Medline between 1978 and 2001 with the total number of pages increasing from 1.88 million pages per year during 1978 to 1985 to 2.79 million pages per year between 1994 to 2001. 1

This represents a 67 percent increase and the overload is not about to stop. One study suggests that the authority of physicians particularly among younger patients is being eroded by the plethora of medical information available on the Internet. 2 The physician strives to maintain competence while the world challenges and questions his/her knowledge at times based upon misinterpretation or misinformation.

Administrative issues, government regulations and third-party payers create delays, hassles and less margin in reimbursement while physicians see increasing numbers of sicker patients. Compounding the issue is the culture of fear and blame and the attendant decreases in quality, increase in medical errors, negative emotions, and distrust. The picture painted above is one where the physician is metaphorically under siege.

The cost of war

When a physician quits the path of medicine because of the pressure or attractiveness of other pursuits, his or her actions charge an enormous cost not only to the individual physician and family but also to the profession as a whole. Replacing a previously competent physician that succumbed to the stressful environment can cost an organization over twice his/her salary given the orientation, learning curve, loss of relationships, and potential loss of patients.

Most tragic of all is the loss of physicians to suicide. In a recent meta-analysis of studies of physician suicides in Northern Europe and the Americas, the research reported that women physicians were over two times more likely and male physicians were 1.4 times more likely to commit suicide than the general population. Risk factors included depression, drug and alcohol abuse and isolation.

There is a suggestion that these physicians were more critical of others and themselves and were most likely to blame themselves for their illness. 3 There is some albeit scanty evidence that when physicians ask for help they may not be taken seriously. Therefore physicians, particularly women physicians, have internal struggles that may end with the loss of life.

Metaphor of healing

What if the language and the images it conveys were ones of healing and peace? How did you feel as you read the above descriptions of what physicians do to survive?

What if we focused on images of physicians as embodying peace and compassion? What if we focused on how to expand upon and sustain the health already present in the patient? What if we engaged the patient as allies in achieving wellness, encouraging them to do research on their illness, providing them with appropriate resources?

Collaborative care is fostering such physician-patient teamwork already. What if in encounters with colleagues, administrators and others, we seek shared understandings and work toward partnering on discovering solutions? What if we focus on the sources of joy, hope and balanced optimism in medicine that exist already but remain under the radar, in the shadow of battle fatigue? What if the metaphor were changed from one of war to one of sustaining peace within and without? If you can suspend the critical mind for a moment, how do you feel now?

The word "healing" actually has two root meanings. From old English it means to make whole. From the Germanic root, it means holy. So there is a spiritual connotation as well as a restorative meaning. Being whole means being fully integrated where thought, word and deed are congruent.

It means being centered where you are able to modify your response to circumstances and not let circumstances dictate your reaction. It means having as top of mind, encounters in relationships where the outcome is positive for both. It means being present and aware of yourself so you can be available to another in the moment because you are clear about your purpose and who you are. It means first healing yourself so you can then heal others.

Incremental steps to healing yourself

A physician is viewed as an expert in health, including the more subtle health of wholeness and congruent behavior. The transition from being hassled to holistic takes time. The cure, or at least a satisfying journey toward self-healing, includes following several simple effective strategies.

Have a chat with yourself.

Set aside time alone without distraction and take a hard honest look at you.

Decide first what is most important to you and what gives your life meaning. This is your priority. When all else fails, in the end, this is what you are living for. When you have to make life decisions, this will enable you to have the appropriate focus.

Second, decide what you enjoy about medicine, what specific activities make you feel strong and whole and what activities are positively deadly. Then decide how you can do more of those activities that engage you and eliminate the others or partner with another person in the areas that you find enervating.

As an example, a physician who was an excellent clinician and well loved by her patients but who was having time management problems was referred for coaching. One of the skills she did well and enjoyed was creating detailed spreadsheets. Her supervisor was more efficient but tended not to focus excessively on details.

They worked out a solution where as long as the supervisor provided a deadline in advance of when data were actually due and general guidelines, she produced a spreadsheet that captured the critical detail her supervisor appreciated. 4 She became more efficient and had more time to spend with patients.

Develop self-awareness

Set aside the beginning of your day to engage in feelings or imageries of peace. Music, sounds of water, prayer or meditation, pictures – whatever you have identified that can help you become more relaxed. Then envision your day going the way you would prefer. Bring to mind past experiences of having workdays that went well, where you were accepting of outcomes and of yourself in the situation and/or where you had peak experiences of performance.

Periodically do an “emotional scan” throughout the day. When you recognize that you are engaged in negative emotions, however you label them (fear, anger, resentment, anxiety), pause, choose to be more neutral or positive before you act. Recall how you want to be in the situation.

Very few people can do this when they are in the grip of strong negative emotion. Therefore, it would be best to excuse yourself physically or delay speaking or acting and focus on breathing until you change your mood. Once you start identifying patterns to negative emotions, you can decide how to address it more permanently. You will start to notice more days where you are more centered.

Breathe

As a physician leader, one can get caught up in going from meeting to seeing patients to paperwork in a frenzied non-stop fashion. The role of the leader however is to take the time to think and strategize, to envision the future. It is impossible to do when one is entangled in daily, often urgent but not important activities to use Covey’s language. 5 Taking time to simply quiet the mind and breathe is a practice used to promote healing. 6 A physician used this technique to prepare for a meeting that was going to be particularly stressful and he was able to present his issues succinctly and persuasively.

Seek peer group support

Unless you are one of the rare physician leaders who have ultimate power and authority over issues in your organization, you are most likely upper-middle management. Here, you can use the energy and support of your colleagues in addressing recurrent systemic issues that would promote an environment of healing. In addition, with trusted colleagues and mentors, you can share your aspirations of using metaphors and language that connote images of healing and obtain feedback on your success.

Ask for help

There is an unforgettable New Yorker cartoon where a drowning man screams “Lassie, get help!” The next panel shows Lassie in the psychoanalyst’s couch.

Unfortunately, physicians because of training, natural selection, or expectations of the system, (probably a combination) take pride in not taking care of their needs, particularly their emotional needs. Certainly when depression, anxiety, rage outbursts, and substance abuse impair work and relationship functioning, it is time for treatment. The critical issue is prevention or early intervention if at all possible.

In assisting you in the practice of centeredness and inner peace, find a role model either within or outside of your organization that is the embodiment of integrity and peace within. Interview them as to what they do and see if any of their practices may be ones you can adopt.

Finally, if you are unable to uncover resources in your organization to assist you on the journey toward personal healing, consider an executive coach. Where systemic forces and organizational culture cause people to return to habitual ways of thinking, doing and being, a coach would be an asset. He/she can help to define your strengths and what it takes to make you whole as well as assist you with identifying how to “broaden and expand” the opportunities to use them. As a leader, you would be modeling the way for others to follow.

Changing the metaphor of war to one of healing in medicine begins with you as one individual. It takes energy, time and commitment. Most certainly it will require coming to terms with how you change yourself within the current environment of medicine. The positive impact on your well-being and those with whom you come into contact, however, is worth the investment.

From Metaphors of War to Images of Healing

The cost of war

Metaphor of healing

Incremental steps to healing yourself

Have a chat with yourself.

Develop self-awareness

Breathe

Seek peer group support

Ask for help

Patreece Thompson, MD, is president of Treece Consulting, LLC, in Glenside, Pa. She can be reached at pthompson@treececonsulting.com

References