There’s a lot of debate currently about how to reduce “moral injury” or burnout in our physicians and other clinicians. Let me start by saying, I agree the system needs to change.
There’s a video going around on Facebook of a physician passionately and angrily denouncing any attempt at increasing physician resilience. His stance is that by suggesting clinicians could learn skills for well-being or “resilience”, we are blaming the victims. He makes the case that burnout is actually “moral injury” – a result of a system that overworks its providers- people who are conscientious, compassionate, devoted, and hard-working, who entered the profession with high ideals, only to have the life sucked out of them by long hours, bureaucratic battles to obtain the right treatment or test, and endless documentation requirements, taking away from precious moments of connection with patients. The video contains a lot of passion, and a lot of expletives. Anger is present; boundaries have been crossed.
The reality is, our healthcare system is not kind to its providers, the very people who our patients depend on for their care. When I hear that providers need to make up their hours or lost “RVU’s” spent away from clinic when on vacation, I feel angry. When clinicians are encouraged or required to see patient after patient in 15 minute increments without any time built in for documentation, I feel angry. When they are up until midnight doing their documentation, I feel angry. And when I hear clinicians criticizing their colleagues for making different choices, choices to work less or take a different job that’s a better fit- I also feel angry. Because let’s face it. To some degree, we create the culture that exists within and influences the greater system- a system made up of multiple interdependent parts that form a whole, and serve a common purpose; a system in which we exist as a crucial part of that whole which is healthcare. This is where building skills for well-being is critical; because if we want the system to change we must be willing to change ourselves.
Change starts with learning to set and respect boundaries – not just with our colleagues and administrators- but with ourselves.
It starts with paying attention to what is serving us and what is not, with finding the courage to set healthy limits without feeling somehow “less than” or “weak.”
It starts with shifting a culture of silently shaming those clinicians who make different choices- who set limits on how many patients they will see, how many hours they will work, and who are willing to accept less pay for those choices.
It starts with learning how to advocate for change in a way that is calm, assertive, intentional, and productive.
It requires taking care of ourselves in the process, because system change doesn’t happen overnight. It’s a marathon.
There are some proven practices that can help us along the way. When I hear someone make a scorning remark about the role of meditation in improving provider well-being, I suspect they’ve never actually tried it for any length of time. Because meditation actually works. It nourishes our overactive minds, helps us create enough space to respond productively rather than reactively, and actually changes our brains by increasing the activity in the part of our brain associated with positive emotions. Stacks of studies have proven the benefits of practicing meditation. The same is true for the practice of gratitude. If you want evidence-based advice on how to truly improve well-being, these two practices are a great place to start.
Learning how to pay attention- to notice the moments of joy, connection, meaning, and purpose that exist in our work despite the chaos- can help us endure the most stressful days. Practicing gratitude for the gifts in our work and our lives can make us happier while we advocate for much needed change in the system. We have a role in creating the culture that exists within an interconnected system- a system in which we, as healthcare providers, are an intricate and essential piece. Changing ourselves is a choice to focus on what we have immediate control over. It is about committing to nourish our overworked minds, hearts, and bodies; setting much needed boundaries; learning to advocate calmly, assertively, relentlessly, effectively; and treating ourselves and each other with compassion along the way. If we can commit to making these changes for our own well-being, we will change the system.