“If physicians aren’t happy, they can’t heal others”
– Vivek Murthy

Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical practice has evolved into a system driven by incentives to meet care quality measure benchmarks, implement incomplete electronic systems, provide care that is satisfying to patients and more. To keep up, physicians must be equipped with the knowledge and tools to practice, but equally important, the skills to self-nurture and remain well in this changing environment.

In 2015, more than 39,000 graduates of accredited residency programs entered the job market, beginning jobs where the burdens of practice were both surprising and overwhelming. As the practice of medicine changes, the patient remains the focal point of care, yet physicians must continue to skillfully manage all other aspects of care including navigating complex systems and relationships, incredibly emotionally charged situations. Such work requires a unique set of skills for passionate, young physicians to fulfill their sacred duty to heal. Hippocrates, often cited as one of the founding fathers of Medicine, held ideal attributes of a physician — wisdom, caring, compassion and honesty.

How can physicians uphold these humanistic ideals while struggling to stay afloat in a sea full of external pressures and forces? The wellbeing of our patients and physicians are on the line, and saying one must be well can be difficult to translate into daily action. We offer practical tips and advice on staying balanced.

Case 1: Managing difficult situations and negative energy

Dr. Jones is a hospitalist caring for 23 patients. When Dr. Jones enters the room to see Mr. Sunny, who is hospitalized for cellulitis, he threatens, “Dr. Jones, I will hurt you if you don’t give me Dilaudid.” Dr. Jones experiences palpitations and becomes visibly upset by this language.

Reflection

Physicians encounter a variety of personalities in various physical states, especially those suffering and in distress. Constant exposure to this energy can be harmful to physicians over time without attention and care. It is important to remain empathetic but create boundaries with patients. Use techniques to offset negative energy to preserve and maintain wellness.

1. Stay calm and remain nonreactive. Consider asking the upset individual to expand upon their feelings and listen. Excuse yourself briefly if needed.
2. Consider using a shielding technique, which is a visualization exercise where you envision yourself surrounded by a cocoon that cannot be infiltrated by anger or negative energy.
3. Consider learning these types of skills in a mindfulness workshop and practice what you learn.

Case 2: Preserving self-identity and humanism in practice

Dr. Jones checks his email and sees a message from administration asking for more discharges today. Dr. Jones gave 300 percent yesterday, having done seven admissions, discharges and assisting a busy colleague. Today, he looks forward to hearing from his patient about her struggles with obesity, but feels pressured that the hospital’s bottom line is at stake.

Reflection

Health care organizations seek to excel in quality metrics and may place pressure on physicians to work harder and faster to achieve these targets. Without the right tools, this rapid pace can create tension and barriers for a physician and patient to spend time together and deepen their partnership.

1. Appreciate and explore each individual’s stories. Focus on the joys of helping another human in their life journey, treasuring the unique connection of the patient-physician relationship.
2. Share with mentors and peers. Talk about your workload and satisfaction with your responsibilities to learn from each other. How can you improve so that you can be your best self?
3. Remember that you are never alone. Take at least 10 minutes every day to think positively, be grateful and experience joy.

Case 3: Identifying and defining your limits

Dr. Lenny skipped lunch to teach a one-hour ambulatory care seminar to medical students. Now, a fully booked second half-day session of clinic awaits. The first patient checks in ten minutes after his appointment time, in-basket messages, and refill requests await replies, unsigned notes are pending completion, and clinic offers numerous pulls for her attention and time. Attempting the impossible, the only immediate fix seems to impossibly create time during the day to reduce extra unscheduled time post-clinic, cutting into time with her children.

Reflection

In a typical ambulatory primary care clinic, a physician’s attention, energy, and time are pulled in multiple directions. The need to be working “at the top of your game,” managing time, delegating tasks, and meeting all the patient care service requirements is expected to be orchestrated perfectly and with finite resources at all times.

1. Focus on your breath to diffuse anxiety and stress. One method to practice is to close the eyes, taking a deep breath in and out and counting to 10. Repeat as often as needed.
2. Acknowledge your limits. Multitasking comes at a psychological cost, despite our best intentions and belief in our own borderline superhuman cognitive abilities. Assess priorities and limitations, identifying who and what truly warrants immediate attention.
3. Communicate with your support staff and patients to delegate tasks towards the goal of high-quality patient care. This goal cannot be achieved single-handedly.

Physicians enter medicine with the ideal to heal and help their fellow humans.  While health care and social systems continually change, individual physicians must acknowledge these changes and equip themselves with skills to cope with the challenges and changes that lie ahead. We strongly encourage physicians to empower themselves and engage in daily self-care practices. While systems of care are evolving to support the changing face of medicine, physicians must remember that without self-care, it is not possible to care for another. Attend workshops to learn self-care techniques, share with and learn from colleagues successful in such practices and become a local advocate of self-care practices and programs in your organization. Craft you own pathway to wellness.

With shared awareness and knowledge of daily barriers to physician wellness, we can create a culture where the health happiness and wellness of physicians is nurtured.

The authors are grateful to their mentors, peers, patients, family, and other sources of inspiration that have shared wisdom and hope in their journey practicing the art of medicine.

Sima Pendharkar is a hospitalist. Tiffany I. Leung is an internal medicine physician. Views expressed are those of the authors and not necessarily those of their employers.

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