How to protect your resilience [PODCAST]

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“Health care delivery will always be inherently unpredictable and challenging. Those drawn to medicine are among our most resilient, but the current landscape reveals acutely a rise in burnout that exceeded acceptable levels even before the COVID-19 outbreak. Such innate resilience in clinicians and clinical care teams is an individual and strategic asset worthy of recognition, protection, and system-wide approaches that nurture and potentiate it. Such system-wide advocacy serves to proactively promote the vitality of health care delivery, quality of care, individual and group purpose, life-work satisfaction, and balance. Ultimately, these all are recognized as antidotes to burnout.”

Pennie Sempell is an attorney and co-founder and CEO, StressPal.

She shares her story and discusses the KevinMD article, “Persistent stressors and resilience: a new way forward for health care communities.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Pennie Sempell. She is an attorney and the co-founder and CEO of StressPal, which integrates leading evidence-based interventions in advanced mindfulness-based therapeutic approaches. She co-wrote the KevinMD article “Persistent stressors and resilience: a new way forward for health care communities.” Pennie, welcome to the show.

Pennie Sempell: Thank you. Thank you for inviting me here.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Pennie Sempell: OK, sure. Well, I have an interesting background, and I’ll tell you, everything that I’ve done in the past has been really helpful to bring me to where I am today. I was a graduate of UC Berkeley in psychology, teaching mind-body approaches and stress reduction classes all the time while I was going through law school. And of course, as an attorney, you’re up front and up close with the impact that stress has in disharmonizing business and family relationships. That led me to get advanced training in a variety of integrative health, mind-body approaches to wellness, as well as mediation and conflict resolution.

I was invited to come into a medical center to work on a grant with ICU patients going through heart transplants, to pioneer how self-care modalities might be helpful for them. It was such a successful program that a group of physicians asked me to join their practice, and for the next 20 years, we really pioneered how you can interface self-care modalities with patients going through really dire situations in their personal lives.

When I saw the pain points for physicians, the rising stress-related chronic diseases in medicine, I joined forces with Dr. Monroe about five years ago to really see what we could do to bring medical-grade tools to help clinicians and their patients. When this pandemic hit, we took a step forward to create StressPal Frontline, specifically for clinical care teams.

Kevin Pho: So when you got involved with physicians and resilience and burnout, was there anything within health care that surprised you?

Pennie Sempell: Well, I think one thing that has surprised me is that there is a general lack of awareness in the public, and I think even professionally, about the advances that have been made in psychology research over the last 20 years in really understanding very effective cognitive strategies for harnessing the brain’s capacity for resilience: How do we perceive, adapt, and learn from stressors in the heat of the moment, and how do we really protect our personal resilience? There have been tremendous advances in that, and it’s been very exciting to start to get into conversations and educating around that. So that’s been a surprise, to see both a lack of awareness but then a real fascination and a growing awareness of the importance of taking care of the caregivers in this process.

Kevin Pho: And you talk a little bit more about that in your KevinMD article, and I’ll ask you about that next. It’s titled “Persistent stressors and resilience: a new way forward for health care communities.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you and Dr. Monroe decided to write it?

Pennie Sempell: Out of our respective experiences, and he has domain expertise in psychological medicine and psychological resilience specifically, we really felt an importance to look at that. How do we get into that stress, the survival response? We’ve got the survival response. It really protects us from danger, that fight-or-flight or freeze response, and that’s essential. But the problem is the stress response itself and its persistence over time. Under persistent stress, we have a high level of symbolic thought, high alert. The brain triggers thoughts, feelings, actions, and physical responses, and those either escalate in the moment or de-escalate in the more resilient brain. There’s an escalation.

So one of the things we really wanted to bring forward in terms of a new way here is how we can really look at the benefits of resilience and improving resilience, not only for the individual but for really bringing forward a capacity to tackle these complex system drivers of burnout within health care. We all know that these solutions are going to happen within the organization itself. No one from the outside can really come in and tell you what to do. But if the levels of burnout and overwhelm are so significant, it’s going to be hard to get to that collaboration.

So by a two-pronged approach, which we’re talking about in this article, we can use these advances in psychology to help the providers, the clinicians, the administrative staff, and care teams to lift, protect, and support their personal resilience, which has the benefit of improving communication, cognitive capacity, clarity, and problem-solving. These are all well-researched, evidence-based benefits of improving resilience, which in turn starts to create more capacity for solving these deeper problems.

Now, that being said, we know that health care will always be one of the most challenging, if not the most challenging, professions. So the fact that doctors are above average in resilience is an important asset to be protected. And it’s also important to remember and to know that your resilience can be really worn down by persistent stressors unless you actively and mindfully protect it, especially in the heat of the moment.

Kevin Pho: So I wanted to follow up on the last point. I was just about to ask: Physicians are already some of the most resilient people. They have to go through medical training, residency, and multiple board exams, and I would say that’s among the most resilient professions out there. So when they go into the real world and you see 50 percent of physicians are burnt out, what’s missing in terms of their resiliency?

Pennie Sempell: So their resiliency, they came in inherently with that really high level of resiliency. They’re in a firestorm. I think resilience is like your PPE. It’s your psychological PPE. So if it’s a small fire, you don’t need much. If it’s a firestorm, like exists in medicine for many people, you need a really great PPE, and you need to protect it as it’s getting damaged. That erosive effect of persistent external stressors really damages our resilience. But we do now know, from this body of research, these very effective cognitive tools, as well as behavioral and physical strategies, to help protect your resilience even in the face of the storm, we might say.

Kevin Pho: So can we talk about some of these specific techniques that you’re talking about, in terms of some actionable tips that you can give to physicians on how they can protect their resiliency in the face of increasing clinical and administrative burdens?

Pennie Sempell: So I would suggest that they do some reading. We’ve got links on our website if people want to look at articles around acceptance and commitment therapy. We’ve distilled this very rich body of it. It’s a mindfulness-based therapeutic modality, which we’ve integrated with cognitive behavioral therapy and traditional mindfulness meditations. The triumvirate is very powerful, combined with acceptance and commitment.

So here are some practical tips. Think of these three words: awareness, assessment, and act. Awareness: Beyond present-moment focus, to really build that resilience, you’re going to cultivate an awareness of your thoughts in the moment, your thoughts, your feelings, your physical responses, and your behaviors. Are you irritable? Are you avoiding, or is there passive aggression? What’s happening here? On the physical side, what’s going on? Are you skipping meals? Are you skipping workouts? How’s your sleep? Thoughts are actually the words you say in your head. So that’s awareness, cultivating an awareness.

Assessing: assessing whether these thoughts and stress-triggered responses you’re having are helping you to achieve, or are aligned with, what you value. Are they helping you in what matters to you? Are they working for you? That’s a candid kind of self-assessment of your own salient behaviors and thoughts. And then to act: to be flexible and open to act on more workable strategies.

Now, what are those strategies? Most people don’t know them, but that’s kind of the core of where we want to introduce brief training here for people. I’ll share one of them. It’s a wonderful metaphor called dropping the shovel. Just that image: You have a shovel, and you’ve got this thought going on, “I’m never going to get this done. There’s not enough time.” Hey, am I digging myself into a hole here? What if I just drop the shovel? There are certain metaphors that have actually been very well studied in psychology, and they’re cognitive strategies that you can use in the midst of this kind of moment that start shifting the part of the brain that’s activating the amygdala and the whole cascade of cortisol and stress hormones. So that’s one of the goals here: to really shift through awareness, assessment of whether it’s aligned with your values, and then acting on more workable strategies.

Kevin Pho: Now, in general, from your experience, how successful are these strategies in helping physicians protect their resiliency?

Pennie Sempell: Well, there’s a deep body of research on this, and we are using these evidence-based modalities. There’s a very significant increase, and it’s surprisingly just a brief course of training. I’m happy to post some things for you, if you’d like me to send you links on this research. There’s some excellent research: Even in a four- to six-week course of training, there’s significant improvement. And these are lifelong skills that you can use to continue to protect your resilience in moments in the day. We’re talking about moments.

So that’s one of the pieces we like to really say here: Resilience as a self-care strategy needs to be part of it, like you brush your teeth and eat healthy food. Taking a few moments a day to protect your resilience is actually an evidence-based benefit that you can take with you for the rest of your days.

Kevin Pho: We’re talking to Pennie Sempell. She is an attorney, and she’s the CEO and co-founder of StressPal, which integrates leading evidence-based interventions in advanced mindfulness-based therapeutic approaches. She co-wrote the KevinMD article “Persistent stressors and resilience: a new way forward for health care communities.”

Pennie, we have talked about burnout in physicians for years on KevinMD and on this podcast, and one of the lines of pushback I get is that if we focus on physicians’ resiliency, it almost places the blame for the burnout on the physician himself or herself, rather than focusing on the root cause, which is more systemic problems. It could be electronic medical records, more check boxes to fill, or seeing more patients in a shorter amount of time. So I guess my question is, what’s your response to that, when you focus so much on resiliency without really addressing the root cause, which is really the systemic change, the systemic health care system putting an increasing amount of pressure on physicians?

Pennie Sempell: That’s true. Well, that expertise is really going to need to happen in the organization. We can provide the piece that’s really about how we support the capacity of those who are making those decisions and solving those problems to be better able to tackle these deep system drivers. And also at the same time, like a two-pronged approach, how do we really help the individuals in the organization choose to really protect and maintain their resilience?

There’s some good research on this also, that resilience is very important to physician well-being. They have innate high resilience that’s really getting slammed down and worn down by these pervasive stressors. So you need both. You need that capacity to tackle the stressors, for which resilience is one of your most powerful and dynamic ways to achieve that, and you need to look at what your own individual organization’s needs are that are contributing to burnout.

Our team has the expertise around the clinical application of the self-care strategies. We’ll leave it to the leadership in the organizations, and to the good wisdom of organizational psychologists and others who facilitate organizations, to tackle these deeper electronic health record issues. How do you delegate to get doctors off of data entry points? How do you really tackle that? We see a collaborative approach is needed there. We hope to be able to help with that one important piece.

Kevin Pho: Now, going forward, what do you feel are some of the challenges that face physicians? Especially during the pandemic, burnout numbers are certainly at all-time highs. What do you see as some of the challenges for physicians in building up and protecting their resiliency going forward?

Pennie Sempell: I think it’s very important that whatever approach an individual takes to self-care, it is doable given their circumstances. For most people, that’s going to mean brief. So there’s going to need to be a selection of how am I going to take care of myself here and my personal resilience. You really want to look at modalities and helpful strategies that you can work into your day, and that’s often going to be a few minutes’ help. Having the ambition to take on something that’s going to take an hour a day, most people will not do. So it needs to fit within your workflow.

And you need to be able to also, I think, focus on and look at what is really at the cutting edge, but what does the evidence really support? I think doctors will find that many of these kinds of stress relief modalities out there, and there are a lot of apps for stress reduction, stress relief, and meditations, are kind of one-off approaches, and that’s often not enough to really rebuild that deep, innate personal flexibility and resilience.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Pennie Sempell: Well, I really am very much appreciative of the movement in health care to start taking care of the care providers. If we can be of any help, we are always happy to be talking to individuals about trials, so that you can try out the StressPal Frontline in your approach. We’re happy to provide information and research that might help your organization to jump-start this piece of tackling the burnout issues. So we’re happy to be of help in providing citations, research, and programs for you to try.

Kevin Pho: Pennie, thank you so much for sharing your time and insight, and thanks again for being on the show.

Pennie Sempell: Thank you.

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