I do not want to be resilient [PODCAST]

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“We all know watching a module on resilience, sitting in a lecture about mindfulness, being told to practice more yoga and breathing techniques does not make you feel less burnout. It’s having the support and buy-in from your workplace, to actually have the time to do the things that feed your soul and fill your cup. Adding more onto an already overflowing plate of life’s stressors only makes it heavier and more overwhelming.

I want support. I want authentic connection and compassion. I want someone invested in my well-being who prioritizes my self-care to prevent me from having to be perpetually resilient. I want someone who values my heartiness and helps to cultivate an environment that fosters continued growth for myself and others.”

Michelle Owens is a palliative care physician.

She shares her story and discusses her KevinMD article, “I do not want to be resilient.”

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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 Michelle Owens. She’s a palliative care physician, and she wrote the KevinMD article “I do not want to be resilient.” Michelle, welcome to the show.

Michelle Owens: Hi, Kevin. Thanks so much for having me.

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

Michelle Owens: I’d love to. So I actually started out in general surgery and then made the switch to family medicine, where I had the opportunity to find out more about hospice and palliative medicine. So I completed my family medicine residency in my hometown and then completed a fellowship in hospice and palliative medicine. I’ve been out in practice now for a little over five years and have had the opportunity to both start an inpatient and outpatient palliative care program at a small community hospital and currently work at a nonprofit hospice agency in a freestanding inpatient hospice unit, where I take care of patients and their families nearing the last hours, days, and weeks of their life.

And so, you know, the work that is done in hospice and palliative medicine can be emotionally depleting and hard. And so it’s really important, for sustainability in this field, to have good strategies to take care of myself and take care of my team, in order to be able to do this work for maybe 20 or 30 more years, at least. And so, with the pandemic, it’s highlighted a lot of the things that really have helped us to care for ourselves, in terms of connection, the power of human touch, being with each other, and just being able to share our stories, and that really seemed to be taken away when COVID hit. All of a sudden, PPE, social distancing, and virtual formats instead of in person really took that away.

And so, looking for ways to be able to authentically connect, take care of myself, and take care of my staff, who I saw were really struggling, I just started to look at different things that were out there. I think that resiliency and self-care and well-being have been thrown around a lot during the pandemic, some for good, some for bad. And I had the opportunity with that to find a program through the American Academy of Family Physicians that was focused just on this. It was called the Leading Physician Well-Being Scholar program, and it’s 10 months long. I just finished it earlier this year, and it was really a wonderful opportunity to get resources for how to advocate for ourselves, different tips and tricks for being able to really focus on our own self-care, and then also to connect with a hundred other family docs who were feeling the same way. And I think that’s been one of the biggest things, just connecting and validating each other, that we’re not alone in feeling the way that we are, and finding ways to make a change.

And so with that, I’ve had the opportunity over the past six months to, you know, write some blogs for our local county medical society, and also started a Facebook group for hospice and palliative medicine interdisciplinary team members who were interested in self-care, and amazingly, in six months we have 300 members. And then I have also advocated at the national level, within my Academy of Hospice and Palliative Medicine, to start a self-care forum with a colleague. And so it’s just trying to find ways to advocate, get the word out, and support each other, and I find that it also helps to support my own self-care.

Kevin Pho: You talk more about that in your KevinMD article, “I do not want to be resilient.” Now, you talk about the stresses specific to hospice and palliative care medicine. What are some of the specific cases that hospice physicians or palliative medicine physicians would face?

Michelle Owens: Oh, goodness, Kevin, I don’t know how much time we have. So, you know, the thing is, this work, meeting people living with serious illness and navigating the last chapter of their life, is really a privilege. It’s an opportunity to connect with people and to ask them questions that sometimes they’ve never been asked before, right? “What makes life worth living to you? What are you willing to go through for more time?” And helping them to navigate some of the hard choices in terms of what they want their last weeks, months, years to look like.

And in the work that I do, oftentimes things have happened quickly. And so, trying to just be present and allow the patient and their family to process what they’re going through, and offering support, oftentimes just listening can be the most therapeutic thing for them and the most comforting. But with that comes having good boundaries, to not take home other people’s heavy challenges or conditions they’re living with.

I mean, in the field of hospice and palliative medicine, we’re often the ones treating symptoms that are causing suffering, but we bear witness to suffering until we can get those symptoms treated. We’re often the ones having the conversations in terms of stopping aggressive treatments, taking people off of ventilators, stopping dialysis, people who are no longer eating and drinking anymore, and talking to their families about how giving them artificial nutrition is unlikely to improve their quality of life and more likely to harm them. And so with that comes a lot of responsibility. So it’s really important for us in this field to have good boundaries, so that we can continue to give the empathy and the compassion for these patients and their families, but also maintain it for ourselves.

Kevin Pho: What are some of the resources available to palliative care physicians to help tackle some of these challenges?

Michelle Owens: So, you know, I think that when I trained as a fellow, one of the biggest things we were encouraged to do was to take our PTO. The fellowship was not as rigorous as residency training, so that in and of itself was somewhat protective. But I will say that as a fellow, I remember my work week being a lot shorter but feeling so much more exhausted, and it took me some time to realize that that exhaustion was due to just the emotional exhaustion and heaviness.

And so I think that it’s talked about a little bit. It’s being talked about a lot more now. I think programs are seeing how important it is, especially, I mean, this is kind of the silver lining of the pandemic, that people have seen, “Oh, we need to talk about this.” And we really need to talk about this not only at a fellow level, a resident level, a medical student level, right? We need to normalize it and destigmatize it. And so, you know, I think we’re so ingrained in medicine that if you’re not going, going, going, right, you’re not the good doctor, you’re not the person who’s the team player. And we really have to support each other.

You know, one of the things that I think has been going on for a while that helps with wellness, and even as a resident we had the opportunity to participate in it, is Balint groups. Balint groups are generally groups that meet with eight to 12 physicians and focus on the relationship between the physician and the patient, geared more to talking about those patients that you see on your schedule that you get a visceral reaction to, that you’re not excited to see, and trying to work through that and hear other perspectives as to what might the patient be going through, what might the physician be experiencing. As a family medicine resident, we had that as part of our training over the course of the three years, and that was really helpful.

And that was also something that this Leading Physician Well-Being program partnered with the American Balint Society on, where we had a longitudinal experience with Balint groups as well. And that’s been something that has been used at a few fellowship programs for hospice and palliative fellows, and I think it is something that could be more beneficial over the long term, even out in training, because of the difficulty of the cases that we do and how heavy it is. And so again, I think, seeing how much passion and support there’s been out there, just in the Facebook group and our national academy supporting us and starting a forum, I don’t think we’ve done enough, but people are open to trying to figure out what that looks like and how we can incorporate it better to support each other and ourselves.

Kevin Pho: Your KevinMD article is titled “I do not want to be resilient.” Can you talk more about your article?

Michelle Owens: Yeah, I’d love to. So, you know, interestingly, resilient has been thrown out a lot, for good or for bad. And for me, it hits me in a way that I have quite a bit of disdain for the word. I feel like a lot of times it’s used, and the word that follows it is training. So, more resilience training, which, for us in training, training is usually never something that improves your well-being per se. It just seems like something that kind of gaslights you on top of all of the other things you have to do.

And so the article came about really because, you know, I’m in Texas, the summers here are pretty brutal, and I had some hanging plants that I had not been tending to that died. And so I thought, “Well, instead of looking at dead plants, I’ll go and replace them.” And my husband’s a physician, and so I think, as our loving partners do, they know how to press our buttons. And so as I told him, “Oh, I’m replacing these hanging plants today,” he said, “Oh, those plants weren’t resilient.” And I was just like, “Ah.” And I said, “No,” I said, “I don’t want to be resilient, though.” I said, “I want to be hearty. I want to have good strategies and support so that I don’t have to get to the point of being resilient,” right?

I mean, if you look up the definition of resilient, and even the images that come along with it, it’s not something that makes you feel good, right? I mean, you’ve basically made it through severe trauma, white-knuckling it to the end of almost death, but then coming out on the end surviving, right? And I don’t want to just survive. I want to thrive, right? I want to have that support from my peers, have the support from my organization, to where I don’t have to be resilient, right? To where I already have the things in place, to where I can be sustainable in the work that I do, I can have the meaning, and I can have those boundaries to continue to do the things that serve me and serve my patients. And so that’s really kind of how the idea for the article came up.

And then just kind of talking about these things, because I think that a lot of us feel this way. And it’s been evident in just the amount of feedback I’ve received from the article, and talking to a lot of my friends who are also physicians, that we feel this way, but oftentimes we feel alone. And I think there’s some concern that if we voice this, we look weak. You know, in medicine, we struggle so much with wanting to be perfect, and if we can’t do it all and we can’t have it all, then we’re not perfect, and we’re struggling, and we feel so alone in that. And I think that that feeds even into the increased physician suicide rate and all of the increased burnout, right? I think we just need to normalize it and speak our truths so that we can validate each other and connect and make a difference, right? We’ve got to do something different in order to maintain our workforce and to be happy in this field and to be happy in medicine.

Kevin Pho: Yeah, and I completely agree with you that resilience almost places the blame of burnout on the clinicians themselves rather than the system that may be leading to some of the symptoms of stress and burnout. So what’s the path forward? If you are running a hospital or academic medical system and you’re seeing an increasing rate of clinician burnout and stress, what would you suggest to be the path forward to help address this?

Michelle Owens: Great question. So, you know, I think one of the biggest things is starting the conversation, right? Opening the dialogue, asking people what they need, asking them what things are going well for them and then what things are not going well, right? “In your day, what things are serving you and helping to fill your cup, and what things are always depleting it?” And I think we know from studies and from people talking about this, right, the electronic medical record oftentimes doesn’t help us but hurts us. So finding ways to help that to be more successful. I think the institutions and the places that are able to institute scribes, or ways to decrease that administrative burden and the documentation burden, are really impactful.

And I think it’s important, too, that if you ask people what’s going well and what’s not going well, you commit to acting on that, right? I think one of the worst things you can do is survey people or start the conversation but then not have any type of follow-through or not have any changes. And so I think it’s really having that authentic conversation, getting the buy-in of the other C-suite administrators about how important it is for us to really have physician well-being and health care worker well-being at the forefront. Because if we continue to lose people, right, the Great Resignation is upon us, I feel like, in health care, and if we don’t do something to stop that, we’re going to be in a really bad place, right? The silver tsunami is coming. The baby boomers are aging, and especially in hospice and palliative medicine, I mean, those are the patients we oftentimes take care of.

But I think, in hospitals, I see a lot of conversations about how chief wellness officers are not very well respected. And I think a lot of physicians find that wellness these days has been free pizzas and thank-yous and a pat on the back, or maybe like, “Here’s an extra PTO day, but if you call out sick because your child is sick, then we’re going to hold that against you.” So I think it’s, again, really getting down deep and having it be a foundation of the organization, that it’s truly supported, right? That, you know, we change some PTO days to be specifically for wellness days, and that they’re mandated, that you use them, right? Like, once a quarter you take at least one wellness day, and that’s not something that you are looked at as not being a team player for. That’s looked at as you’re modeling well how to take care of yourself, for your staff, for your patients, right? So I think it’s just reframing that narrative, having the conversation, and then making changes that are going to be sustainable and impactful.

Kevin Pho: We’re talking to Michelle Owens. She’s a palliative care physician, and she wrote the KevinMD article “I do not want to be resilient.” Michelle, what are some of your take-home messages that you want to leave with the KevinMD audience?

Michelle Owens: You know, I think, importantly, it’s just to know that you’re not alone, right? I think we’re all feeling this in some way, and so to know that these feelings are valid. I would actually be more concerned if you’re not feeling this way, right? I mean, the pandemic has highlighted a lot of the things that are broken in our system. And so, number one, knowing you’re not alone. Number two, advocating for yourself and advocating within your organization for well-being, finding out what resources you have, finding out what the buy-in is for it, and trying to champion it, or find someone else who’s willing to do that, and advocate as well.

And if the organization’s not going to support you, you don’t have to stay, right? Life is too short. That is one of the things that I see day to day in my work, that we are not promised tomorrow. And so we can’t think, “Well, in five years I’ll do something different. In 10 years I’ll do something different.” We have to make change now, because if we don’t advocate for ourselves and do what’s best for us, there’s no way we can sustain and continue to do the good work that we do for our patients, for their families, and also for our families, right? If we don’t take care of ourselves, we can’t take care of them. So, you know, be kind to yourself, do the things that fill your cup, say no to the things that deplete it, and just know, again, that we’re in this together and we can change the narrative together.

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

Michelle Owens: Thank you so much, Kevin.

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