Why is it hard to find grace in medicine? [PODCAST]

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“We can talk about the system-based approaches we have instituted to avoid burnout and the negative emotional consequences that arise from medical errors, miscommunication, or negative outcomes that occur outside our sphere of control: Just culture. Peer review. Physician health and wellness committees. Social events. CMEs about burnout. Burnout surveys. State-run physician health programs. These have positive impacts.

But what else? When we go home and collapse on the couch, wondering what happened to that pre-med we used to be, the one who rejoiced at the acceptance letter to medical school, thinking the hard part was over. Naive? Yes. But there is beauty in that innocence. How do we find that joy in the privilege we have to be health care professionals? How do we love medicine again?”

Marsha Hamner is a hospitalist.

She shares her story and discusses her KevinMD article, “Why is it hard to find grace in medicine?”

Suggested reading: The Case for Grace: A Journalist Explores the Evidence of Transformed Lives

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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. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today’s show is with Marsha Hamner. She’s a hospitalist. She wrote the KevinMD article “Why is it hard to find grace in medicine?” Marsha, welcome to the show.

Marsha Hamner: Thank you for having me.

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

Marsha Hamner: Sure. I grew up in San Antonio, Texas, and I went to college at Colorado State University, where I wanted to study equine science. And then I discovered I was terrible at it. So I did a mission trip to central Mexico one summer in college and fell in love with medicine. So I went to medical school at Texas A&M College of Medicine. I did my internal medicine residency at St. Joseph’s in Denver, and I’ve been a hospitalist since 2003.

I’m currently the regional medical director of a hospitalist department that encompasses three hospitals in northern Colorado. I started that position about two weeks before the pandemic began. Fortunately, I had been with the group for 15 years, so I did know my team very well. But it really gave me an opportunity to lead and also to do some writing. It started as a newsletter for the hospitalist group and then really transformed into a bit of a narrative medicine project that evolved into a blog, SeekingGraceInMedicine.com, where I write about how we can really promote the culture of grace in medicine, but also for ourselves personally, really focusing on women and our roles as wives and mothers, for those of us who carry those roles as well.

I am married. My husband is a pathologist. He’s an extroverted pathologist; they do exist. And together, we have a blended family of eight children.

Kevin Pho: And you talk more about grace in medicine in your KevinMD article titled “Why is it hard to find grace in medicine?” But before we get into that, what exactly do you mean when you say grace in medicine?

Marsha Hamner: So grace is really an antidote to those voices in our heads that tell us that we’re less than. So for instance, if I forget to pick up my daughter from the dance studio, I’m going to feel guilty about that. I might have what we call mom guilt. If I start saying to myself, “I’m a terrible mother because I’ve left my daughter at the dance studio, and I’ve been through a divorce,” that’s not just guilt. That’s shame. It’s really getting to the heart of who we are.

And in medicine, we experience that as well. If we forget to answer a page from a nurse, for instance, we might feel guilty about it and apologize. But if we get a diagnosis wrong, and someone is harmed from that, potentially even dies, and we come home and we say, “I’m a terrible doctor. I’m a terrible person,” and we listen to those voices in our heads, that’s shame. And that’s ultimately what leads to not only burnout, and what we discuss as burnout in medicine or moral injury, but despair. And grace is really the antidote to that.

So many of us in this profession are absolute perfectionists, and we are in a vocation where perfection is not obtainable, and that dichotomy can lead to shame. It can lead to despair. And if we stop and tell ourselves, “I’m not expected to be perfect. I’m not expected to be perfect as a physician, as a wife, as a mother, as a friend,” and we also extend that to others and surrender some of those expectations, then that’s grace, and being able to move forward. In many ways, it’s very linked to forgiveness, forgiveness of ourselves, forgiveness of others. And that’s very freeing from the prison that we often put ourselves in.

Kevin Pho: Now, you lead a physician group, and over the course of your journey, you’ve talked to a lot of physicians. How often do you think physicians feel those thoughts of shame and despair?

Marsha Hamner: It’s been interesting, and in writing, I think I’ve realized that a lot more people feel that than what we admit, especially on a day-to-day basis. There are opportunities where I’m able to dialogue with individual physicians about that at work. But since writing the article and blogging, I’ve had the opportunity to have a lot more conversations about that, and people saying, “I thought I was the only one. I thought I was alone.” And in finding a community of people where we can be transparent and discuss this, because I think many, many of us share those feelings, I think there’s healing.

Kevin Pho: So what are some examples of things that you’re hearing when you have these conversations with other physicians?

Marsha Hamner: I think a lot of it goes beyond our professional lives. A lot of it goes into our personal lives as well. Most of the physicians I talk with are women. I think many of us struggle with what we call work-life balance: wanting to be, you know, very successful in our careers, very driven to be successful in our careers, but also wanting to be there for our families, wanting to be there for our children. And it’s so difficult to balance that. And I think that’s a lot of what I hear from women especially, is trying to find that.

Sometimes I think we’re trying to also live someone else’s dream, live someone else’s life. And I think a lot of people feel that way as well. I said, “Well, I really should be doing this. I should be doing that.” And really, it’s our own journeys that we need to be pursuing.

There is also, especially through the pandemic, the issue of moral injury, which I know that you’ve dialogued about on your show before: that we’ve been placed in situations where we can’t deliver the care that we want to deliver. You know, we’re not used to delivering ICU care in a hallway. And that has had a remarkable effect, in a negative way, on physicians, nurses, and other health care team members.

Kevin Pho: So in your KevinMD article, you talk about next steps, and your article’s titled “Why is it hard to find grace in medicine?” So talk more about your article. Talk about some next steps once we identify what the issue is.

Marsha Hamner: Sure. I think one is community. I think grace is found in community. We have a community of people within the walls of our hospitals or our clinics, wherever we practice, where we can start to have these conversations and be more transparent. Giving grace starts with ourselves, and then that can extend to others. But I think we have to learn to give it to ourselves first before we can really extend it to other people, whether that be our patients, our colleagues, or our family members. And really knowing that we can come to each other in community to talk about these things can be very healing.

Kevin Pho: So when you say that we have to give grace to ourselves, how does one go about doing that?

Marsha Hamner: I think there’s a lot of ways to do that. I think for me personally, my faith is very important to me. So time and prayer and meditation about that, reading about it, focusing on it, and spending quiet time before the beginning of the day is very important.

One of the things we talk about a lot is the three good things, about gratitude, right, that we practice it. So at the end of the day, there’s the practice of listing the three good things that happened to you during the day, and studies have shown that that can be as effective as an SSRI in treating depression. I think with grace, we can do the same thing. Ask ourselves, maybe at the beginning of the day or at the end of the day, “What are three ways that I can show grace to myself or others?” And/or, “What are three ways that I was able to do that today?” And make it a practice, like anything that we do, from medicine to tennis. We have to practice to become good at it. And so having consistency and doing that, like the three good things of gratitude, can really help rewire our brains to show grace to ourselves and others.

Kevin Pho: And then you talk about the importance of community. So how can a physician find a community to help themselves with this?

Marsha Hamner: That’s part of what I wanted to do with the blog, the Seeking Grace in Medicine blog. And sometimes just reading articles together can really open up the opportunity to talk about this. Most of the time, that’s informal, just being brave enough to have those conversations. Those aren’t conversations you can just jump into without relationship. And so really developing close relationships with our colleagues, and just not being afraid to jump into those difficult conversations, I think is a good way to start.

Kevin Pho: We’re talking to Marsha Hamner. She is a hospitalist. She wrote the KevinMD article “Why is it hard to find grace in medicine?” Marsha, any resources that you can suggest for physicians who want to find out more about this?

Marsha Hamner: Certainly, people are welcome to check out my blog. I think there’s also other places outside of medicine where we can really focus on this too. I mean, it’s not just the community of medicine that we need to be in. I think it’s important that we relate to people outside of our profession.

One of the things I wrote about in the article is that sometimes we feel isolated from the rest of the world, and we feel like the only people who can understand us are within the walls of our hospital or clinic. And that’s just not true. I mean, whether that be a spiritual group, a church group, or something even secular, I think it’s critical that we get involved in things outside of medicine too, and find people who perhaps have a different perspective than the insular environment that we often find ourselves in.

Kevin Pho: Now, Marsha, what are some of your take-home messages that you want to leave with the KevinMD audience?

Marsha Hamner: I would say, when you have those voices inside your head, that many of us do, that say that you’re a bad doctor or a bad mom, my friend, recognize that for what it is. It’s a lie. It’s not true. It’s not a message that’s coming from God into your head. And call it for what it is, and then tell it to go away. And sometimes even that act can mean a lot. And try the three good things, and transforming it into the three ways you can show grace to yourself and others every day.

Kevin Pho: And how can people reach you?

Marsha Hamner: They can reach me through my blog, SeekingGraceInMedicine.com.

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

Marsha Hamner: Thank you.

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