Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes
In this episode, our guest Susan MacLellan-Tobert, a pediatric cardiologist and physician coach, delves into the challenges faced by healthcare workers during the COVID-19 pandemic. Despite being in the post-disaster recovery phase, burnout rates are increasing, and organizational trust is deteriorating. Susan identifies incomplete grief as one of the primary contributors to these issues.
Health care professionals are continually exposed to sources of grief, such as adverse childhood experiences, medical training, and daily practice. Over time, these layers of grief accumulate, leading to burnout and impacting organizational trust. However, healthcare workers often struggle with admitting they need help and the perceived stigma associated with seeking assistance.
Susan MacLellan-Tobert is a pediatric cardiologist and can be reached at Health Edge Coaching.
She shares her story and discusses her KevinMD article, “Healing from the pandemic: a journey to recovery.”
The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.
With so many demands on their time, physicians today report record levels of burnout. Burnout is caused by many factors, one of which is clinical documentation. Studies indicate physicians spend two hours documenting care for every hour spent with patients.
At Nuance, we are committed to helping physicians do what you love – care for patients – and spend less time on clinical documentation. The Nuance Dragon Ambient eXperience, or DAX for short, is an AI-powered, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.
Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.
VISIT SPONSOR → https://nuance.com/daxinaction
SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://earnc.me/96d1fA
Powered by CMEfy.
Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Sue MacLellan-Tobert. She’s a pediatric cardiologist and a physician coach. Today’s KevinMD article is titled “Healing from the pandemic: a journey to recovery.” Sue, welcome back to the show.
Susan MacLellan-Tobert: Hey, Kevin, thanks for having me today. It’s great to be here.
Kevin Pho: So we’ll get into your most recent article a little bit, but for those who didn’t listen to our first episode together, just briefly share your story and journey.
Susan MacLellan-Tobert: Yeah, thanks. So as you mentioned, I’m a pediatric cardiologist. I’ve been in practice for, oh gosh, a little over 20 years, and I’m in the Midwest, originally from Alberta. In the recent few years, I have kind of started a little bit of a side journey into physician coaching. I’ve worked with our team at my institution to develop an internal coaching program, which has amazingly become a robust program offering coaching services to our peers. And on the side, I like to write a little bit too. So that’s my story in a nutshell.
Real physician voices, twice a week
Free, and one click to unsubscribe.
Kevin Pho: Excellent. So you mentioned that you’ve been practicing for 20-plus years and more recently delved into physician coaching. Give us an example of how physician coaching has moved the needle for some of your peers.
Susan MacLellan-Tobert: Sure, sure. So we have five coaches at our institution, and we offer individual and group coaching. I think, really, coaching is kind of like having a thought partner, an expert companion that can come alongside you and often just listen. In medicine, so many times we don’t feel like we have someone who will objectively listen to us and our story, and that’s what we do as coaches. We listen, we don’t fix, we don’t advise. We offer up kind of generative questions, I would call them, for people to do some introspection and self-discovery, to grow in self-awareness.
And I think many times in medicine, our path of training has resulted in us kind of becoming heads on a stick. But coaching allows us to kind of reconnect with all of us, including our emotional side, our thoughtful side, sometimes our spiritual side, really helping someone become their best self.
Kevin Pho: All right, so let’s talk about your most recent KevinMD article. It is titled “Healing from the pandemic: a journey to recovery.” Now, how did this particular piece come together?
Susan MacLellan-Tobert: Yeah, it’s been my observation in the past year, probably, that there’s been more strife and stress among our clinicians than I have ever seen before. And certainly the pat answer is, “Well, we just came out of a pandemic, or we’re coming out of a pandemic; it must be related to that.” But there was more to the story, I felt. Why, just coming out of a pandemic, would we be having such difficulty communicating, really caring for one another, having compassion for one another?
As I kind of did a little journey of self-discovery, my sister and I landed on the topic of grief. Our family has, in fact, had some relatively recent experience with family member loss, and she completed a program on grief recovery. I decided to read that book myself, and it just kind of felt to me like two pieces of the puzzle connected: As we look at coming out of this very complex disaster, when you look at disaster recovery, a disaster recovery timeline, let’s say, there is room for grieving. And yet, lo and behold, in medicine we have not paused to resolve some of this grief.
And so I see it kind of gelling in my brain, how if we did a little bit of grief recovery, if somehow we discovered our best ways individually to recover from grief, the grief of the pandemic among all the other layers of things that have caused us grief over many years, maybe there would be a way that we can then be ready to move forward, to get back to what I think I’ve noticed in the lay press lately: the joy of medicine. I’ll be honest, I don’t know if I’ve ever felt joyful in medicine, but that’s kind of like, “Let’s do this again, let’s love what we’re doing.” We’re not there yet. There’s this recovery period that still has to occur. How do we pause to do that? That’s a big question to be answered still.
Kevin Pho: So before getting into some of the solutions and how we can pause for grief, tell us some of the stories that you’re seeing that make you think that clinicians are not coming out of the pandemic as healthy as you would like to see.
Susan MacLellan-Tobert: Sure. So I think one of the biggest disconnects that we’re seeing as a theme among our coaching team right now is communication, impaired communication: managers not understanding clinicians, clinicians not understanding managers, lack of clarity of expectations. So this is a communication piece, and I think where we’re falling down is we’re coming in and telling each other what we want each other to do. We’re not taking time to pause, to listen, to understand the other person’s intention and expectations. We feel like we’re on this hamster wheel; we just need to get it done because we need to improve our bottom line. And in fact, impaired communication, feeling devalued, feeling not listened to, feeling unsupported, not only can it create that emotion of grief, but if you bring grief into it initially, it’s only going to impair that communication piece more.
Kevin Pho: So what are some of the things that we can do to help process and grieve through these past three years?
Susan MacLellan-Tobert: Yeah, yeah. Well, when I figure out the entire answer, I’ll let you know. But what I’m landing on right now is, well, take a step back. What is grief, right? Grief is an emotion. It’s different than burnout, because burnout is an occupational hazard, right, of which there’s probably a component of grief.
But I’d like to just kind of envision for a minute an iceberg. Above the surface of the ocean, we see what is burnout, how this manifests in a clinician with inefficiency, fatigue and exhaustion, cynicism, poor functioning in the workplace, right? It’s clearly defined as an occupational manifestation. Yet we don’t just bring our work selves to our work; we bring all of ourselves. So underneath the surface of the water, Kevin, is going to be all the things that contribute to who we are.
And not to kind of be a Debbie Downer and stick with just the negative things, but what causes grief in our life? Well, way, way down at the bottom, it could be starting with something like adverse childhood experiences, who we were before we were in medicine. If we look at the process of medical training, lots of grief develops there: a competitive environment, maybe we’re not feeling supported, we’re not being listened to, we’re being told what to do, poor patient experiences, scary stuff, trauma that we begin to participate in, seeing patients dying. Lots of unresolved grief, layering again on that iceberg.
Then we have work trauma: microaggressions; I’ve talked before about betrayal by leadership; poor communication; feeling a disconnect with our colleagues; overwork. Oh my gosh, the EMR causes me grief every day. Then you layer into that the psychosocial transition that occurred during the pandemic. Not only have we never navigated this, but it absolutely caused us a great sense of loss of what we had, not even including family members and friends that we may have lost. Layers and layers and layers.
And so how does that manifest, then? Yeah, it can certainly manifest as burnout, but the manifestation of grief also includes mourning. When I am at my saddest, I don’t want to connect with you, I don’t want to hear your side of the story. I’m going to sit in my mud puddle, and I’m going to stew. What is even worse than that is it can lead to other mental health issues, depression, suicide, terrible statistics that we now see climbing among health care professionals. So until we get to understanding that grief is part of this emotional package that can lead to all of this strife, including burnout, until we bring awareness to it, we’re not ready to start to heal.
Now, I’m not a grief expert, and the majority of my life experience with grief has been trying to mitigate it myself as I deal with loss of patients, loss of family members, loss of health, for instance. What I’ve landed on is it’s really important that we take time to do this. We take time for ourselves; all of our self-care avenues, whatever they might be for you and me, are important: finding time to rest and recover, to say no. We can do lots of things in medicine; we don’t have to do it all. And then to really share with our colleagues, our leaders, people that we’re connected with, that we need a little grace, a little compassion.
Now, on the other side of it, how do we provide this emotional first aid if we see somebody grieving? Well, it’s not to advise, it’s not to try and solve their problem, it’s not to fix it. It’s to listen, and to listen with compassion. And even though we might do that with our patients, I kind of put out to the crowd: How well do we do that with one another? We’re really good at fixing and advising, but to take time to just pause and listen, actively listen, put our own agenda on the back burner and be totally present for the person across from us, that’s a skill that requires honing. And so, you know, there are two sides to the coin on that: listening and being present if someone is grieving, and then knowing ourselves enough to pause, to take time to do what’s going to refill our energy.
Kevin Pho: Now, are you seeing health care administrators or health care leaders giving physicians that type of space so they can just listen?
Susan MacLellan-Tobert: So our group is walking that out right now. The answer, quite frankly, is no, and I don’t see it in my other connections across the country. We’re not giving anybody space. My leaders that I work with need to heal as much as I need to heal. So we have to really bring it into the limelight: Now that there’s this component of grief before we can begin to thrive again, what are we going to do about it? And we need to have really candid conversations. We’re starting that work now. How that’ll pan out, I don’t know, but I’m willing to walk that line and really just, you know, encourage people to be creative and courageous about exploring that with their other team leaders.
Kevin Pho: So tell us a little about this program. What approach is your institution taking?
Susan MacLellan-Tobert: So our plan as a coaching group is really to work with our managers so that they can understand how clinicians prefer communication, and to work with our clinicians to kind of, what’s the word I’m looking for, kind of reconnect with our managers and understand their demands. And what seem like demands maybe can be shared as more of an engaged, cooperative conversation: What are our expectations? How are you doing today? Let’s have a little bit more compassion for one another.
And there’s some work that can be done, including with second victim syndrome, some of the approaches to how we manage adverse events, so that we can pull in those resources to help us with grief resolution. So like I said, we’re exploring this right now. More to come, more to come.
Kevin Pho: Now, let’s say a physician is listening to you, and what you said really, really connects and resonates with them regarding the need to process that grief. What are some immediate steps that they can do next?
Susan MacLellan-Tobert: Yeah, so in the article that I had shared with you, I talked about some individual steps. And this little brief handbook that I use, that I reference, I found actually most helpful, probably, in my journey in learning about grief. It provided the most helpful steps to mitigate what I was working on in the moment.
I think some of the keys are reflecting back at our points in life where grief occurred. You could do that, for instance, just with the pandemic: How was that journey? What was that timeline journey for you, and when did you feel the emotion of grief welling up? And then choose a piece out of there to work on actively. So this takes some active engagement. It’s not about shoving the emotions in the back drawer and forgetting about them; we’re really good at that as clinicians. But instead, we’re going to bring it to the forefront. So you need time, you need compassion and space for yourself to process some of what is going to be difficult memory work.
And you’re going to actively look at where maybe there were areas you could apologize for, how maybe you weren’t even fully present or connected when an event was going on. Who do you need to forgive around that event? Forgiveness isn’t for the other person; it’s for ourselves. It’s for us to heal. Is there any incomplete communication that we need to finish up? So maybe there’s a dangling conversation that you don’t feel is quite resolved. Are you bold enough to go gently finish that conversation with that colleague or leader, to just complete the strife around it?
And then really just kind of saying, “Hey, I’ve done some deep grief work here. Am I settled or not? Do I need to do more?” And if you’re settled, then just release it, set it aside so you can move forward. And then choose, moving forward: What am I going to do for myself to get me to my next place in life, where maybe there is a little bit more happiness and joy?
Kevin Pho: Sue MacLellan-Tobert, she’s a pediatric cardiologist and a physician coach. Her KevinMD article is titled “Healing from the pandemic: a journey to recovery.” Sue, tell us some of your take-home messages that you want to leave with the KevinMD audience.
Susan MacLellan-Tobert: Take-home messages: I would just encourage people to bring awareness to this topic of grief. Is there grief that exists? Is it unresolved? What might you do to take care of yourself in that resolution of it? Who might you just reach out to, to listen to? That kind of immediate psychological first aid does not involve fixing, just being present. And I just empower everyone to give it a try.
Kevin Pho: Sue, thank you so much for sharing your time and insight. Thanks for coming back on the show.
Susan MacLellan-Tobert: Hey, thanks, Kevin.
Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes
