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Join Sarah Samaan, a retired cardiologist and Master Certified Physician Development Coach. We’ll delve into the pressing issue of physician dignity, discussing the challenges physicians face in today’s health care landscape and Sarah’s strategies to combat disrespect and reclaim dignity. Tune in to gain valuable insights and practical advice for health care professionals looking to create a more respectful and sustainable work environment.

Sarah Samaan is a retired cardiologist and a Master Certified Physician Development Coach. She can be reached at Mindful Physician Coaching and LinkedIn. She is the author of DASH Diet for Dummies.

She discusses the KevinMD article, “Mitigating physician burnout: Rediscovering your dignity.”

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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 Sarah Samaan. She is a retired cardiologist and a Master Certified Physician Development Coach. Today’s KevinMD article is titled “Mitigating physician burnout: Rediscovering your dignity.” Sarah, welcome back to the show.

Sarah Samaan: Oh, thank you so much. I’m really excited to be back.

Kevin Pho: So Sarah was on recently. Go to the upper right-hand corner; there’s a search icon, and you can search for Sarah’s name to hear her story. But today, I want to get straight into your article, “Mitigating physician burnout: Rediscovering your dignity.” How did this article come together?

Sarah Samaan: Well, I’ve been hearing so many stories lately from physicians about disrespect, and about the various burdens from patients, health care systems and administration that physicians encounter, and how so much of this has served to undermine our dignity. That includes, unfortunately, interactions with patients and patients’ families, which is something we never experienced, or rarely, I should say, in years past.

Kevin Pho: So tell us about the current status of respect or disrespect toward health care professionals. What’s it like today?

Sarah Samaan: I think physicians have grown to expect disrespect on multiple fronts. When we look at surveys of physicians and other health care providers and what they’ve experienced, a recent report from MDLinx found that nearly 100 percent of people had experienced some type of aggressive verbal interaction. The violent episodes were less common, but these aggressive or disrespectful verbal interactions were an almost universal experience.

Kevin Pho: And how does that affect clinicians?

Sarah Samaan: It certainly contributes to burnout. When you’re doing your job, doing the best you can under circumstances that are more onerous than in years past, under greater pressure for more throughput and to address people’s questions in a shorter amount of time, being undermined or mistreated this way can definitely contribute to burnout. In fact, there’s good evidence that physicians who experience these types of interactions are perhaps twice as likely to experience burnout.

Kevin Pho: So there’s always that balance between navigating all the inefficiencies and obstructions that impede patient care and things like patient satisfaction scores. Add the disrespect, and it sounds like there’s so much on a clinician’s plate today that could contribute to their burning out.

Sarah Samaan: Yes. And unfortunately, I think physicians often don’t have either the mentorship or the training to approach and navigate these situations. So physicians, and especially women, will often self-deprecate, apologize or make light of their discomfort in these situations, rather than addressing it in a professional, respectful but definitive way.

Kevin Pho: So what are some techniques physicians can use whenever they encounter episodes of disrespect from patients?

Sarah Samaan: Well, first of all, I think it’s important to call it out. That doesn’t have to be an aggressive or purely confrontational discussion, but just note it, acknowledge it and speak it out loud: “This is what I heard. Am I correct in hearing what I heard? Did I hear this the way it came across?” Perhaps give the patient, or the other person, a chance to restate, but call it out. Don’t just accept that treatment as normal, or it will continue.

Kevin Pho: So let’s get a little more granular about calling it out. What kind of verbiage, what kind of approach, what specific phrases can physicians use when it comes to calling out perceived disrespect?

Sarah Samaan: It always helps to mirror something back. If somebody says something that’s blatantly disrespectful, just use their words and relate them back. That gives them the opportunity to rethink what they said, clarify it, or even restate it and apologize, maybe for being misunderstood. It gives them a chance to restate.

Kevin Pho: Now, can you share a story or an anecdote, either from your past experience or from the experience of one of your clients, where they used some of these techniques to de-escalate a situation and call out disrespect, and tell us what the outcome was?

Sarah Samaan: Well, certainly these are experiences most physicians have encountered. I can give you a story of my own, where a patient’s family was frustrated with the timing and progress of the workup. Everything had been done appropriately, but it was just taking a little more time. So I took the time to sit down and explain: “Well, this is how these things happen. We will notify you as soon as the information is there, and this is the plan we’ll put in place.” That way there’s an expectation, rather than the patient being so frustrated and scared and lashing out at the physician.

Giving the patient something to hold on to not only gives them a greater understanding of the physician’s role and how the physician is working to serve them, but also gives them a way to defuse their stress. A lot of times these disrespectful episodes aren’t just because patients are unpleasant people, or their families are cruel or illogical. It’s that they’re under a lot of stress. So one of the steps I recommend physicians implement is to focus on communication, because often, if you can communicate even a few sentences just to clarify, you can begin to defuse a situation that might otherwise get out of control.

Kevin Pho: One of the things you mentioned in your article, when it comes to disrespecting physicians, is violating boundaries. What are some examples of these boundary violations?

Sarah Samaan: I think younger physicians especially grew up in a time of oversharing, of feeling very comfortable making connections with people they didn’t know, sharing a lot of personal details and creating this sort of fluid conversation with strangers. As a result, I think it’s very easy for people who live in that kind of world to allow themselves to get drawn into online “friendships” with patients, employees, administrators or other people from whom it’s perhaps best to keep a professional distance. When we’re sharing our personal lives with our friends and family, we show a different side of ourselves, and that’s not always the side of ourselves that a patient, or someone in a professional situation, needs to see. Not that there’s anything wrong with the way people are living their lives, but as physicians, we are held to a different standard. If we allow those borders to become looser, the expectations may be different, and the way our patients, staff and administrators interact with us may become very familiar. Unfortunately, that familiarity can, as they say, breed contempt, or lead to overstepping boundaries that are better left in place.

Kevin Pho: Now, what are some gentle ways physicians can reinforce those boundaries if they are overstepped?

Sarah Samaan: Well, first of all, don’t accept it when somebody asks to be your friend on social media. It’s very easy just to say, “It’s my policy,” or perhaps, “It’s the organization’s policy.” I think it’s increasingly becoming part of the normal routine that the policy is not to have social media friendships with patients or employees.

Kevin Pho: So it seems like some of these episodes of disrespect can be mitigated at the communication stage, right? Because I think a lot of what we’ve talked about is a little reactive. Is there anything clinicians can do proactively, on a preventive basis, to keep these episodes from occurring in the first place?

Sarah Samaan: I think in that respect, we do need to advocate for a respectful work environment. The majority of physicians are now employees of larger organizations, and if we don’t speak up, it’s unlikely anybody else will speak up for us. To be frank, a lot of times the administrators physicians are working with are not in the medical profession, and they don’t necessarily understand the importance of these boundaries and the importance of physicians being treated respectfully. We understand the importance of treating our patients respectfully and maintaining their dignity. I think we universally know it’s necessary and important, and part of our practice, to create a respectful environment for our patients, but we also have to expect that same respect to be given to us. And if we don’t make that clear, as physicians, to the administration we work with, then nothing may change. They have to hear from us.

Kevin Pho: And how can we do that? Ideally, you want that culture to come from the top down, from the administrators, but in cases where that doesn’t happen and clinicians need to speak up, like you said, what are some ways they can gently approach the administration to create a more welcoming, respectful culture?

Sarah Samaan: Right. And again, as you said, a more welcoming culture is going to be more welcoming for physicians as well as for patients and staff members. So bringing these issues up in the meetings we’re all part of is important, asking that this be put on the agenda. It’s also important that when these situations, communications and conversations occur, they are noted. That doesn’t have to be punitive, but we should keep track, because it’s easy to be told that perhaps you misunderstood, or that it’s not as serious a problem as you’re making it out to be. If you collect them, that’s something you can share with the administrators, or with the other people involved in creating a workplace that’s going to be beneficial and respectful.

Kevin Pho: We’re talking to Sarah Samaan. She’s a retired cardiologist and a Master Certified Physician Development Coach. Today’s KevinMD article is titled “Mitigating physician burnout: Rediscovering your dignity.” Sarah, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Sarah Samaan: Well, I have five steps I want physicians and other health care providers to keep in mind. First of all, establish boundaries. Realize that your boundaries are crucial to maintaining your professional relationships and protecting your own well-being. Being a caring and compassionate physician is not the same thing as being a friend, and it’s important to understand that difference. So, as I said, be cautious about social media interactions in particular, and be cautious about your conversations. Focus on the patients, respect them and understand their concerns.

The next step would be to focus on your communication, so that it’s respectful, and so that you model the same kind of respect you would expect from the patient and their family, or from your colleagues. Be empathetic, be compassionate and be mindful in your communication, but don’t overshare about yourself, and model a professional form of communication. When you’re communicating through the EHR, keep those messages brief and focused, so that you maintain your boundaries while still addressing the concerns.

Next, don’t accept disrespect. If somebody is overtly disrespectful to you, be firm but polite, call it out and say it as it is. Perhaps read back, or speak back to them, the words they said, and allow them some grace to restate what they might have been trying to convey. And of course, if you’re dealing with more overt, perhaps physical, disrespect, it’s really important to make note of that and keep yourself and your staff safe, and don’t let yourself be talked into accepting that type of situation. Engaging with security and reporting these episodes may be necessary if the disrespect is really overt, or if it’s interfering with your ability to care for the patient; then perhaps it’s time for the patient to go to another physician.

Advocate for a respectful work environment. As I said, if you don’t speak up, it’s not likely anybody else will speak up for you. We want to be given the same dignity and respect we owe our patients, our staff and our colleagues.

And finally, take care of yourself, and prioritize your well-being. I know that mindfulness is sometimes used almost as a weapon, a way of telling physicians, “You need to do this, and this is how you’re going to cope with these problems.” But mindfulness techniques truly can help you stay present. Mindfulness is not just a catchphrase or a cop-out. When you use it for your own enlightenment, it can help you stay present for your patients and for yourself, and composed during difficult situations, so I really encourage people to look into those types of techniques. And just don’t overlook the importance of making time for yourself, your family and your friends, and staying connected to the world outside your practice, so that you don’t feel the need to soften those boundaries.

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

Sarah Samaan: Thank you so much for having me.