Physician suicide is hitting the headlines at the moment, thanks in part to the outstanding efforts of Dr Pamela Wible to highlight these tragic events. More than 400 doctors end their lives each year in the USA, mostly young doctors and medical students at the beginning of their career.
Surveys all around the world document high levels of stress and burnout among health professionals. In Australia, the Beyond Blue survey showed that nearly one-in-two doctors under the age of thirty had symptoms of emotional exhaustion and cynicism. One-in-eight had thoughts of suicide in the previous twelve months. Many factors contribute to this heavy burden of psychological distress, including inhuman work conditions, lack of support from seniors, the emotional trauma of the day-to-day work, and feelings of anxiety and incompetence.
What can be done to support our young doctors and prevent this tragic loss of our brightest and best? While the healthcare system is not going to change anytime soon, there are ways young doctors can address their own vulnerability together. Earlier this month, sixty young doctors and medical students in Dresden, Germany, showed us how. The event is indelibly marked in our memory.
Led by young doctors and medical students, a growing network of organisations in Europe and beyond is forging a new future for healthcare, one based on humanity and caring. With a vision of holistic care, compassion and healing these young leaders are not waiting for their seniors to change the system – they are taking direct action. Organisations include Humans of Health (international summer leadership school), Compassion for Care (in the Netherlands), Medizin und Menschlichkeit (Medicine and Humanity, in Germany), Medizin mit Herz und Hand (Medicine with Heart and Hand, in Germany, organisers of a famous integrative medicine summer academy), PAF (Positive Attitude Formulas – Hungary), Humanizing Intensive Care (Spain), TellerrandMedizin (Medicine beyond the edge – Austria) and our own Hearts in Healthcare networks.
My book ‘TIME TO CARE – How to love your patient and your job‘ has become a source of inspiration and support for these young leaders – to the extent they have already inspired foreign language editions in Dutch and German and there’s discussion underway to add Hungarian and Spanish versions. It was the June 2016 launch of the German edition of my book in Dresden that brought us all together.
Two of the young leaders of Medizin und Menschlichkeit (Dr Marie Downar, the translator of my book, and Dr Oxana Atmann, in the picture) arranged a one-day symposium on humanity in medicine, to coincide with my book launch. The next day we hosted a workshop for more than fifty young doctors and a handful of medical students, What happened on that second day left a deep impression on us all.
We began with our ‘Reawakening Purpose‘ workshop, which pairs people to tell stories about a day when they had ‘an extraordinary connection’ to a patient, then to share stories in the open circle. It’s a magical process that re-connects health professionals to the hopes and ideals that brought them into medicine, then inspires everyone in the room with stories of compassion and healing. The circle of story-sharing is very intimate. We practice deep listening and so there are no comments or questions until all the stories are finished. We then begin an open dialogue – what we can learn from the stories and how we can apply that in practice. Because it’s such an intimate process, we normally recommend a maximum of 16 participants for the Reawakening Purpose workshop. Occasionally we’ve stretched it to 20 people but the bigger the group, the less powerful it seems. Over the last three years we’ve taken more than 1,000 health professionals through this workshop, in several different countries, and many others are using the workshop in their own workplace.
To be honest, as workshop facilitators we felt nervous about this event. We don’t speak German and we feared that the process of translation between German and English would be intrusive and difficult. And we had serious doubts about attempting such an intimate process with a huge circle of sixty people. But, in the event, something magical happened.
In the pairs, we invited people to share stories in their native German and then, in the open circle, we invited people to speak the same stories in English. Despite English being a second language for almost everyone in the room, the communication wasn’t hindered. An amazing spirit settled into the room and we were deeply moved by the stories, the emotions, and the tears in people’s eyes. The closing round took more than an hour. We asked each participant to share just ‘one thing’ they had learned in the workshop, which they could apply to their own practice or perhaps teach to another. As each person spoke, it became apparent that a huge shift had occurred in the room.
Although I’m well advanced in my medical career, I remember vividly the terror and the trauma of the early years of my practice as a doctor. To hold the lives of patients in your hands but at the same time to feel inadequate, inexperienced and sometime incompetent is a huge psychological burden, made worse by the criticisms of our seniors. What these young doctors learned in the workshop is that there are two equally important aspects to being competent as a doctor: the technical medical knowledge/skills and the human capacity for compassion and caring.
In the symposium the day before, these young doctors heard the scientific evidence showing that compassionate caring, of itself, profoundly affects clinical outcomes – often as powerfully as the medicines we give. So although the trainee doctors felt inadequate and vulnerable in terms of their medical knowledge, it was deeply affirming to understand that they already had a fully developed capacity for human caring and compassion. Moreover, reconnecting to the heart of their practice in this way, gives them much more meaning in their work and is a source of joy and satisfaction.
Research also shows that doctors who are more empathetic and compassionate are less likely to burn out. It’s those who become like robots who are at greatest risk of self-harm.
On that day in Dresden, the collective insight and new realisation shared by these young doctors was powerful. They left the room changed. We also had a strong sense that a new community was born, those committed to supporting each other in more compassionate ways of being doctors, regardless of what their seniors taught.
In the afternoon we gathered again to have a dialogue about self-care. I explained that the care for each patient begins long before we meet the patient: if we want to sustain the capacity for compassion and caring, we have to strengthen our own hearts first. I didn’t have to teach a single topic, all the wisdom we needed was already in the room. I simply posted a list of words like self-compassion, mindfulness, kindness, appreciation, positivity, spirituality… and invited people to begin a dialogue. Among these young doctors was a wealth of knowledge in self-care: from the every-day aspects of good food and exercise all the way to advanced spiritual practices. People felt safe to share their own struggles, vulnerability and failings. With deep compassion, others in the group offered their wisdom and support. It was very touching for us to witness the affection and love shared in the group.
Our workshop was held in the conference room of a working hospital. At the conclusion of the day, it seemed fitting to end in silence while we all sent healing thoughts to the busy health professionals at work in the wards and departments around us. To be in the room that day was a deep privilege.
Dr Pamela Wible has expressed outrage at the cynical offerings of ‘resiliency training‘ to trainee doctors who are suffering in an inhume and unsupportive work environment – as if that was the answer to the problem and lets the supervisors off the hook. She’s demanding that the senior medical leaders and health executives take responsibility for the care of junior doctors and to halt the epidemic of suicides.
While we strongly support her in that call to action, we wanted to share our experience that much can be done to support young doctors today, without waiting for the system to become more caring and supportive to those who work within it.
If we were to hazard a guess, we’d say that the sixty young doctors and students who gathered with us in Dresden that day will be the most powerful force for a rehumanised system. We shouldn’t underestimate how powerfully junior doctors can influence their seniors to change the culture, when they show compassion for their seniors’ own suffering. The most powerful way we can change the world is to change our own attitude.