VIEWPOINTS
Healing Our Invisible Wounds
Alexandra Wolanskyj-Spinner , MD , is Professor of Medicine in the Department of Hematology at Mayo Clinic in Rochester , MN .
The content of the Editor ’ s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated .
Have a comment about this editorial ? Let us know what you think ; we welcome your feedback . Email the editor your response , along with your full name and professional affiliation if you ’ d like us to consider publishing it , at ACNEditor @ hematology . org .
● MANY PATIENTS whose paths cross ours , as hematologists , will inevitably face premature death due to their underlying disease . Yet , we learn from each case , strive to do better through new research and therapeutic strategies , and find the strength to move forward . After all , humanity is at the core of our inspiration to pursue our specialty .
But , when do we stop to consider the cumulative effect of these losses ? Do we take time to process our emotions , or do we quickly intellectualize and move on ? When do we take time to heal our invisible wounds ?
Our sense of loss in medicine has never been more pronounced . In the Medscape National Physician Burnout & Suicide Report 2021 , subtitled “ Death by 1,000 Cuts ,” approximately 42 % of the more than 12,000 physicians surveyed reported experiencing burnout . In 2020 , 69 % of physicians reported being happy or very happy at work ; in 2021 , that number dropped to 49 %. One-fifth of respondents said they experienced clinical depression , and many cited burnout as a major contributor . This progressed to suicidal ideation in 13 % of those who said they were depressed , and 1 % said that they have attempted suicide . 1
Although the causes of burnout are multifaceted , including stress from excessive clerical obligations , patient outcomes contribute significantly to these statistics . We are at a crisis in our profession : Health care providers are conditioned to minimize their needs and ignore self-care . As one survey respondent wrote , “ Doctors try to have compassion and forgive patients , but we need to have compassion for ourselves , too . Doctors don ’ t give themselves enough of a break .” Indeed , remembering to be self-compassionate has elevated my capacity to maintain compassion in my work .
A deliberate step we can take to support and normalize struggle is to share our own narratives . In the struggles I have faced both personally and professionally , I have sought out opportunities to disclose to trusted colleagues and , in doing so , have been honored by their trust in me as well . This normalization of the struggle allows for healing in the moment .
Darrell Kirch , MD , president emeritus of the Association of American Medical Colleges ( AAMC ), recently shared his personal mental health journey and pleaded with health care providers to do the same . 2 “ If more of us are willing to describe ... how we have benefitted from treatment and been able to thrive in our careers , eventually we will reach a tipping point of destigmatization ,” Dr . Kirch wrote . “ The salutary result could be fewer of our colleagues suffering in silence .”
Grassroots efforts within health care organizations , such as the H . E . L . P ( Healing the Emotional Lives of Peers ) Program at Mayo Clinic , offer peer support for health care professionals who are profoundly affected by a clinical event . This four-step program is centered on exploration of the experience and normalization of the surrounding emotions . Sharing with a trusted colleague the tragic or unexpected loss of a patient may not lessen the initial “ punch in the gut ,” but may mitigate the long-term effects . 3 Mayo Clinic ’ s “ MyStory ” series offers a similar opportunity for students to learn from senior trainees and faculty members about challenges they faced and failures they overcame during medical school . This programming provides an open forum for honest discussion and is attended by students only , to create an environment where they can safely share their own struggles . 4
Only one-third of respondents in the “ Death by 1,000 Cuts ” survey reported that their workplace offers a program to reduce stress or burnout . However , we need to go beyond that and think bigger to combat this scourge on our profession . A meta-analysis of controlled interventions to reduce physician burnout demonstrated that the small benefits of these programs can be enhanced by organization-directed approaches . 5
We are at a crisis in our profession : Health care providers are conditioned to minimize their needs and ignore self-care .
Just as our approach to caring for patients with hematologic disorders has evolved , so must our approach to supporting clinician mental health and well-being . Modeling that it is not only OK , but important to take time to center yourself after an emotionally devastating event . We should regularly check in with our colleagues and ourselves , such as pausing for moments of silence to acknowledge loss before starting morbidity and mortality conferences . We can use artistic expression to process our emotions . We can encourage one another to seek support .
As a specialty , let ’ s make a pact to look out for each other . To not assume we are OK , but to ask if we are OK . Only in doing so can we begin to heal some of our invisible wounds .
Alexandra Wolanskyj-Spinner , MD Associate Editor
References
1 . Medscape . ‘ Death by 1000 Cuts ’: Medscape National Physician Burnout & Suicide Report 2021 . Accessed February 9 , 2021 , from https :// www . medscape . com / slideshow / 2021-lifestyleburnout-6013456 .
2 . Kirch D . Physician mental health : my personal journey and professional plea . Acad Med . 2021 January 25 . [ Epub ahead of print
3 . Finney RE , Jacob A , Johnson J , et al . Implementation of a second victim peer support program in a large anesthesia department . AANA J . [ in press ]
4 . AMA Ed Hub . “ MyStory ” Series : Normalizing Struggles During Medical School Training . Accessed February 9 , 2021 , from https :// edhub . ama-assn . org / steps-forward / module / 2763262 .
5 . Panagioti M , Panagopoulou E , Bower P , et al . Controlled interventions to reduce burnout in physicians : a systematic review and meta-analysis . JAMA Intern Med . 2017 ; 177 ( 2 ): 195-205 .
6 ASH Clinical News March 2021