college connection
PROFESSIONALISM
FIVE FUNDAMENTALS OF CIVILITY: TAKE CARE OF YOURSELF
The Spring 2016 issue of College Connection provided an introduction to“ The Five Fundamentals of Civility for Physicians,” a series of articles that examines the impact of incivility to a profession and strategies to foster civil behaviour. This article, written by Dr. Michael Kaufmann, focuses on looking after yourself as well as your patients.
“ That’ s not how my mentor puts it,” said the resident. Young and eager, he was sitting forward in his seat, following me closely, challenging.“ Surgery is a demanding specialty. If you’ re not tough enough to stand it, you should get out,” he added— or words to that effect. Oh no, I thought, he’ s swallowed the poison!
That happened during my lecture to a group of residents at a university in Ontario. I was speaking about physician health and risk, burnout and substance use disorders, our vulnerability, and self-care as an imperative.
Later, I found out the resident who spoke up— which I appreciated— was just beginning his surgical training. I could see his process of professionalization was well underway, and it didn’ t seem like he was going to be much exposed to a vital message: our health is just as important as our patients’ health.
It seemed to me that he was at risk of following a traditional path of self-sacrifice; denial of his own basic physiological and emotional needs in the name of surgical training and practice. And worse, he would believe that it was a good idea to do so, that it would make him a great surgeon. Maybe.
Certainly he’ ll have plenty of exposure to all of the amazing opportunities his training will provide. But one day, taut and exhausted, I wouldn’ t be surprised if he lashes out at a colleague or co-worker in a most uncivil way. Tightly wound, he will, as they say, shoot the first thing that moves.
Civility and self-care are linked. As Spath and Dahnke said,“ Civility is claiming and caring for one’ s identity, needs and beliefs without degrading someone else’ s in the process.” I’ m in a position to interview doctors who have forgotten that. Burned out and perplexed, they’ ve drifted away from the awe of medical practice. Instead, they see their patients as problems, their colleagues and co-workers as irritants, at the very least, and sometimes as the enemy. I even see that transition in the faces and mannerisms of learners: eyes wide with amazement as students; spent and jaded by the final years of schooling. They are already shouldering a load that is difficult to set down.
Civility And Burnout
What happens when a person has to perform day after day under demanding conditions beyond their personal comfort zones, unable to unburden themselves? Yes, there is learning and growth, to a point. After that, there is fatigue, exhaustion, distress, burnout, illness and, for some, incivility.
We are learning that choosing civility isn’ t always easy. Sometimes we have to dig deep to find the respect and awareness required to communicate in a civil and effective fashion. This is especially true at times of prolonged stress, when we’ re most likely to fall back on more deeply ingrained modalities of fight, flight, or aggression.
Burnout can impact upon an otherwise healthy individual, and looms as one of the greatest challenges to the veterinary profession. We can examine burnout in more detail. Maslach described the dimensions of burnout as exhaustion( physical and emotional depletion), depersonalization( a cynical detachment from work and coworkers), and a sense of ineffectiveness and lack of personal accomplishment.
Major antecedents of burnout include excessive workload, perceived lack of control, insufficient reward, poor professional community support, a sense that fairness is absent, and a mismatch between one’ s personal and occupational values with those perceived in the workplace.
Highly motivated veterinarians with intense investment in their profession are at risk. Treating co-workers badly has negative impacts upon patient care. Chronic stressrelated irritability, impatience with others, and failing empathy all predispose to workplace conflict and low morale.
The“ Self Versus Service” Dilemma At the Physician Health Program( PHP), we regularly receive calls from individuals who are stressed and feel like they are burning out. Their account often reflects the following pattern: they are feeling overwhelmed by their workload and under-appreciated. Maybe they’ re drinking a bit too much, or perhaps a client has complained about their manner. When they have sought support and relief, it’ s been met with a message pushing the problem back upon them— something like,“ These are tough times and we all have to work harder.”
Veterinarians are often being pushed to respond to unlimited demands. I’ m sure those in positions of responsibility are also stressed by these systemic pressures. Still, a compassionate, active listening response to a colleague in distress would, all by itself, offer a measure of relief. And in the end, how is
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