On Being a Doctor and a Human in the Pandemic: Connection and Vulnerability

By Amy Blair

With each passing 24 hours, my roles of physician and physician educator and mother (and human of the planet Earth) have been taxed in complex ways. The problem-solving demands are intense and the solutions often feeble, weakened by uncertainty, if not paralyzed. It feels as if the rug were pulled out from under my stable pillar of work-life balance and I teeter and totter as the emails, announcements, protocols, and crash courses in new technologies try to blow me over each day. It is a new flavor of exhausting. A sympathetic overload (as in autonomic nervous system).Read More »

Called to Serve: A Medical Student Response to Canceled Classes and Rotations in the Pandemic

By Elizabeth Southworth

“So what’s the plan for the students” asked my attending during morning rounds on Monday March 16th. We were discussing the many changes that had already occurred over the past several days; the rooms in the Surgical ICU that had been sequestered for possible corona virus patients, the restrictions on visitors to the hospital, and the impending decision regarding 3rd and 4th year medical students on clinical rotations. Moments later the email came in – “All M3 and M4 students will immediately stop participating in their clinical clerkships or those electives that involve patient contact”. With those words, my 4th year of medical school came dramatically to a halt.Read More »

The Guilt Does Not Go Away: A Physician’s Tribute to Elephant Mothers

By Maha Mahdavinia

It started almost from the moment my son was born, after I held that precious little breathing miracle of life in my arms and he stopped crying right away. I was filled with joy and love, as if beautiful, peaceful music was playing in my ears. I wanted to hold him all the time and never leave him. Then I remembered: My maternity leave was only six weeks. All of a sudden, the music stopped. It was replaced by a gnawing pain in my belly. Not from the unexpected ruptures of birth — I couldn’t care about those less at that moment. The pain came from guilt. In six weeks I would have to leave my baby every day, from very early in the morning until six or seven at night, when I came back from the hospital. I was a medical resident, and my work hours were long and uncompromising. As I sat in the recovery room of the maternity ward, my mind turned from awe and wonder to anguish and doubt. What was I thinking having a baby? I was so busy with work, and my job was very stressful. Surely I wouldn’t be a good mother.Read More »

Avoiding Compassion Fatigue: Drain Less, Recharge More

By Eran Magen

You open yourself up to the pain of others, in order to be a comforting presence in the middle of a terrible experience. It helps them, and it drains you. It is exhausting to experience so much secondhand suffering. Over time, it sucks the color out of your own life, leaves you depleted, less able to connect with the next person and to enjoy your own life.Read More »

10:56 – The Minute a Patient’s Life Ends and a Medical Student’s Life Changes

By Rachael D’Auria

The hierarchy in medicine, dark humor used to cope with difficult patients, and embarrassment of not knowing answers to endless questions being thrown your way are some of the many horror stories students above me have attempted to prepare me for. However, no amount of preparation could prepare me for witnessing my first death.Read More »

“I Shall Be Released.” Restorative Justice Techniques Can Address Healthcare Burnout & Attrition

by Jay Behel

Burnout, provider dissatisfaction, and attrition remain at near-epidemic proportions among healthcare providers. A 2017 survey found that 39% of physicians reported significant burnout, and nearly a third of physicians were contemplating leaving practice in a 2012 survey.  Nurses seemed to be faring better in a survey released earlier this year with only 15% reporting burnout. However, 41% reported feeling disengaged from their work.

The myriad wellness programs launched to address these problems have disproportionately focused on private, individual aspects of wellbeing like diet, fatigue, and exercise offering similarly individual solutions like yoga and meditation.

Missing from the strategy to help healthcare providers is a coherent plan to address the systemic, communal factors underpinning the crisis, namely the disengagement and isolation fostered by our mechanized and monetized healthcare environment.

While they’re often reserved for use in criminal justice settings, community-building and conflict resolution practices rooted in the philosophy of restorative justice offer a remedy for the alienation of the contemporary healthcare provider and, perhaps, our entire healthcare system.

I began looking for ways to introduce RJ practices at Rush Medical College in Chicago after attending a training in California.  While the whole experience had a powerful impact on how I think about my work as a healthcare leader, I was most struck by the flexibility of the circle practices—their ability to make space for the silly and the serious, for simple connection and complex problem-solving.  I was also impressed by the speed and apparent ease with which participants, myself included, made themselves vulnerable and voiced hard truths.

Following this experience, I brought training to our campus, and our student leaders subsequently held a series of restorative justice circles to address tensions over a curricular transition. Participating students expressed their needs and, ultimately, reaffirmed their commitment to respect and care for one another. After the circles, the number of students reporting peer conflict and incivility dropped.  Moreover, several students noted that the experience of sitting in circle completely changed their sense of the learning environment and their place in it. One student noted: “I feel that I have gained social capital knowing that there is a community of peers I can reach out to whenever I need support.“

Rooted in indigenous traditions, restorative justice (RJ) is a theory that emphasizes building community and repairing harm through cooperative processes that include all stakeholders.  RJ practices convene groups of people to engage in meaningful dialogue about substantive issues that impact community and individual functioning. These processes can help a group identify and gain mutual understanding of both the personal and collective sources of disconnection, create the conditions that incentivize growth, and build or rebuild trust.

One essential RJ practice is the community-building circle.  A circle is usually convened around a desire to both build connections and address tensions and conflicts disrupting the group’s ability to fully function as a community. Guided by a trained circle-keeper and structured around the use of a talking piece, community-building circles provide safe, inclusive space for the revelation of issues both large and small, personal and universal.

More fundamentally for the healthcare space, RJ, particularly circle practices foster the personal connection and humanistic values that brought most people to the field in the first place. Healthcare institutions in New Zealand and Australia are leading the way in employing restorative practices.

Integrating these practices certainly requires an up-front commitment of time and money, and RJ-driven culture change takes time and inevitably involves some moments of painful self-examination at both the personal and institutional levels.

Nevertheless, the pay-off over time, in reduced attrition, increased provider satisfaction, and better patient care, would greatly outstrip the initial investment. And, in an industry that has become so focused on efficiency and metrics, RJ may be key to building capacity.

While these practices alone cannot repair our fractured healthcare landscape, they do offer a roadmap by which providers can navigate the terrain with their souls intact.

 

Jay Behel, PhD, is Associate Dean of Student Affairs and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Rush Medical College in Chicago.  He is a Public Voices Fellow with the OpEd Project.

“You will be alright” – A Doctor’s Reflection on the Power of Hope

By Mahboobeh Mahdavinia

Alanna and Anthony are not yet ten years old, but they have been to the emergency room more times than most adults. Every few months since they were babies, their parents have raced them to the hospital for asthma attacks, superinfections of their severe eczema, or food allergy reactions. They each have been intubated twice in their precious few years of life.

But for the last year, Alanna and Anthony have not had to come to the ER in crisis. Instead, their parents have brought them to see me in my allergy clinic for scheduled medication shots and follow-up visits. I consider Alanna and Anthony a success story, or at least the start of one. But most hospitals would not – and neither would insurance companies.

The truth is, Alanna and Anthony have missed multiple appointments, and consequently missed almost half of their shots. Other patients I see have similar spotty records. Administrators who oversee my clinic have pointed out the large cost of no-show appointments. When inconsistent patients do come, their appointments often go overtime, creating conflicts with nursing and staff schedules. Some other hospitals and  clinic administrators would almost surely have come up with plans for dismissing Alanna and Anthony from the practice. However, we have all come to the agreement that we should do whatever it takes for them to stay as long as they choose. Read More »