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 »

By Elizabeth Southworth

“So what’s the plan for the students” asked my attending during morning rounds on Monday March 16^th. 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 3^rd and 4^th 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 4^th year of medical school came dramatically to a halt.Read More »

If I do not survive Covid

Please note the hopes we shaped before

The concerts, hikes and family feasts

Still on schedule, still in store.Read More »

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 »

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 »

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 »

by Anu Antony

I am a plastic surgeon, a profession that involves understanding women’s aspirations not only in the corporeal sense, but also being cognizant and mindful of their psyche – the inner thoughts and feelings that drive them to choose plastic surgery.Read More »

By Hedy Wald

Looking back, looking forward. It’s what we do on the eve of a new year. 24 hours away from a fresh start, resolutions, inspirations, and even some trepidations . . .  2020 sounds like science fiction and yet, here we are.Read More »

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.