For me, physical symptoms are a clue to something I don’t want to know about myself. If I have a sore throat, I wonder if there’s something I need to say that isn’t being said. If I get a neck pain, I might attribute it to stress or a virus, but I also think, “Who or what is being a pain in the neck to me?” The pain in my right shoulder stumped me. I asked myself, “Am I shouldering too much responsibility?” One of my employees was making everyone around her unhappy. She was the puppy in the practice, charming at first, but very disruptive when any form of self-discipline was required, even after three years of training. The office dynamics were beyond the help of a dog whisperer. I eventually made the painful but right decision to let her go, but the shoulder pain persisted. I began to think the pain was a protective armor that no longer served me, but I couldn’t let go of it. That’s when I turned to my friend Ed for help.
The hallway at Seashore Healing Arts Center was chilly, but the space heater was on in Ed’s massage room. I sat against the wall in a metal-framed chair with an aqua vinyl seat. Ed sat across from me, holding his tape recorder. He always recorded his intuitive sessions. He asked me why I was there before he closed his eyes to center. A few minutes later, he turned on the tape recorder. First, he listed the muscles which were involved. He knows I’m a doctor, so he can be technical: anterior deltoid, subscapularis, pectoralis, rhomboid. Then he delved deeper. “I see you in the hospital in your white coat, wearing glasses and holding a clipboard and writing. You look very intense and focused. The way you’re holding your shoulder is not only physical, but mental and emotional. You’re thinking, ‘I have to finish.’”
His prescription? “Be aware of your shoulder when you’re in the hospital. Make sure you’re fully expanding that area of your chest when you breathe. That dark, contracted area will lighten up. You’ll have more joy when you interact with your patients.” Joy? Was that supposed to be part of the patient-doctor interaction? I had forgotten that. The next day, as I stared at the long list of patients on my computer screen, I felt my shoulder tighten. I made a conscious effort to straighten my posture, relax, breathe, and to allow the lightness to enter. I’m sleeping a lot better now. I’m no longer unconsciously perpetuating the injury.
Now, my body gives me confirmation of making better decisions. I used to apologize constantly to my patients about my cold hands. Somehow, just knowing the physiology of sympathetic arousal, of the “fight-or-flight” response, wasn’t informing me about my own ongoing stress, until I learned about biofeedback. It took a technologic form of self-awareness, in the form of a thermistor placed on my finger, to get me to make my cold hands warmer. My migraine headaches went away. Now, my hands are always warm.
I’m not alone in my struggles against burnout and stress-related symptoms. Physician burnout is a well-described phenomenon in both the lay press and in peer-reviewed journals. Here is a definition of burnout from Dr. Tait Shanafelt from an editorial in JAMA (September 23/30, 2009—Vol 302, No. 12).
Burnout is a pervasive problem among physicians. The burnout syndrome is characterized by losing enthusiasm for work (emotional exhaustion), treating people as if they were objects (depersonalization), and having a sense that work is no longer meaningful (low personal accomplishment).
Fortunately, there is also research to show that physician burnout is preventable and treatable. Enthusiasm for work can be restored once it’s lost. But physicians can’t do it all by themselves. The most successful health care institutions have made provider wellbeing a priority. Some researchers have started calling it “The Quadruple Aim”. Unless health care providers remain happy and engaged and enthusiastic, the other three goals of the Triple Aim will never be accomplished.
What one factor do you think would make your life easier? More time for self-care? More clerical support for documentation? Or something else?