Responding to Suffering
Last year I started attending monthly lectures put on by the Nevada Physician Wellness Coalition (NPWC), an organization in line with my heart, as it is focused on decreasing physician burnout and suicide. There has been so many insightful presentations on topics such as humanism in medicine, compassion fatigue, resilience, moral injury, and physician burnout, all topics I have been studying and writing about in the last several years.
I was familiar with all of these topics because I was there: burned out, running out of resilience, heavy with moral injury and compassion fatigue. I'm happy to say that I've dug myself out of those dark places, even though the challenges of medicine continue to bombard me daily. I am fortunate to have created enough work/life integration that I can continue to show up at work with an open heart, ready to care for others and be a model to staff of how to bring compassion into the workplace. I don't always get it right of course, and am still learning how to let go of being a perfectionist. I own up to my mistakes and learn something new everyday about how I can be a better physician, colleague, and overall human.
A recent presentation by NPWC was entitled "Responding to Suffering." Per Oxford dictionary, suffering is defined as "the state of undergoing pain, distress, or hardship." None of us go into medicine expecting to not witness suffering, though I think we erroneously believed we would be able to stop or at least decrease the suffering of our patients by making accurate diagnoses and treatment decisions. Sometimes this is the case, though at other times, we cannot alleviate all the suffering and have to be satisfied with supporting patients and their families in other ways.
There are many types of suffering my patients experience, not just physical. As the NPWC lecture pointed out, there is emotional, social, spiritual, economic, cultural, and existential suffering. As competent physicians, we are trained to rush in and fix the problem that is causing the suffering. Sometimes the disease or psychosocial distress is not fixable, and in that case, all we can do is be present for the patient and their families, if the structure of our workplace affords us the time to do that. Unfortunately, listening and just spending time with patients is not financially productive, though in my opinion, can do so much more than prescribing a medication. I have always been committed to making sure my patients are seen as something more than just a disease process. They are human beings with goals and dreams, joys and sorrows, just like me.
While I do enjoy putting on my physician thinking cap, trying to interpret the patient's currently status, come up with a list of possible reasons for their complaint, and then order appropriate labs and/or imaging, I also enjoy getting to know them. Being in rehabilitation medicine, I like to sit and listen to their concerns about their functional recovery, offering words of empathy and hope. I know deep in my bones that I make a difference in the lives of my patients, that with my style of doctoring, focused more on quality of care versus quantity, I am decreasing their suffering. And that makes me feel good as it satisfies the desire to serve others, the very reason I went into medicine in the first place.
Patients aren't the only ones that experience suffering. All the members of the healthcare team, being human themselves, also experience their own suffering. We put our own distress aside every day in order to show up for our patients. There is also the additional secondary trauma of being exposed to daily suffering as well, more emotional burdens to carry on top of our own personal ones. I wish I could say that the culture of medicine makes it a priority to take care of the suffering of the healthcare providers, or at least makes a concerted effort to give support, and not wait for the struggling provider to reach for help, as it often is too late. There is still a culture of silence in medicine, where caregivers keep their own distress to themselves, in fear of being perceived as unable to complete their job. For now, I daily do what I can to bring attention to the this irony, for if we don't take care of the caregivers, they cannot be there to care for the patients.