WORCESTER MEDICINE
As I See It
A Pre-existing Condition in Medicine Christine Runyan, PhD, ABPP
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OVID-19 shined a light on a pre-existing condition in medicine – our healthcare system has been failing to tend to the well-being of its workforce. Physicians and advanced practice clinicians are mostly a privileged population. But, the process of becoming a doctor involves extensive and expensive training, repeated trauma exposures, geographical relocation and sometimes isolation, poor access to one’s own healthcare, fear about seeking help due to licensing, consent to disrupted sleep and 80-hour work weeks, as well as chronic stress in order to meet the demands of a culture that expects perfection and tireless self-sacrifice. Doctors do not lack resilience. The rigorous training paradigm ensures they
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...trying to be resilient in the face of chronic stress with a mindset of perfectionism allows the voice of self-criticism to flourish.
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have the ability to “bounce back in the face of adversity.” So why do over 400 physicians die by suicide every year and rates of burnout are well over 50%? Because trying to be resilient in the face of chronic stress with a mindset of perfectionism allows the voice of self-criticism to flourish. Clinicians achieve excellence, in part, by repeatedly bowing at the altar of self-criticism and demanding more and better for themselves. This behavior is rewarded throughout training. Once training ends, however, this welloiled mechanism is extremely hard to turn off simply because the evaluations, feedback, and grading have stopped. The cognitive and behavioral habit loops have been formed. My clinical practice has been exclusively with physicians for the past few years and
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the most pernicious threat I try to defuse is a negative internalized voice - the voice of not being and doing (good) enough. No amount of sophisticated technology can do what health professionals have done these past few months - offered care with uncertain evidence, sat with the dying, comforted family members from afar, held one another in fear and grief, celebrated unexpected recoveries, and simply showed up. We have asked and expected clinicians to show up in ways they were never trained to do. No one has been trained in how to emotionally manage months of mass casualties. No one has been trained on how to keep showing up despite feeling feckless on the job. No one has been trained how to keep regular life afloat at home and anxiety at bay, while working day after day with a little known biohazard. A fortuitous side effect of COVID-19 are the writings, videos, and social media outcries by healthcare professionals coalescing into one common message: pay attention to our needs. So how can we pay attention to the needs of healthcare professionals? Access to high quality, private, low barrier, and expert mental health care is needed but we also need to move beyond a model of providing care only after people are suffering. Even with the financial strain facing most healthcare organizations, there remains an ethical and moral imperative to address workforce well-being by offering protected time to learn and practice skills such as emotional intelligence, managing secondary trauma, compassionate communication, presence, conflict mitigation, self-compassion, emotional regulation, opportunities to process various events in the community, and skills to regulate one’s own nervous system. These are all the things that buoyed me over these past months, helped my patients, and ultimately will improve the healthcare any of us receive. + Christine Runyan, PhD, ABPP is Professor, Dept. of Family Medicine and Community Health, University of Massachusetts Medical School, UMMHC and Co-Founder, Tend Health, LLC
NOVEMBER / DECEMBER 2020
