• To Care is Human

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    To Care is Human

    How many of you are familiar with these situations?

    • In the OR lounge, surgeons lament the loss of autonomy, the lack of gratitude, the growing burden of documentation and the long hours they work.
    • In attending your institution’s committee meetings, you note an increase in the number of “impaired physician” incidents.
    • A hard-working colleague was seriously hurt in an evening traffic accident. He had been on call all weekend. Both fatigue and alcohol were suspected factors.
    • Your community has recently been stunned by the suicide of a well-respected physician who seemed to have everything life could offer.

    The central focus of being a physician is caring. Each one of the examples above suggests there’s an individual who needs a supportive, caring person. In our profession of medicine, we are called upon to care for our colleagues, our trainees and, indeed, ourselves.

    Just as the airlines remind us to put on our oxygen mask before attending to others, the analogy that we must care for ourselves in order to be caring physicians is appropriate. 

    It is difficult to address such issues. Ophthalmology is a wonderful specialty, full of ways to help our patients, enriched by society’s value placed on preserving vision and blessed with talented individuals who have chosen this field. In large part, our cups are far more than half-full.

    We do not usually face the constant fatigue of helping terminal patients or interacting with increasingly complex hospital systems. Yet in all probability, each of us has had experience with incidents like those above. It need not involve us as individuals. It is far more likely to involve a medical colleague in distress.

    When such circumstances present themselves, they are uniformly difficult to address and often are accompanied by a code of silence or imposed confidentiality by virtue of committee rules or bonds of friendship. Moreover, the adage of “physician, heal thyself” may add a component of guilt, connoting an individual responsibility to solve such problems, as well as a perceived weakness of character to ask for help.

    Our profession is no longer silent on this topic. Burnout is rising, depression among physicians exceeds that of any other learned professions and the incidence of physician suicide is higher statistically than the incidence of opioid-related deaths. Financial experts lament the loss of time and talent available when this spectrum of conditions affects healers. Physician wellness, also known as physician well-being, has burst into the consciousness of medical organizations.

    This topic is best reviewed in “To Care is Human,” published in the New England Journal of Medicine. The authors, Victor J. Dzau, MD, Darrell G. Kirch, MD, and Thomas J. Nasca, MD, represent the leadership of three major medical organizations: the National Academy of Medicine (formerly the Institute of Medicine), the American Association of Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME).

    At the recent annual educational conference of ACGME, the authors, all presidents and CEOs, each told their own story, reflecting on times in their careers where the responsibilities of being a physician impacted their own well-being.

    Susan H. Day, MD

    One related his experience as a first-year medical student encountering cadaver dissection. It required shutting out feelings that the human body he was working on at one time was someone’s friend, parent or colleague. Long hours and unrelenting fatigue unlike any he previously experienced set in. His sense of smell and touch were overwhelmed by elements that, under ordinary circumstances, would be repugnant. Classmates joked about specific features of their own cadaver “specimens.”

    A deep depression overcame him at the conclusion of the course. He considered dropping out but was rescued by a caring student dean. After taking time away from his studies and receiving professional help, he resumed his career.

    A second author admitted that telling his story was the hardest thing he had ever done because he came from a cultural background where it was simply not acceptable to show vulnerability.

    During his first year as a resident, his wife fell seriously ill and was hospitalized. Serving on an ICU rotation, his attending told him that he could not leave the ICU to see her (the rotation required 24/7 coverage). He resigned his residency, but with an immense sense of guilt that he didn’t have what it took to be a doctor. Eventually he was able to return to his training but continued to suffer immensely from a sense of personal failure.

    The final speaker addressed his soul-searching experiences as a medical school dean and subsequent leadership positions centered on education. His most difficult days by far surrounded the deaths of students, residents and colleagues. These deaths included accidents, malignancies and suicides – the last category were the most difficult to accept. The deaths by suicide involved individuals he knew well.

    “If only” he could have helped, he thought. “If only” he had known there was a problem. “If only” these individuals were helping patients with their talents and skills.

    It is through such vivid storytelling that we can best see what opportunities we have to help our own. A refocus on humanism in medicine for the sake of those who help patients is long overdue.

    The prevalence of burnout, depression and suicide in physicians cannot be ignored. Burnout is not a mental illness, but rather a work environment issue. The responsibility we have to ourselves and to our colleagues carries an importance akin to that of patient care.

    Ophthalmology and ophthalmologists are not immune. Younger generations have different experiences and have fewer years of honing resilience skills. As their mentors, we must approach them with values that they understand and with values which emphasize humanism. 

    At the Academy’s Mid-Year Forum 2017, physician well-being was front and center in discussions. Consequent to this discussion, tool boxes to address physician wellness can be found on the Academy website (https://www.aao.org/member-services/physician-wellness).

    These resources address significant wellness issues unique to ophthalmology, such as ergonomics to prevent our major ophthalmic occupational hazard of back injuries.

    Courses offered at Academy annual meetings provide further help to our membership. We even provide therapy animals and promote yoga sessions during the meeting.

    Preventive medicine is a major factor in physician well-being, and the importance of diet, lifestyle, work-life balance and critical assessment of one’s own values are just a few examples.

    Fortunately, the stigma of emotional distress and the taboo of addressing this topic are diminishing.

    There are more resources today than ever before. You can find information on physician wellness the websites of the National Academy of Medicine (https://nam.edu/initiatives/clinician-resilience-and-well-being ), the Accreditation Council for Graduate Medical Education (https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources ) and the American Medical Association (https://www.ama-assn.org/ama-member-benefits/practice-member-benefits/physician-wellness-program ). 

    How should we address this broad topic as individuals? We have such extraordinary responsibility as physicians. Our careers center on listening, discerning and helping. Such skills deserve to be shared among our colleagues. It starts with ourselves.