“Look for the helpers.” That's what Mr. Rogers says his mother told him in scary situations. Over the last three years, we've certainly had to look to — and seek help from — the helpers. It’s been physicians, nurses and all kinds of medical professionals who were the backbone of our society as a pandemic ravaged the world.
But, where do the doctors look to? We expect them to be the strong ones in our society, but realistically, they're dealing with the challenges that the rest of us often face as well, like burnout or even imposter syndrome. Who helps the helpers? Who heals the healers?
Dr. Gail Gazelle, assistant professor of medicine at Harvard Medical School and author of “Mindful M.D.: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout,” sat down with GBH’s All Things Considered host Arun Rath to discuss how health care professionals can navigate healing themselves.
Arun Rath: We did a show that I hosted for the first couple of years of the pandemic called In It Together, and I talked to a lot of medical professionals while things were especially crazy. Has anything gotten easier? Is there less stigma in terms of physicians and medical professionals seeking out help?
Gail Gazelle: This is such an important topic — because levels of burnout in medical professionals were high pre-pandemic. And as we all know, the stresses on the health care system and medical providers were really phenomenal in the three years that we’ve seen in the pandemic. It would be wonderful to think that now that we’re at a different point in the pandemic, those stresses have decreased, but I’m not sure that’s the case.
As we all know, the pandemic fueled the Great Resignation, and there are tremendous levels of understaffing of physicians, nurses, technicians, therapists. What that means is the ones who remain in the workforce are bearing the burden of all of that understaffing.
Additionally, we’re in such a state of polarization in our society, aren’t we? The impact that that’s had on health care has also been unprecedented, like the levels of violence and threats towards members of the medical and nursing professions. All of this is bearing down on our already-weakened health care system, and I think the impact on physicians, nurses and others really cannot be understated.
"We can be training them [health care workers] that it's perfectly normal to have vulnerabilities; that's part of the human condition."Gale Gazelle, author of “Mindful M.D.”
Rath: This is a new thing, right? There used to be a universal reverence — for understandable reasons — for people working in health care, people on the front lines. That just fractured in a way that it seems like it’s not going to heal.
Gazelle: It’s a concerning time. Statistics from the U.S. Bureau of Labor Statistics show that injuries due to violent attacks on health care professionals went up 67% between 2011 and 2018. We don’t have better statistics than that currently, but one can imagine that those levels of violence — just like we’re seeing high levels of violence in other sectors of society — are increasing in health care, which really is a microcosm of the broader society that we live in in the United States.
So I hope that we can talk a little bit about, well, how can we help health care professionals cope? How can we give them the skills that they don’t necessarily get in their training to weather all of the difficulties we’re seeing?
Rath: Let’s talk about that. There’s been a whole new group of people who have become medical professionals in the last couple of years while all of this is going on. Are there resources for people to get the help they need so they can keep on?
Gazelle: The good news is that there are more resources than there were even a decade ago. Unfortunately, in our medical training, we learn to always be the captain, to always have the right answer, to never show weakness and to never call in sick — heaven forbid. That’s something that I don’t know has changed significantly, and I think that’s an area where we can be training people in a different way.
We can be training them that it’s perfectly normal to have vulnerabilities; that’s part of the human condition. So we really want to help physicians, in particular, to step away from that sense that if they seek help, if they see a coach, a mental health professional, etc., that somehow, that can be used against them.
Rath: Is that changing now? Is there any kind of push to change that from the medical school level and up?
Gazelle: There’s a tremendous focus now on wellness for physicians, everything from the American Medical Association to the American College of Physicians — really, to almost every professional society that physicians engage in — have turned an eye toward wellness. So I think that’s very hopeful news. How much of that has actually changed the patterns of medical training and medical school residencies and fellowships is unclear. I think there’s still room for improvement.
You know, we used to think about the medical profession as somewhat of a dinosaur profession, that change really took a very long time. But I want to hold out hope that that type of change can occur because, again, the physician workforce is suffering, and we need to do everything that we can — as early in the career trajectory of the future physician as we can — to give them the skills that they need to weather all of the difficulties that are occurring in our health care system.
Rath: I know that what you’ve looked at in your work has to do with long-term trauma, as well as short-term and immediate stresses. Talk about some of the particulars that people on the front lines in health care have had to deal with.
Gazelle: I recall coaching a physician in New York City who was just burned out to a crisp, really wasn’t sure if he could go on in his career. He told me about all of the deaths that he was seeing, having to tell the husband of the mother of their teenage sons that she had died and that he hadn’t been able to save her from COVID.
What was really interesting was that the physician wasn’t focusing on the good that he was able to do. In other words, his training had taught him that he was a failure if he couldn’t cure disease, or if he couldn’t heal or couldn’t increase longevity. His focus was on what he was not able to do, and that was really too much. He needed the sustenance of really focusing on the good that he was able to do.
It also gives us a little bit of a clue of one action we can take to help decrease burnout and really restore that sense of meaning and purpose that all physicians deserve to have.
Rath: That one action you mentioned is mindfulness, which you go into detail about in your upcoming book, “Mindful M.D.: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout.” Can you talk a little more about that?
Gazelle: You know, I think that when people hear the word “mindfulness,” they have an image of monks meditating on a mountaintop — and that certainly is part of mindfulness. Really, what I get at in my book and what I do with the physicians that I coach is really thinking about mindfulness as mental training, really learning how to become the master of one’s mind, as opposed to the captive.
In that example that I just gave, mental training helped [the NYC physician] helped him shift his focus and helped him really be aware of where his mind was focusing, which was not helping him. So the mental training of mindfulness helped him step out of the kind of blinders that we can have when we’re in burnout when we don’t see the good that we’re doing.