Our humanity is more powerful than our expertise
November 30, 2016
I spoke to 20 individuals during a recent week taking calls on the Physician and Family Support Program (PFSP) help line (1.877.767.4637). Two recurring themes emerged that particular week among the often complicated and compelling stories related by physicians, residents and medical students. A major theme was stress, interwoven with anxiety and depression. The other theme was career dissatisfaction, both early and mid-career.
PFSP big picture 2015
Looking at the bigger PFSP service picture for 2015, over 1,400 people called the help line. The callers included more than 600 physicians, about 200 residents, 100 medical students and 200 spouses. For 41% of the callers, the primary reason for calling was mental health issues (stress, anxiety, depression), followed closely by relationship and family issues (frequently marital and child-rearing problems) 40% of the time. Occupational health issues (8%), psychiatric problems (5%) and addictive disorders (3%) comprise most of the other reasons colleagues call the line. Callers often identify more than one issue.
In between calls, I looked at the list of keynote and plenary speakers for the International Conference on Physician Health in Boston (ICPH) held this past September. The title of the conference: “Increasing Joy in Medicine.”
Who attends a physician health conference?
Clinicians, preceptors, academic researchers, students, residents, residency program directors, members of physician health programs, regulatory authorities and others with an interest in the health of colleagues and trainees gather every two years at the ICPH. Conference presenters and participants share a formidable expertise in the realm of physician health.
Since the term “physician health” was first coined a generation ago, the concerns of physician health programs have expanded from dealing with drunk doctors to combatting burnout, facilitating individual and organizational wellness, and more recently to fostering job satisfaction and promoting career-long resilience.
What was on the agenda?
The opening keynote speaker at this year’s conference was Dr. Jon Kabat-Zinn:
The healing and transformative power of mindfulness: Embodied joy and well-being in the practice of medicine and life.
Other presentations over the three days included:
- Resiliency: Building individuals and culture to keep the joy in the job – A train the trainer workshop (C. Dewey, W. Swiggart).
- Attitudes and experiences of early and mid-career pediatricians on division of domestic responsibilities and strategies to achieve work-life balance (A. Starmer, M.P. Frintner, K. Matos, B. Byrne).
- A randomized controlled trial evaluating the effect of COMPASS (Colleagues Meeting to Promote and Sustain Satisfaction) small group sessions on physician well-being, meaning and job satisfaction (C. West, L. Dyrbye, D. Satele, T. Shanafelt).
Dr. Liselotte Dyrbye, internist, Mayo Clinic researcher and physician health advocate also articipated in an international medical education panel:
Highlighting innovative changes in American, British and Canadian medical school curricula and their potential to positively impact physician health in the future (other panelists: Debbie Cohen, OBE, MD, FFOM, FRCGP, FRCP, FAcadMEd; Genevieve Moineau, MD, FRCPC; and William Tierney, MD).
Surveying the various physician health topics on the agenda, I predict that a conference showcasing physicians’ joy in medical practice won’t happen for a few years yet. In 2016 the focus is on ways to increase joy and job fulfillment, and rediscover meaning in our work. From my conversations with colleagues on the help line, I know that for some of us happiness at work (and home) remains elusive.
How do physician health experts meeting at a hotel in Boston influence the work of PFSP?
A few members of the PFSP team attend and sometimes present at the national or international physician health conference each year. The distillation and trickle-down of research findings and insights continue after everyone has returned home. As with any conference, physician health or otherwise, the success of participants in applying their new knowledge varies.
Pushback against expertise
We are also witnessing the phenomenon these days of a pushback against the authority of experts and the discounting of their expertise. Recall the controversies about climate change science, or the recent failure of expert economic opinions marshalled by the “remain” side in the Brexit referendum [see Rafael Behr in The Guardian Weekly, July 15, 2016].
Examples in health care are not hard to find. Harm reduction programs such as supervised injection sites are only slowly being accepted. The negative perception of palliative care for patients with advanced cancer persists [see Camilla Zimmerman et al in Canadian Medical Association Journal (CMAJ), July 12, 2016] – despite good research in favor of both of these initiatives. Such ambivalence reveals our biases for and against evidence and expertise. What is the basis of our respect for or skepticism of experts, or our patients’ enthusiasm or indifference for what we have to tell them? Why is it often hard to change opinion or behavior despite good quality evidence?
Many of us do turn to experts – our family doctors, mentors, therapists and psychiatrists – and benefit from their expertise, support, assessment and treatment in times of trouble. Why are we more likely to accept their expertise and assistance in a crisis – our escalating mental health issues, dysfunctional relationships or organizational nightmares – than we are to respond to expert recommendations or guidelines about health promotion and disease prevention?
The small world of physician health is one characterized by fluctuating networks of influence. In the July issue of CMAJ, a Canadian Medical Association (CMA) advertisement tells us it is “Creating a new vision for physician health.” (Poking around on the CMA website, I was hard-pressed to find out what that new vision is.)
Skills for stress management
In an editorial by Roger Ladouceur in Canadian Family Physician (February 2015) on distress among residents, his list of references includes the names of a few of the presenters at ICPH 2016.
My week of on-call included conversations with a couple of stressed and anxious residents. That prompted me to visit the Resident Doctors of Canada website (residentdoctors.ca). There I found a presentation on skill based resiliency training for residents, presented by Drs. Christina Nowik, Gillian Shaw and Nureen Sumar at the Family Medicine Forum 2015. It includes a tool called the mental health continuum model to help residents be more aware of their mental health needs.
It also describes and provides examples of the acquisition of four skills to help deal with stress at work:
- Tactical breathing
- Goal setting
- Positive self-talk
The promotion of such skills in 2016 arises partly from an increasingly robust physician health literature that, in turn, is fostered by conferences like ICPH. The two residents I spoke with on the help line needed more than a referral to a website; at the same time, it is heartening to see proposals for curricular interventions to address the well-being of residents on the resident doctors website.
Something even more powerful than expertise
Reflecting on our attitudes toward experts and expertise is a dynamic enterprise. As we refine how we use our own expertise and respond to that of myriad experts around us, we should consider Dr. Rachel Remen’s comment about the relative power of expertise within a service profession like medicine:
Fixing and helping are strategies to repair life. We serve life not because it is broken but because it is holy. Serving requires us to know that our humanity is more powerful than our expertise.
Reference available upon request.