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First, Do No Harm!

In a climate of scrutiny and gaining a competitive edge are we losing sight of what is most important?

Have we dehumanised clinical practice due to perceived time constraints, financial inefficiency or is it we are focused on attending to a presentation rather than the person???

We are fortunate enough to be practicing in a time where there has never been more access to healthcare services, to funding for healthcare facilities and research, however according to Pain Australian Annual review 2017 ¹ the cost of pain treatment has more than double since 2009 (Monthly rise from $231 - $473). Our spending on pain medications has also increased by 53% during this same period.

In 2017 chronic pain alone cost the Australian economy 34+ billion (per year)

What’s more concerning is 30-40% of Australians with chronic pain presenting for care have major depression. Amongst this population, suicidal behaviours are 2 - 3 times higher than the general population worldwide.

Where are we going wrong? Is it we are trying to “fix” people?

Here’s a thought from my relatively short time in clinical practice.

When was the last time you truly connected and understood the person sitting in front of you. All too often I hear as practitioners we need to distance ourselves from our patients, particularly the ones who are draining, too talkative, catastrophises etc. This perplexes me, as the underlying reason for these characteristics displayed by your patient may be the access point we need to understand in order to offer the support they seek.

So my question to you: Is it our job to FIX our patients?

What if we challenged the idea “Our job isn’t to fix... rather to provide support to help the client/patient find THEIR way!”

Sounds counterintuitive to what the perception of what a healthcare provider does, however as we continue down this rabbit hole we aim to bring clarity to the role of a health provider.

Let’s start with reframing context around the word ‘FIX”

The idea you are “fixed” or need “fixing” would allude to the fact you are broken. You’re not broken, you’re a hell of a lot stronger than you think! The wording “fix” is an absolute term which creates the idea there is a definite start and finish to resolving a problem. Are we not ever adapting creatures influenced not only by the mechanical world we (as hands on practitioners) for so long have focused on, but also emotionally intelligent beings seeking understanding of ourselves, our environment and the longing to be part of a community?

 

What we are all seeking is connection, not someone to fix us.

 

(If you require a comical view on this point I’d suggest watching It’s not about the nail ²)

 

Maybe what we need in our tool belt isn’t the latest and greatest technique, assessment protocol, treatment tool, diagnostic instruments etc, rather to improve our ability to Communicate and Connect with Compassion.

In his Ted Talk, How 40 seconds of Compassion can save a life ³, Dr. Stephen Trzeciak defines Compassion as the emotional response to another’s pain or suffering involving an authentic desire to help. Different to sympathy and empathy which are the understanding components, compassion also involves taking action.

Science shows that compassionate care is beneficial for ⁴:

  • health (better patient outcomes),

  • healthcare systems and payers (lower costs), and

  • healthcare providers (lower burnout)

Dr Trzeciak continues to discuss the following interesting points:

  • What is remembered in negative healthcare experiences is the lack of compassion of the healthcare provider.

  • A Harvard University study reported nearly 50% of Americans believe the health care system & providers are not compassionate

  • ⅔ patients have had a meaningful health care experience with a lack of compassion

  • 70% of opportunities for compassion are missed by physicians, &

  • Compassion comprises of < 1% of all communication between physicians and patients.

Dr Trzeciak continues by explaining as a result of this data Practitioner “Burnout” is becoming more common. Burn out is characterised by de-personalisation (which is the inability to make a personal connection), emotional exhaustion and reduced personal accomplishment⁵.

Burnout Syndrome not only affects health care practitioners, however also has far-reaching implications on their patients and the healthcare system.

Practitioners experiencing burnout are reported to be ⁶:

  • at a higher risk of making poor decisions;

  • display hostile attitude toward patients;

  • make more medical errors; and

  • have difficult relationships with co-workers.

Burnout among Practitioners also increases risk of:

  • depression;

  • anxiety;

  • sleep disturbances;

  • fatigue;

  • alcohol and drug misuse;

  • marital dysfunction;

  • premature retirement and

  • perhaps most seriously suicide.

A national survey of the health and wellbeing of junior doctors in Australia revealed 71%of doctors were concerned about their own health, and 63% about their colleagues health ⁷.

How do we overcome burnout? How do we Re-Connect?

What we need to overcome burnout is not in another location, not escaping to a remote location or  a retreat, but right within yourself. True, time away may allow you to rest and reflect, however in my experience, if the underlying fear or frustration has not been resolved than you will return back to where you left. You need to return to why you decided to take on a role in which your task is to  support others… do you remember?

When was the last time you reflected on your values and beliefs. The author of the book, ‘Start with Why” and “Leaders Eat Last” Simon Sinek presents an incredibly logical explanation in his Ted talk  How Great Leaders Inspire action ⁸.

His explanation of the Golden Circle helps to explain the emotional connection we have to WHY we do WHAT we do. Following the concepts outlined in this book has helped me personally find my purpose (especially in Clinical Practice). On days I feel like burnout is creeping upon me, when I look at my appointment calendar kicking off some mornings at 6am and have an internal sigh, I remind myself WHY I made a choice to choose a profession to support another. By knowing our why helps us as practitioners to turn up every day, for ourselves and our community. From the moment we step foot in the clinic we must understand practicing compassion is very important to the success of our patient-outcomes, however to reduce burnout, self-compassion is key.

A study by Lown et al.⁹ report to sustain compassion and prevent burnout, providers also need the opportunity to:

  • Reflect,

  • Share challenges and successes with each other, and

  • Provide and receive support from each other

 

Neff et al. 2015 define Self Compassion  as relating to oneself with compassion by actively encouraging the expression of warmth, concern, and caring toward the self ¹⁰.  

So may I leave you with a thought… next time you are face to face with someone asking you for help, forget your latest and greatest computer with online based clinical software, put down the ipad, put away your phone and stop trying to FIX people, just be present, be compassionate and connect with one person at a time!



References

  1. Pain Australian Annual review 2017

  2. It’s not about the nail Source: Youtube

  3. How 40 seconds of Compassion can save a life  Source: TedX

  4. Stephen Trzeciak, Brian W. Roberts, Anthony J. Mazzarelli. Compassionomics: Hypothesis and experimental approach. Med Hypotheses. 2017 Sep; 107: 92–97. Published online 2017 Aug 12. doi: 10.1016/j.mehy.2017.08.015

  5. Gunasingam N, Burns K, Edwards J, et al. Reducing stress and burnout in junior doctors: the impact of debriefing sessions Postgraduate Medical Journal 2015;91:182-187.

  6. Kumar S. Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare (Basel). 2016;4(3):37. Published 2016 Jun 30. doi:10.3390/healthcare4030037