Building Relationships with Physicians Building Relationships with Physicians and Mid-Level Providers:and Mid-Level Providers:

Practical WisdomPractical Wisdom

NACC National MeetingNACC National MeetingColumbus, OhioColumbus, OhioMarch 13, 2006March 13, 2006

Chaplain Mary E. Johnson, MAChaplain Mary E. Johnson, MAAssistant Professor of OncologyAssistant Professor of OncologyMayo Clinic College of MedicineMayo Clinic College of Medicine

ObjectivesObjectives

• To identify physician and mid-level provider (MLP) support w/in the scope of the chaplain’s role (theory)

• To identify intersections between the cultures of medicine and ministry (rationale)

• To identify collaborative strategies that support and encourage the chaplain-physician relationship (approach)

ApproachApproach

• Why is this important?

• Cultural Comparison

• What is taught?

• Support strategies

• Education strategies

WHY IS THIS IMPORTANT?WHY IS THIS IMPORTANT?Some Questions to ConsiderSome Questions to Consider

• Is physician support part of your mission?

• What opportunities exist for physician support in your ministry setting?

• What has worked? What hasn’t worked?

It is easy to philosophize; the philosopher is said to be

the one who bears with equanimity the suffering of others.

W. J. Mayo, Minnesota Medicine. 1936.

I had thought that life was brokenand that I, armed with the

powerful tools of modern science,would fix it.

R.N. Remen, Kitchen Table Wisdom. 1996.

The well-being of physicians is important to the

well-being of their patients.

Shanafelt, et al., Annals of Internal Medicine. 2002

While much has been written about physician depression, burnout, substance

abuse and broken relationships, very little is known about physician

well-being and its ability to enhance care.

Shanafelt, et al., Oncology. 2005

Loss is one of the most commonaspects of the practice of medicine.The way in which we deal with loss impacts the way we deal with the

rest of our lives.

R. N. Remen, 1996

WHAT IS TAUGHT?WHAT IS TAUGHT?

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THE CULTURE OF MEDICINETHE CULTURE OF MEDICINE

• Cure

• Fix

• Solve

• Resolve

WHAT IS TAUGHT?WHAT IS TAUGHT?

• Pharmacology - Pharmacology - Pain Management

• Palliology - Palliology - Symptom Management

• Psychiatry - Psychiatry - Coping D/O Coping D/O (pathologization)(pathologization)

(CurrMit Database, AAMC, 2005)(CurrMit Database, AAMC, 2005)

CASE EXAMPLECASE EXAMPLE

• Christmas Eve

• ICU

• Pulmonology Fellow

• Third withdrawal in 48 hours

• “I didn’t go into medicine to do this.”

SUPPORT/EDUCATION SUPPORT/EDUCATION STRATEGIESSTRATEGIES

• Casual contact opportunities

• Mutual education opportunities

• Invite yourself to the table

• Participate in institutional leadership

• Read the literature

The dying need the friendship of the heart--its qualities, care, acceptance,

vulnerability, but they also need the skills of the mind--the most sophisticated

treatment that medicine has to offer.On its own, neither is enough.

Dame Cicely Suanders

BIBLIOGRAPHYBIBLIOGRAPHY

Mayo, William J., “Education Guides the Young to Good Citizenship, Minnesota Medicine. Vol. 19, July, 1936.

Remen, Rachel Naomi, Kitchen Table Wisdom: Stories that Heal. Riverhead Books, New York, 1996.

Shanafelt T, Bradley K, Wipf J, Back A, “Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program, Annals of Internal Medicine. Vol. 136, 2002.

BIBLIOGRAPHYBIBLIOGRAPHY

Shanafelt T, Novotny P, Johnson M, Xinghua Z, Steensma D, Lacy M, Rubin J, Sloan J, “The Well-Being and Personal Wellness Promotion Strategies of Medical Oncologists in the North Central Cancer Treatment Group, Oncology. Vol 68, 2005.

Curriculum Management Information Tool (CurrMit) Database, American Association of Medical Colleges.

Mitchell K, Anderson H, All Our Losses, All Our Griefs: Resources for Pastoral Care. Westminster Press, Philadelphia, PA, 1983.

ADDITIONAL RESOURCESADDITIONAL RESOURCES

• jama.org (J. of the American Medical Association – A Piece of My Mind)

• jco.org (J. of Clinical Oncology – When the Tumor is not the Target)

• annals.org (Annals of Internal Medicine – On Being a Doctor)