burnout & storytelling as healing - … · burnout & storytelling as healing...
TRANSCRIPT
BURNOUT & STORYTELLING AS
HEALING TRICIA GANDELA
MONET FLENNAUGH
MONICA HERNANDEZ
MATTHEW GARAY
KHALYLA KUHN
WHAT DO YOU EXPECT?
Expecta(ons of Pa&ents
• The doctor is knowledgeable and skillful
• The doctor will heal and relieve suffering
• The doctor is compassionate, a good listener, is paLent
• The doctor acts as a paLent advocate
• The doctor has authority and is to be respected
Expecta(ons of Doctors
• Will be able to diagnose and find the best treatment for their paLents
• Will be respected by paLents as well has other healthcare providers
• Financial stability
• Busy; long hours
• Surrounded by helpful mentors
Along with the rewards that come with choosing the pathway to becoming a doctor, there are also many factors that lead to overwhelming responsibiliLes. There are expectaLons that come from paLents, mentors, and from doctors themselves that make a compilaLon of reasons for burnout.
An example of an individual’s take on the expecta6ons of pa6ents and doctors: h9p://www.ncbi.nlm.nih.gov/pmc/ar6cles/PMC2158016/pdf/jroyalcgprac00269-‐0023.pdf
REALITY OF THE OUTCOMES RELATED TO EXPECTATIONS Some expecta6ons are described as myths and the perfect picture of being a doctor may be skewed: • Length of schooling (approximately 8-‐9 years) and loans to pay
• Long hours plus overLme and on-‐call shiYs
• The pressures of presenLng themselves to mentors/liaisons (and paLents) as knowledgeable and competent
• Physical and mental exhausLon
• Balancing personal life vs. work life
• Keeping up with research, conLnuing educaLon, change in policies
• Finding funds to support their research
THE NATURAL DEFENSE: COPING • “Lethal, this becoming and being a doctor! Denying hope and fear, ritualized defenses pulled up around
ears like turtlenecks, these doctors, to survive, had become machines, sealed off from humans—from wives, kids, parents—from the warmth of compassion and the thrill of love. I realized that it wasn’t just that they’d kept on riding Po9s about the Yellow Man, no. They’d ignored his suffering, his months of fatal depression. And because I felt helpless and didn’t know what to do, I’d ignored it too.” (328) – The House of God by Samuel Shem
THE NATURAL DEFENSE: COPING (CONT.) • Outside of work, doctors are faced with the challenge of idenLfying ways to cope with the burnout. An
example of creaLng an outlet as a way to cope is through storytelling. Whether it is through verbal communicaLon, art, dance, or wriLng, expression of one’s emoLons can help keep doctors’ personal life balanced with that of being a doctor. Po]’s in House of God did not have a method to cope, but rather kept his depression to himself.
STORYTELLING AS COPING IN TELEVISION
• Scrubs depicts the experiences of interns during their first year out of medical school. The show in itself is narrated by Dr. Dorian, aka J.D. Dr. Cox, the interns’ mentor, is one example of how the doctors may face burnout. Dr. Cox touches on mental illness, financial issues, feelings of inferiority, fear, and respect.
• h]p://youtu.be/t-‐b6GIo1g68
STORYTELLING AS COPING IN TELEVISION (CONT.) • At the end of each episode, the tone turns from comedic to serious, where J.D. lays out a sort of “moral
of the story”. Although J.D. is telling the stories to the TV audience, a sense of comfort and relief is found through the narraLon and that even with all that goes on in the hospital, there are always lessons to be learned.
• Even though most of the stories involve what is going on in the hospital and the paLents, each character faces personal issues as well. The characters find support through confiding in one another with their thoughts and feelings of love, friendship, failure, confidence, fear, and even death.
• h]p://youtu.be/YUcw5j5viZ8
AIDS: A DIFFICULT TRUTH
• AIDS is a disease that historically has had a negaLve sLgma a]ached to it.
• “The unsafe behavior that produced AIDS is judged to be more than just weakness. It is indulgence, delinquency—addicLons to chemicals that are illegal and to sex regarded as deviant” (AIDS and Its Metaphors by Susan Sontag)
• In the film Philadelphia, we discover that once Tom Hanks becomes HIV posiLve, he is ostracized not only for his condiLon, but also for being homosexual and he is discriminated against because of his sexual pracLces.
• “AIDS marks a turning point in current ajtudes toward illness and medicine, as well as toward sexuality and toward catastrophe. Medicine had been viewed as an age-‐old military campaign now nearing its final phase, leading to victory. The emergence of a new epidemic disease, when for several decades it had been confidently assumed that such calamiLes belonged to the past has inevitably changed the status of medicine. The advent of AIDS has made it clear that the infecLous diseases are far from conquered and their roster far from closed” (AIDS and Its Metaphors by Susan Sontag)
• Nurses and physicians at the Ponce De Leon Center in Atlanta struggle with the burnout of dealing with an excess of HIV paLents. There are 1600 employees for every 5,100 paLents, averaging about 1 staffer for every 32 paLents (Where Everyone Wants to Work, by Elizabeth Laudau, CNN)
• “Poverty and drug use in Atlanta help make it the 8th highest metropolitan area in the country for new AIDS diagnoses, stated Dr. Vincent Marconi associate medical director of the Ponce clinic.
• “We are stretched to the seams” -‐Dr. Armstrong of the Ponce clinic.
• “My biggest frustraLon is that there’s not enough hours in a day to take care of all that needs to be done. These people are very needy. A lot of them are homeless, have a mental illness, substance abuse problems and HIV and hepaLLs C, and that’s overwhelming to them”-‐Dr. Lane Tatman of the Ponce clinic.
• The physicians cope with the stress and aggravaLon that comes with lack of Lme and resources to treat paLents by gejng creaLve. Nurses make it a goal to schedule all of a paLent’s appointments in one day because they realize the difficulty it takes some of their paLents to even show up at the center.
• Another innovaLve technique that the Ponce De Leon Center uLlizes is their staff: many of them live with HIV. This makes it easier for paLents to relate to their physicians, which ulLmately makes the staff’s responsibility of providing care easier; the paLents feel a deeper connecLon with the staff which moLvates them more to trust their physicians when they prescribe them medicaLon and ask about their personal lives. The doctors and nurses also someLmes share their own unique stories about their life dealing with HIV and it typically serves as a sense of hope and moLvaLon to the recently diagnosed paLents.
HEALING CONNECTIONS
• In addiLon to the difficulLes that lie in becoming a doctor, many professionals face harsh realLes once they are working in the field.
• First, physicians must survive a grueling journey through medical school and retain as much knowledge as possible to finally put it into pracLce.
• In the field the stakes are high and lives are on the line. The pressure to perform is intense, this forces doctors to find coping mechanisms to handle the pressure.
• In The House of God, Samuel Shem exposes the brutality of medical training and provides examples of how doctors react in an intense hierarchal insLtuLon that demands so much of them.
“THE ESSENCE OF MEDICAL CARE, AND LIFE, IS CONNECTION.” • The House of God remains very popular among many medical professionals today. This can be due in
part to one of the novel’s theme: “the danger of isolaLon, the healing power of good connecLon. And any good connecLon is mutual.”
• This is very important because as Chuck, in intern in the novel explains, “how can we care for our paLents, man if nobody cares for us?”
• Over thirty years aYer the novel was published, Samuel Shem goes back and propose four new laws that illustrate the importance of coping and finding healing within the profession:
• “Law 14: ConnecLon comes first. IsolaLon is deadly, connecLon heals.”
• “Law 15: Learn empathy”
• “Law 15: Speak up.”
• “Law 16: Learn your trade, in the world”
h]p://www.theatlanLc.com/health/archive/2012/11/samuel-‐shem-‐34-‐years-‐aYer-‐the-‐house-‐of-‐god/265675/
STORYTELLING AS HEALING
• Storytelling can help people cope with specific issues like grief, stress, or spiritual ma]ers. The power of narraLve goes back to pre-‐literate socieLes and ancient cultures as a means to convey their history and tradiLon. In the pracLce of medicine, despite the potenLal for a huge exchange of stories, much is lost in the pracLcality and objecLveness. A doctor for example, can tell a paLent why they feel ill, spit out medical facts, and tell them what the future holds for them but having someone who has shared a similar experience may be more powerful than a doctor’s explanaLon. PaLents are more likely to remember a story than a citaLon of individual facts.
STORYTELLING AS HEALING
• In Carver’s “Small Good Things,” we see two parents, Ann and Howard, lost in the shock of losing a son. Dr. Francis, who cared for their son explained the scenario of what had just transpired as best as he could. He gave them a medical synopsis, a story in a sense, but not what Ann nor Howard received comfort from. Instead, Ann and Howard found accidental comfort in the story of a baker, a man who had appeared cold and cruel to them just hours before their conversaLon. Ann and Howard found meaning in the baker’s story, one that made sense to them in their moment of devastaLon of losing their child. They had found a moment of relief from this stranger, a slice of solace, a piece of “their own medicine.”
DO DOCTORS BURN OUT TOO QUICKLY?
• Gawande’s essay exemplifies a perfect example of how bad a burned out doctor can actually be
• According to a CNN survey, nearly 1 out of 2 doctors report signs of faLgue!
• Heavy workload and lack of sleep is to blame
• h]p://www.cnn.com/2012/08/23/health/Lme-‐doctor-‐burnout
DO DOCTOR’S BURN OUT TOO QUICKLY?
• From Gawande’s essay, it seems like the character of “Hank Goodman” had no outlet to release his frustraLons at work!
• “Work-‐aholic” lifestyle got the best of Goodman aYer many years
SOLUTION?
• There’s no “perfect” soluLon but Shem’s novel The House of God sheds light on some possible ways to help doctors.
ROY BASCH
• Shem seems to imply that one way to ease the pain and stresses of being a doctor is to have friends!
• Roy had a good companion, Chuck, and also had a lot of sex…
• According to WebMD, this acLvity can help a person who is stressed out to the max!
• h]p://www.webmd.com/sex-‐relaLonships/guide/10-‐surprising-‐health-‐benefits-‐of-‐sex
“YELLOWMAN” FROM HOUSE OF GOD
• Po]s didn’t really have a way to cope with the stresses at work
• The death of the “Yellowman” pained Po]s deeply
• What if Po]s had more friends to talk to?
• Example: have more acLviLes to take his mind off work.
• He had none of this and he became extremely withdrawn….
TAKE HOME LESSON – DON’T GET BURNED OUT! • Gawande tells us just how bad a stressed out doctor can be
• I’m sure no one would want to be taken care of by another “Hank Goodman”
• The take home lesson: learn from Roy Basch and have an outlet to relieve the stresses from work (e.g., play basketball, hanging with his buddy Chuck, having lots of sex…)
REFERENCES • Carver, R. (1991). Where I'm calling from: selected stories. New York: AtlanLc Monthly Press.
• Holden H.M. (1977). Medical Sociology 2: The needs and expectaLons of doctors and paLents. Journal of the Royal College of General Prac66oners, 27, 277-‐279.
• Sifferlin, A. (2012, August 28). Is Your Doctor Burned Out? CNN RSS. Retrieved August 11, 2013, from h]p://www.cnn.com/2012/08/23/health/Lme-‐doctor-‐burnout
• Shem, S. (1978). The House of God. New York, New York: Bantam Dell.
• Shem, S. (2012). Samuel Shem, 34 Years Ader ‘The House of God. The Atlan6c RSS. Retrieved August 11, 2012 from h]p://www.theatlanLc.com/health/archive/2012/11/samuel-‐shem-‐34-‐years-‐aYer-‐the-‐house-‐of-‐god/265675/
• h]p://www.youtube.com/watch?v=t-‐b6GIo1g68&feature=youtu.be . “Dr Cox Top 5 Rants” Youtube. 7 July, 2007
• h]p://www.youtube.com/watch?v=YUcw5j5viZ8&feature=youtu.be. “Scrubs Best Serious Moments Part 2” Youtube. 20 June 2009