At Resident Doctors of BC, we care about care—resident care as well as patient care. And it’s a truism well worth revisiting often; you cannot look after someone else if you don’t look after yourself. We consider this so important that self-care is at the core of our annual New Member Orientation. Each year, Orientation introduces residents to each other and to the tools they need to do their work effectively, caring for themselves as well as others. It’s an empathy that works both ways, and that empathy was the theme of this year’s event at UBC Robson Square, as keynote speaker Dr. Brian Goldman made poignantly clear.
Dr. Goldman is host of White Coat, Black Art, a CBC Radio 1 program aiming to take the mystery out of medicine, and author of Night Shift and The Secret Language of Doctors, best-selling books that offer behind-the-scenes views of the ups and downs of medical professionals and the medical profession. Through these channels Dr. Goldman has made it his mission to bring empathy back to the bedside.
“Empathy,” said Dr. Goldman, “is the secret sauce”—the ability to put yourself in someone else’s shoes that is as vital in the daily lives of medical professionals as in the daily lives of everyone. As he pointed out, we can’t help others if we can’t help ourselves. Empathy powers the greatest acts of kindness, but it can also lead to burnout. And empathy is by no means a given in every person or situation. In Dr. Goldman’s words, healthcare has “lost its empathy mojo,” partially as a result of a fragmented system. He argued that our system is one in which so many complex parts can sometimes fail to come together for a positive result, and where the pressures of unreasonable expectations of perfection and the stress of “moral distress” (the inability to pursue a desired course of action), can lead to misdiagnosis, patient dissatisfaction, and physician disillusion.
Getting in touch, and keeping in touch, with one’s own feelings, Dr. Goldman insisted, is part of keeping the life-work, head-heart balance that is perhaps more critical to a physician’s career than any other. He shared a recent experience of how it worked in his own personal life: shortly before arriving in Vancouver, he had been with his critically ill father-in-law. Near death from a series of comorbidities that were further complicated by advanced Alzheimer’s disease, Dr. Goldman’s father-in-law was not able to communicate his own needs and wishes. What care scenario would he choose? All supports withdrawn and death at home? Provide all supports and prolong his life in a hospital setting?
“Our family was planning a big wedding,” Dr. Goldman said, “and with this in mind, we put ourselves in my father-in-law’s shoes. Would he want to be alive for it? Knowing him, and loving him, we felt that, yes, he would. And that even if it was difficult to communicate with him, he would appreciate our choice on his behalf.”
Some might see these as futile efforts under the circumstances. As Dr. Goldman pointed out, it was important not just as a physician but as the patient’s son-in-law to do his best to offer him that golden opportunity of having options. It’s the difference between asking, “What would he want, what would he need?” rather than stating, “This is how it’s going to be.”
It is the same principle, he said, that should be used when delivering bad news to a patient or their family. Ask what your patient knows about their situation, he advised. Step into their shoes. Don’t let their storms overwhelm you, but help them navigate so they themselves don’t capsize. Don’t be afraid to let them immerse themselves in what they are feeling. It’s part of what they need to do to heal. Yet protect yourself, too, because you need to be able to continue to help others without being absorbed into the traumas you are helping them heal from or live with.
How do you recognize empathy burnout? Stress, sleep-deprivation, unresolved residue from negative encounters with allied health professionals: they can all add up, said Dr. Goldman. If a sense of dissatisfaction settles in, he urges self-enquiry. “Ask yourself: why don’t I care? Then ask yourself: what do I need to do to get back to why I care?” Give yourself protected time, he said. Don’t stop doing the things that nurture you. Don’t fall into the habit of what he calls ‘unhealthy shame.’ “The culture of medicine today treats mistakes like anomalies,” he said. But mistakes happen every day to everybody. Talk to someone and let out your frustrations or fears. You’ll find everybody is in the same boat. “Curiosity is a great motivator for change,” he noted. “Instead of blame and shame, ask, why did it happen that way? How can we make it better?” As Dr. Goldman reminded his audience, “We are hardwired from infancy to be empathetic. We just need encouragement. ‘Remember, it’s all about [the patient],’” he added, quoting his late friend, the author and commentator Dr. Robert Buckman. “‘It’s not about you.’” But it can’t be about the patient at all, said Dr. Goldman, if it isn’t also about taking care of yourself.
And if you need a little help to do that, there are numerous resources available. Resident Doctors of BC’s primary purpose is to support residents, and our office is always here to answer any questions you may have. There is also the Employee Family Assistance Program (EFAP), the Physician Health Program (PHP), and the UBC Resident Wellness Office. Additionally, on the national level, Resident Doctors of Canada led the development of a skills-based resiliency training curriculum to help residents learn to cope in the face of the challenging situations they encounter every day.