Narrative Medicine

Narrative Medicine Monday: Who Heals the Healer?

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Dr. Huma Farid asks “Who Heals the Healer?” in her recent essay in JAMA, and her answer might surprise you. Farid describes weeping alongside her patient early in her obstetric training when she delivers a stillborn baby. The gravity of this experience affects Farid deeply as she reflects on human suffering, recognizing “that my work would encompass taking care of women at some of the worst times in their lives.”

As Farid progresses in her career, though, she realizes that she no longer has the same reaction, the same connection to the suffering of her patients: “My eyes dry, I wondered, when was the last time I had truly connected with a patient, empathized with her sorrow, and allowed myself to feel a sliver of her pain?”

Farid acknowledges that at that time she was also going through her own personal difficulties, and that despite this, she did her best to “remain empathetic and kind” to her patients: “I tried to give as much of myself as I could, but I felt like I had a finite, limited reserve of empathy.” Do you view empathy as a finite resource, or have you experienced a similar limited reserve to connect with your patients?

Farid’s commentary really resonated with me. It seems a simple statement to say doctors are human too, but it’s a reality we often forget. Most doctors are incredibly resilient and, even so, it only takes one personal life stressor to topple the precarious balance of mental and emotional rigors that come with being a physician in today’s healthcare environment. As Farid notes, the decline in empathy “may be driven by the demands of modern medicine and exacerbated by personal experiences.”

When I experienced my own significant personal life upheaval a few years ago, I, like Farid, “was still able to perform my clinical duties and to provide good patient care despite struggling to be empathic. However, studies have demonstrated that physician empathy improves both patient outcomes and patient satisfaction….” Ideally, for both the patient and physician’s sake, we would find ways to combat the decline in empathy that is an inherent byproduct of the current healthcare environment.

Ultimately, Farid determines that empathy “enables us to understand and connect with a patient’s perspective, an invaluable resource in an environment that has become increasingly polarized and rife with divisions.” Farid describes an interaction with a patient where she “mostly listened” and, in return, receives heartfelt thanks and hugs. Through that emotional and physical connection, Farid regains a piece of her “profoundly and imperfectly human” self. May we all find a way to move in that direction.

Writing Prompt: Farid wonders “what it meant for me that I had lost some ability to feel a patient’s pain.” If you’re a healthcare professional, have you lost some of that ability throughout your medical training or career? Think about a time you failed to have empathy for a patient’s suffering or, as a patient, that you felt your healthcare provider had little empathy for your pain. Alternatively, describe a time that your empathy has been “rekindled.” Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: The Burnout Crisis in American Medicine

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A recent article in The Atlantic by writer and resident physician Rena Xu highlights the toll rigid regulations and decreasing autonomy takes on medical professionals.  In “The Burnout Crisis in American Medicine,” Xu illustrates the causes of burnout and the consequences of a system that makes it challenging for doctors to do what they were trained to do – care for patients.

In the article, Xu tells the story of a patient admitted to the hospital for cardiac issues. She is then found to have a kidney problem that is in need of a surgical procedure. Unfortunately, the anesthesiologist who tries to book the the surgery finds that the computer system won’t let him schedule it because the patient already had a cardiac study scheduled for the following morning. A computer system issue took hours of Xu’s time, all because “doctors weren’t allowed to change the schedule.”

Xu expresses understandable frustration that her “attention had been consumed by challenges of coordination rather than actual patient care.” I’m sure every medical professional can relate. In today’s healthcare environment, much of the work we do in medicine is clerical and administrative. Xu notes that “doctors become doctors because they want to take care of patients.” Instead, many of our “challenges relate to the operations of medicine–managing a growing number of patients, coordinating care across multiple providers, documenting it all.”

I liked Xu’s analogy of a chef attempting to serve several roles in a restaurant without compromising the quality of the meals. The restaurant owners then ask her to document everything she cooks. There are a bewildering array of options for each ingredient and “she ends up spending more time documenting her preparation than actually preparing the dish. And all the while, the owners are pressuring her to produce more and produce faster.” Any physician who has worked with the ICD-10 coding system can relate.

Xu notes the looming physician shortage in coming decades as the population ages and a large swath of physicians retire: a crisis in its own right. The only remedy is to improve “the workflow of medicine so that physicians are empowered to do their job well and derive satisfaction from it.”

Patients might not realize that “burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care.” As patients, we should be fighting for our healthcare organizations to promote a culture and systems of wellness among medical providers. The care we receive depends on it.

Writing Prompt: If you’re a physician, what is greatest stressor in your daily practice? Have you had to make “creative” work-arounds, like the anesthesiologist in Xu’s article, just to do the right thing for your patient? If you’re a patient, have you considered how your physician’s well-being might affect their ability to care for you? What systemic barriers are in the way of addressing this crisis? Write for 10 minutes.

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