From the Desk of Carl J. Foster, MD

Spring has sprung! The morning air is filled with the rich vocal ensemble of singing birds.   The bare trees of winter are once again adorned with leaves. Flowering plants and the constituents of many vegetable gardens are virtually flying off the shelves of nurseries. Such is part of this annual rite of seasonal reawakening. But despite the annual rebirth of the out-of-doors that shifts our focus and preoccupation our indoor struggles remain. The imperative of those struggles persist and the necessity of our participation in them is inescapable. These indoor struggles are embodied in what has been referred to as the “evolving healthcare environment”.

Many forces are conspiring to affect the ecosystem in which we work.  These forces do not merely include new found evidence upon which we would construct the care that we provide our patients. But they also include governmental, regulatory, and economic forces as well. The GOP led House of Representatives passed the American Health Care Act (AHCA) which has been criticized and literally rejected out of hand by the GOP led Senate, which is laboring on its own proposal. It remains an enigma when the two Houses will deliver on their campaign promise to “Repeal and Replace Obamacare”. And even more enigmatic is how that outcome will impact our patients’ access to health insurance. In Ohio, in response to the ongoing opioid abuse crisis, the Governor and the Legislature have both introduced separate plans that would limit the amount of prescription opioids that clinicians can write for patients at any one time. In addition the Ohio Pharmacy Board has announced a proposal that would require the ICD-10 code identifying the diagnosis for which an opioid prescription is written be included on that prescription. Doctors are also bothered by flat or decreased reimbursement, rising expenses, and increased administrative and data-entry requisites which have made the practice of medicine more stressful and less rewarding.

The state of affairs in which we find ourselves leads to varying degrees of burnout. Broken down by specialty, anywhere from 40 to 60% of our colleagues are afflicted with this malady1. They experience emotional exhaustion from which they don’t recover after time off. They are often cynical and negative about their patients. They can also exhibit “compassion fatigue” and treat their patients with insensitivity and a lack of sympathy2. They may experience a sense of ineffectuality and a reduced feeling of achievement. As with any disorder the best treatment is prevention. Dike Drummond MD has published 3 prevention steps that I have found to be rejuvenating in my practice. They are the “Squeegee Breath”, “It’s been too long”, and the “Treasure Hunt”2.

The “Squeegee Breath” is a simple purgative exercise that, “like a window washer’s squeegee, in a single stroke it can wipe you clean of stress, allowing you to see clearly and be present with your patients”. “Take a big breath – up to the top of your head – and hold it for a 3 count => Then exhale all the way to your toes inviting any stress, tension or worry out with your out breath => Hold the full exhale for a 3 count => Then allow your breath to breathe normally”. Dr. Drummond recommends that physicians take this “Squeegee Breath” each time they touch a doorknob to go in the room with a patient … and see what difference they notice in the quality of their day”2.

“It’s been too long” involves reestablishing old relationships. It involves identifying someone with whom it seems like “too long” since one has connected. It could be anyone, friend or relative. The physician then reconnects with that person, arranges a meeting either “by phone or in person…for a minimum of 15 minutes”. If this is a good experience Dr. Drummond advises that the physician and his counterpart arrange another meeting and keep in touch which will add more life balance for both2.

“The Treasure Hunt” is an approach for finding more joyfulness in one’s work. Dr. Drummond recommends that one recalls “…what is one interaction you remember that made you smile and reconnected you with what you love about your career again?” He further recommends that “… on your next work day and before you start to see patients that you set an intention to experience this again in the day ahead” and then”to seek it out and savor it” at least once a day2.

To survive and flourish in this changing milieu adaptation is imperative. Although these strategies are simply employed they are deceptively effective. One enables the physician to reduce the level of stress in their workday. The second allows the physician to tap into the resources of their relationships and the sense of well-being that can be derived from renewing them. And the third step encourages an examination of the physician’s practice experience which involves a change in focus that magnifies that which is good. These techniques are simplistic but valuable. They are self-implemented and relatively time efficient. They provide an easy method to help regain one’s footing in this ever-changing healthcare environment.

  1. https://wire.ama-assn.org/life-career/report-reveals-severity-burnout-specialty
  2. https://www.thehappymd.com/blog/bid/290398/Physician-Burnout-3-Signs-and-3-Simple-Prevention-Steps