Once upon a time, I was a burnt out scientist who had lost all sense of creativity, purpose & fulfillment in my work. Since hanging up my lab coat and discovering the incredible learning opportunities beyond the Ivory tower, I’d been quietly pursuing my own independent research program studying the ways health practitioners work with others for the past 6 years. I’ve shadowed doctors and nurses, ran a few wellbeing programs, ran workshops, gave talks and facilitated hundreds of conversations with people working in a hospital; custodians, café staff, admin, volunteers, health care practitioners, executive staff, clinicians, researchers, support workers to discover some overlapping themes that pose a risk to your own health and life satisfaction.
Doctor and health care worker mental health concerns and suicide have been in the spotlight recently to bring awareness to the broader population of this issue that impacts everyone participating in our healthcare system. This is not unique to Australia – it’s a global issue.
There are a number of contributing factors to this problem both external and internal to the health care worker that creates distance between them and their patients and negatively impacts professional, personal and patient satisfaction.
If we strip away all the external problems that are blamed for the woes of healthcare, we’re left with the only one who actually has the power to change anything - the health care worker.
Fundamental to achieving desired outcomes of patients, their health care team and the healthcare service is the presence of a healthy, connected and strong doctor/health care worker-patient partnership. I've identified EIGHT distancing practices that harm health care workers, create ineffective therapeutic partnerships and suck the joy from helping others:
1. EMOTIONAL DENIAL, DISCOMFORT & DISTANCING
2. SUSTAINED THERAPEUTIC ALLIANCE & RUMINATING ON PATIENT
3. CLINICAL BIAS AND ASSUMPTIONS ABOUT PATIENT
4. EXISTENTIAL & ETHICAL DILEMMAS
5. IGNORING MEDICAL INTUITION
6. POWER IMBALANCE: VALUING PROFESSIONAL KNOWLEDGE OVER PATIENT EXPERIENCE OR GIVING IN TO PATIENT DEMANDS
7. APPROVAL ADDICTION
8. DEFENSIVE, FEAR-BASED, RISK-AVERSE MEDICINE
Each of these practices have antidotes. The solutions are simple (not easy) and inexpensive (self-investment) and require:
- Development of self-awareness through specific practices & processes to monitor the assumptions that are unconsciously driving decisions and actions that perpetuate this harm spiral.
- Intention to do no harm along with being beneficial but not be driven by fear-based thinking, defensive medicine and risk aversion
- Ways to process your experiences and embody the learning to add to your armament of inner resources, morale, practical wisdom, resilience and positive coping skills
- Coaching communication, facilitation & negotiation skills to work collaboratively with anyone
- Working in partnership with patients/clients, their families, colleagues and healthcare teams and allowing the healthy partnership to be the vehicle for beneficial change and healing
- Seeing your work and what patients bring to you as a privilege and a gift to help you fulfill a higher purpose or calling
- Having a very clearly defined role that extends beyond the label of ‘doctor’ or 'nurse' & a clear vision for yourself, work and life and for each person you work with.
- Becoming a mentor and receiving regular mentoring while participating in reflective practice and debriefings to continually learn, challenge and evolve the way you practice in an objective, safe, constructive and non-judgemental environment
- Becoming the medicine (yes, you read correctly)
An evidence base already exists for these solutions. Though they're great starts, it will take more than hearing an inspiring talk at a conference, yearning for change or attending a workshop to support long term beneficial changes in the culture of practice. We also need to be discerning about the programs that are seen as best that may not be the most effective ones that address core issues and the source of problems to create sustainable and positive cultural changes over time.
There are many negative, unconscious habits that infiltrated the way health care workers respond to the perceived needs of patients and care while neglecting their own that have silently permeated all levels of training and education. Every approach will need to be adapted to the unique healthcare context, culture and needs so there's can't be a one size fits all band-aid program. Trainers, mentors and leaders should be those who already embody all of the capacities and qualities listed above needed to form and maintain healthy partnerships, who can consistently model them and mentor others to do the same to improve everyone's experience of healthcare. Are you prepared to follow them?
As an individual, you have immense power to be the change you want to see in practice. You will be asked to evaluate and reevaluate the importance of some of your beliefs, attitudes, assumptions and ways of working with others that have been damaging to yourself and your work. It takes courage, assertiveness, initiative, humility (that's a toughie) and a willingness to say NO in the face of models and antiquated processes that harm yourself and can harm your relationship with others. Change starts with you, right now.
Blessings ahead for pioneering a different way,