Editor’s Corner: Healing Our Invisible Wounds

Alexandra P. Wolanskyj-Spinner, MD
Professor of Medicine in the Department of Hematology at Mayo Clinic in Rochester, Minnesota; Associate Editor, ASH Clinical News

Many patients whose paths cross ours, as hematologists, will inevitably face premature death due to their underlying disease. Yet, we learn from each case, strive to do better through new research and therapeutic strategies, and find the strength to move forward. After all, humanity is at the core of our inspiration to pursue our specialty.

But, when do we stop to consider the cumulative effect of these losses? Do we take time to process our emotions, or do we quickly intellectualize and move on? When do we take time to heal our invisible wounds?

Our sense of loss in medicine has never been more pronounced. In the Medscape National Physician Burnout & Suicide Report 2021, subtitled “Death by 1,000 Cuts,” approximately 42% of the more than 12,000 physicians surveyed reported experiencing burnout. In 2020, 69% of physicians reported being happy or very happy at work; in 2021, that number dropped to 49%. One-fifth of respondents said they experienced clinical depression, and many cited burnout as a major contributor. This progressed to suicidal ideation in 13% of those who said they were depressed, and 1% said that they have attempted suicide.1

Although the causes of burnout are multifaceted, including stress from excessive clerical obligations, patient outcomes contribute significantly to these statistics. We are at a crisis in our profession: Health care providers are conditioned to minimize their needs and ignore self-care. As one survey respondent wrote, “Doctors try to have compassion and forgive patients, but we need to have compassion for ourselves, too. Doctors don’t give themselves enough of a break.” Indeed, remembering to be self-compassionate has elevated my capacity to maintain compassion in my work.

A deliberate step we can take to support and normalize struggle is to share our own narratives. In the struggles I have faced both personally and professionally, I have sought out opportunities to disclose to trusted colleagues and, in doing so, have been honored by their trust in me as well. This normalization of the struggle allows for healing in the moment.

Darrell Kirch, MD, president emeritus of the Association of American Medical Colleges (AAMC), recently shared his personal mental health journey and pleaded with health care providers to do the same.2 “If more of us are willing to describe … how we have benefitted from treatment and been able to thrive in our careers, eventually we will reach a tipping point of destigmatization,” Dr. Kirch wrote. “The salutary result could be fewer of our colleagues suffering in silence.”

Grassroots efforts within health care organizations, such as the H.E.L.P (Healing the Emotional Lives of Peers) Program at Mayo Clinic, offer peer support for health care professionals who are profoundly affected by a clinical event. This four-step program is centered on exploration of the experience and normalization of the surrounding emotions. Sharing with a trusted colleague the tragic or unexpected loss of a patient may not lessen the initial “punch in the gut,” but may mitigate the long-term effects.3 Mayo Clinic’s “MyStory” series offers a similar opportunity for students to learn from senior trainees and faculty members about challenges they faced and failures they overcame during medical school. This programming provides an open forum for honest discussion and is attended by students only, to create an environment where they can safely share their own struggles.4

Only one-third of respondents in the “Death by 1,000 Cuts” survey reported that their workplace offers a program to reduce stress or burnout. However, we need to go beyond that and think bigger to combat this scourge on our profession. A meta-analysis of controlled interventions to reduce physician burnout demonstrated that the small benefits of these programs can be enhanced by organization-directed approaches.5

Just as our approach to caring for patients with hematologic disorders has evolved, so must our approach to supporting clinician mental health and well-being. Modeling that it is not only OK, but important to take time to center yourself after an emotionally devastating event. We should regularly check in with our colleagues and ourselves, such as pausing for moments of silence to acknowledge loss before starting morbidity and mortality conferences. We can use artistic expression to process our emotions. We can encourage one another to seek support.

As a specialty, let’s make a pact to look out for each other. To not assume we are OK, but to ask if we are OK. Only in doing so can we begin to heal some of our invisible wounds.

Alexandra Wolanskyj-Spinner, MD
Associate Editor

References

  1. Medscape. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Accessed February 9, 2021, from https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456.
  2. Kirch D. Physician mental health: my personal journey and professional plea. Acad Med. 2021 January 25. [Epub ahead of print
  3. Finney RE, Jacob A, Johnson J, et al. Implementation of a second victim peer support program in a large anesthesia department. AANA J. [in press]
  4. AMA Ed Hub. “MyStory” Series: Normalizing Struggles During Medical School Training. Accessed February 9, 2021, from https://edhub.ama-assn.org/steps-forward/module/2763262.
  5. Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205.

Disclaimer: The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.