BURNOUT & STORYTELLING AS

HEALING TRICIA  GANDELA  

MONET  FLENNAUGH  

MONICA  HERNANDEZ  

MATTHEW  GARAY  

KHALYLA  KUHN  

 

 

 

WHAT DO YOU EXPECT?

 

Expecta(ons  of  Pa&ents    

•  The  doctor  is  knowledgeable  and  skillful  

•  The  doctor  will  heal  and  relieve  suffering  

•  The  doctor  is  compassionate,  a  good  listener,  is  paLent  

•  The  doctor  acts  as  a  paLent  advocate  

•  The  doctor  has  authority  and  is  to  be  respected  

Expecta(ons  of  Doctors    

•  Will  be  able  to  diagnose  and  find  the  best  treatment  for  their  paLents  

•  Will  be  respected  by  paLents  as  well  has  other  healthcare  providers  

•  Financial  stability  

•  Busy;  long  hours  

•  Surrounded  by  helpful  mentors  

Along  with  the  rewards  that  come  with  choosing  the  pathway  to  becoming  a  doctor,  there  are  also  many  factors  that  lead  to  overwhelming  responsibiliLes.  There  are  expectaLons  that  come  from  paLents,  mentors,  and  from  doctors  themselves  that  make  a  compilaLon  of  reasons  for  burnout.    

An  example  of  an  individual’s  take  on  the  expecta6ons  of  pa6ents  and  doctors:  h9p://www.ncbi.nlm.nih.gov/pmc/ar6cles/PMC2158016/pdf/jroyalcgprac00269-­‐0023.pdf  

REALITY OF THE OUTCOMES RELATED TO EXPECTATIONS Some  expecta6ons  are  described  as  myths  and  the  perfect  picture  of  being  a  doctor  may  be  skewed:  •  Length  of  schooling  (approximately  8-­‐9  years)  and  loans  to  pay  

•  Long  hours  plus  overLme  and  on-­‐call  shiYs  

•  The  pressures  of  presenLng  themselves  to  mentors/liaisons  (and  paLents)  as  knowledgeable  and  competent  

•  Physical  and  mental  exhausLon    

•  Balancing  personal  life  vs.  work  life  

•  Keeping  up  with  research,  conLnuing  educaLon,  change  in  policies  

•  Finding  funds  to  support  their  research  

THE NATURAL DEFENSE: COPING •  “Lethal,  this  becoming  and  being  a  doctor!  Denying  hope  and  fear,  ritualized  defenses  pulled  up  around  

ears  like  turtlenecks,  these  doctors,  to  survive,  had  become  machines,  sealed  off  from  humans—from  wives,  kids,  parents—from  the  warmth  of  compassion  and  the  thrill  of  love.  I  realized  that  it  wasn’t  just  that  they’d  kept  on  riding  Po9s  about  the  Yellow  Man,  no.  They’d  ignored  his  suffering,  his  months  of  fatal  depression.  And  because  I  felt  helpless  and  didn’t  know  what  to  do,  I’d  ignored  it  too.”  (328)  –  The  House  of  God  by  Samuel  Shem  

THE NATURAL DEFENSE: COPING (CONT.) •  Outside  of  work,  doctors  are  faced  with  the  challenge  of  idenLfying  ways  to  cope  with  the  burnout.  An  

example  of  creaLng  an  outlet  as  a  way  to  cope  is  through  storytelling.  Whether  it  is  through  verbal  communicaLon,  art,  dance,  or  wriLng,  expression  of  one’s  emoLons  can  help  keep  doctors’  personal  life  balanced  with  that  of  being  a  doctor.  Po]’s  in  House  of  God  did  not  have  a  method  to  cope,  but  rather  kept  his  depression  to  himself.  

STORYTELLING AS COPING IN TELEVISION

•  Scrubs  depicts  the  experiences  of  interns  during  their  first  year  out  of  medical  school.  The  show  in  itself  is  narrated  by  Dr.  Dorian,  aka  J.D.  Dr.  Cox,  the  interns’  mentor,  is  one  example  of  how  the  doctors  may  face  burnout.  Dr.  Cox  touches  on  mental  illness,  financial  issues,  feelings  of  inferiority,  fear,  and  respect.  

•  h]p://youtu.be/t-­‐b6GIo1g68  

 

 

STORYTELLING AS COPING IN TELEVISION (CONT.) •  At  the  end  of  each  episode,  the  tone  turns  from  comedic  to  serious,  where  J.D.  lays  out  a  sort  of  “moral  

of  the  story”.  Although  J.D.  is  telling  the  stories  to  the  TV  audience,  a  sense  of  comfort  and  relief  is  found  through  the  narraLon  and  that  even  with  all  that  goes  on  in  the  hospital,  there  are  always  lessons  to  be  learned.  

•  Even  though  most  of  the  stories  involve  what  is  going  on  in  the  hospital  and  the  paLents,  each  character  faces  personal  issues  as  well.  The  characters  find  support  through  confiding  in  one  another  with  their  thoughts  and  feelings  of  love,  friendship,  failure,  confidence,  fear,  and  even  death.  

•  h]p://youtu.be/YUcw5j5viZ8  

 

AIDS: A DIFFICULT TRUTH

•  AIDS  is  a  disease  that  historically  has  had  a  negaLve  sLgma  a]ached  to  it.                  

•  “The  unsafe  behavior  that  produced  AIDS  is  judged  to  be  more  than  just  weakness.  It  is  indulgence,  delinquency—addicLons  to  chemicals  that  are  illegal  and  to  sex  regarded  as  deviant”  (AIDS  and  Its  Metaphors  by  Susan  Sontag)    

•  In  the  film  Philadelphia,  we  discover  that  once  Tom  Hanks  becomes  HIV  posiLve,  he  is  ostracized  not  only  for  his  condiLon,  but  also  for  being  homosexual  and  he  is  discriminated  against  because  of  his  sexual  pracLces.    

•  “AIDS  marks  a  turning  point  in  current  ajtudes  toward  illness  and  medicine,  as  well  as  toward  sexuality  and  toward  catastrophe.  Medicine  had  been  viewed  as  an  age-­‐old  military  campaign  now  nearing  its  final  phase,  leading  to  victory.  The  emergence  of  a  new  epidemic  disease,  when  for  several  decades  it  had  been  confidently  assumed  that  such  calamiLes  belonged  to  the  past  has  inevitably  changed  the  status  of  medicine.  The  advent  of  AIDS  has  made  it  clear  that  the  infecLous  diseases  are  far  from  conquered  and  their  roster  far  from  closed”  (AIDS  and  Its  Metaphors  by  Susan  Sontag)  

     

•  Nurses  and  physicians  at  the  Ponce  De  Leon  Center  in  Atlanta  struggle  with  the  burnout  of  dealing  with  an  excess  of  HIV  paLents.  There  are  1600  employees  for  every  5,100  paLents,  averaging  about  1  staffer  for  every  32  paLents  (Where  Everyone  Wants  to  Work,  by  Elizabeth  Laudau,  CNN)  

•  “Poverty  and  drug  use  in  Atlanta  help  make  it  the  8th  highest  metropolitan  area  in  the  country  for  new  AIDS  diagnoses,  stated  Dr.  Vincent  Marconi  associate  medical  director  of  the  Ponce  clinic.    

•  “We  are  stretched  to  the  seams”  -­‐Dr.  Armstrong  of  the  Ponce  clinic.    

•  “My  biggest  frustraLon  is  that  there’s  not  enough  hours  in  a  day  to  take  care  of  all  that  needs  to  be  done.  These  people  are  very  needy.  A  lot  of  them  are  homeless,  have  a  mental  illness,  substance  abuse  problems  and  HIV  and  hepaLLs  C,  and  that’s  overwhelming  to  them”-­‐Dr.  Lane  Tatman  of  the  Ponce  clinic.    

•  The  physicians  cope  with  the  stress  and  aggravaLon  that  comes  with  lack  of  Lme  and  resources  to  treat  paLents  by  gejng  creaLve.  Nurses  make  it  a  goal  to  schedule  all  of  a  paLent’s  appointments  in  one  day  because  they  realize  the  difficulty  it  takes  some  of  their  paLents  to  even  show  up  at  the  center.    

•  Another  innovaLve  technique  that  the  Ponce  De  Leon  Center  uLlizes  is  their  staff:  many  of  them  live  with  HIV.  This  makes  it  easier  for  paLents  to  relate  to  their  physicians,  which  ulLmately  makes  the  staff’s  responsibility  of  providing  care  easier;  the  paLents  feel  a  deeper  connecLon  with  the  staff  which  moLvates  them  more  to  trust  their  physicians  when  they  prescribe  them  medicaLon  and  ask  about  their  personal  lives.  The  doctors  and  nurses  also  someLmes  share  their  own  unique  stories  about  their  life  dealing  with  HIV  and  it  typically  serves  as  a  sense  of  hope  and  moLvaLon  to  the  recently  diagnosed  paLents.    

HEALING CONNECTIONS

•  In  addiLon  to  the  difficulLes  that  lie  in  becoming  a  doctor,  many  professionals  face  harsh  realLes  once  they  are  working  in  the  field.    

•  First,  physicians  must  survive  a  grueling  journey  through  medical  school  and  retain  as  much  knowledge  as  possible  to  finally  put  it  into  pracLce.    

•  In  the  field  the  stakes  are  high  and  lives  are  on  the  line.  The  pressure  to  perform  is  intense,  this  forces  doctors  to  find  coping  mechanisms  to  handle  the  pressure.    

•  In  The  House  of  God,  Samuel  Shem  exposes  the  brutality  of  medical  training  and  provides  examples  of  how  doctors  react  in  an  intense  hierarchal  insLtuLon  that  demands    so  much  of  them.    

“THE ESSENCE OF MEDICAL CARE, AND LIFE, IS CONNECTION.” •  The  House  of  God  remains  very  popular  among  many  medical  professionals  today.  This  can  be  due  in  

part  to  one  of  the  novel’s  theme:  “the  danger  of  isolaLon,  the  healing  power  of  good  connecLon.  And  any  good  connecLon  is  mutual.”  

•  This  is  very  important  because  as  Chuck,  in  intern  in  the  novel  explains,  “how  can  we  care  for  our  paLents,  man  if  nobody  cares  for  us?”  

•  Over  thirty  years  aYer  the  novel  was  published,  Samuel  Shem  goes  back  and  propose  four  new  laws  that  illustrate  the  importance  of  coping  and  finding  healing  within  the  profession:  

•  “Law  14:  ConnecLon  comes  first.  IsolaLon  is  deadly,  connecLon  heals.”      

•  “Law  15:  Learn  empathy”  

•  “Law  15:  Speak  up.”  

•  “Law  16:  Learn  your  trade,  in  the  world”  

h]p://www.theatlanLc.com/health/archive/2012/11/samuel-­‐shem-­‐34-­‐years-­‐aYer-­‐the-­‐house-­‐of-­‐god/265675/  

STORYTELLING AS HEALING

•  Storytelling  can  help  people  cope  with  specific  issues  like  grief,  stress,  or  spiritual  ma]ers.  The  power  of  narraLve  goes  back  to  pre-­‐literate  socieLes  and  ancient  cultures  as  a  means  to  convey  their  history  and  tradiLon.  In  the  pracLce  of  medicine,  despite  the  potenLal  for  a  huge  exchange  of  stories,    much  is  lost  in  the  pracLcality  and  objecLveness.    A  doctor  for  example,  can  tell  a  paLent  why  they  feel  ill,  spit  out  medical  facts,  and  tell  them  what  the  future  holds  for  them  but  having  someone  who  has  shared  a  similar  experience  may  be  more  powerful  than  a  doctor’s  explanaLon.  PaLents  are  more  likely  to  remember  a  story  than  a  citaLon  of  individual  facts.    

STORYTELLING AS HEALING

•  In  Carver’s  “Small  Good  Things,”  we  see  two  parents,  Ann  and  Howard,  lost  in  the  shock  of  losing  a  son.    Dr.  Francis,  who  cared  for  their  son  explained  the  scenario  of  what  had  just  transpired  as  best  as  he  could.  He  gave  them  a  medical  synopsis,  a  story  in  a  sense,  but  not  what  Ann  nor  Howard  received  comfort  from.  Instead,  Ann  and  Howard  found  accidental  comfort  in  the  story  of  a  baker,  a  man  who  had  appeared  cold  and  cruel  to  them  just  hours  before  their  conversaLon.  Ann  and  Howard  found  meaning  in  the  baker’s  story,  one  that  made  sense  to  them  in  their  moment  of  devastaLon  of  losing  their  child.  They  had  found  a  moment  of  relief  from  this  stranger,  a  slice  of  solace,  a  piece  of  “their  own  medicine.”  

DO DOCTORS BURN OUT TOO QUICKLY?

•  Gawande’s  essay  exemplifies  a  perfect  example  of  how  bad  a  burned  out  doctor  can  actually  be  

•  According  to  a  CNN  survey,  nearly  1  out  of  2  doctors  report  signs  of  faLgue!  

•  Heavy  workload  and  lack  of  sleep  is  to  blame  

•  h]p://www.cnn.com/2012/08/23/health/Lme-­‐doctor-­‐burnout    

DO DOCTOR’S BURN OUT TOO QUICKLY?

•  From  Gawande’s  essay,  it  seems  like  the  character  of  “Hank  Goodman”  had  no  outlet  to  release  his  frustraLons  at  work!  

•  “Work-­‐aholic”  lifestyle  got  the  best  of  Goodman  aYer  many  years    

SOLUTION?

•  There’s  no  “perfect”  soluLon  but  Shem’s  novel  The  House  of  God  sheds  light  on  some  possible  ways  to  help  doctors.    

ROY BASCH

•  Shem  seems  to  imply  that  one  way  to  ease  the  pain  and  stresses  of  being  a  doctor  is  to  have  friends!    

•  Roy  had  a  good  companion,  Chuck,  and  also  had  a  lot  of  sex…  

•  According  to  WebMD,  this  acLvity  can  help  a  person  who  is  stressed  out  to  the  max!  

•  h]p://www.webmd.com/sex-­‐relaLonships/guide/10-­‐surprising-­‐health-­‐benefits-­‐of-­‐sex    

“YELLOWMAN” FROM HOUSE OF GOD

•  Po]s  didn’t  really  have  a  way  to  cope  with  the  stresses  at  work  

•  The  death  of  the  “Yellowman”  pained  Po]s  deeply  

•  What  if  Po]s  had  more  friends  to  talk  to?    

•  Example:  have  more  acLviLes  to  take  his  mind  off  work.  

•  He  had  none  of  this  and  he  became  extremely  withdrawn….  

TAKE HOME LESSON – DON’T GET BURNED OUT! •  Gawande  tells  us  just  how  bad  a  stressed  out  doctor  can  be  

•  I’m  sure  no  one  would  want  to  be  taken  care  of  by  another  “Hank  Goodman”  

•  The  take  home  lesson:  learn  from  Roy  Basch  and  have  an  outlet  to  relieve  the  stresses  from  work  (e.g.,  play  basketball,  hanging  with  his  buddy  Chuck,  having  lots  of  sex…)  

REFERENCES •  Carver,  R.  (1991).  Where  I'm  calling  from:  selected  stories.  New  York:  AtlanLc  Monthly  Press.  

•  Holden  H.M.  (1977).  Medical  Sociology  2:  The  needs  and  expectaLons  of  doctors  and  paLents.  Journal  of  the  Royal  College  of  General  Prac66oners,  27,  277-­‐279.  

•   Sifferlin,  A.  (2012,  August  28).  Is  Your  Doctor  Burned  Out?  CNN  RSS.  Retrieved  August  11,  2013,  from  h]p://www.cnn.com/2012/08/23/health/Lme-­‐doctor-­‐burnout  

•  Shem,  S.  (1978).  The  House  of  God.  New  York,  New  York:  Bantam  Dell.    

•  Shem,  S.  (2012).  Samuel  Shem,  34  Years  Ader  ‘The  House  of  God.  The  Atlan6c  RSS.  Retrieved  August  11,  2012  from  h]p://www.theatlanLc.com/health/archive/2012/11/samuel-­‐shem-­‐34-­‐years-­‐aYer-­‐the-­‐house-­‐of-­‐god/265675/  

•  h]p://www.youtube.com/watch?v=t-­‐b6GIo1g68&feature=youtu.be  .  “Dr  Cox  Top  5  Rants”  Youtube.  7  July,  2007  

•  h]p://www.youtube.com/watch?v=YUcw5j5viZ8&feature=youtu.be.  “Scrubs  Best  Serious  Moments  Part  2”  Youtube.  20  June  2009