In my recent post on the stigma associated with burnout, I shared messages that clinicians learned in training and on the job about self-care, being human, and being vulnerable. Their responses illuminate the toxic culture that exists in our health care system. Turning this culture around should be a top concern for every one of us. As one participant wrote, “The general public should care. Patients have a stake in this. Who will be around to take care of them?”
In this post I’ll focus on some suggested solutions (from me and from participants in the session) to create a more positive environment for care providers, non-clinical staff, and for patients and families.
Create a safe place to connect with peers.
Psychologists tell us that the way to disarm shame is to share the secret with others who can accept it.
I realize today that shame, and the stigma about needing help if you’re a care provider, profoundly affected my career path and even my sense of identity. When I was overwhelmed, exhausted, stressed, and scared, did I reach out for help? No, I kept going until I hit a wall, burned out, and left clinical practice. After leaving, did I talk publicly about the chaotic conditions and broken system that led to my burnout? No, I blamed myself and kept quiet for a decade and a half.
When invited to speak on clinician burnout at a recent conference, I decided to focus on the stigma that kept me from seeking help. Upon reflection, I saw that at its core was a mostly unspoken dictum that care providers cannot be fallible and cannot have human needs—as if the only way to help the vulnerable is to be completely invulnerable oneself. I wanted to see how clinicians in practice today view this stigma.
During the session I asked participants—who were physicians, nurse practitioners, psychologists, and students—to write out some of the messages they learned about self-care, being human, and being vulnerable during training or on the job. They submitted their entries on index cards, and volunteers shared their examples in real-time. Here’s what they had to say.
For years I wondered why despite being a confirmed urbanite, I love camping. Then I realized that camping gives me full permission to improvise—to make creative use of the limited materials I have to get the job done. Hence, shirt tails are fair game for wiping coffee grounds out of measuring spoons.
Similarly, I am inspired by people and groups that use the resources we have at our disposal in health care in creative new ways. Like the first explorers, these folks are testing approaches to provide care that are more effective than the status quo. Given the escalating health care costs, we need to be looking for ways to make the available financial resources work better for us. And, studies have shown that health care delivery includes a lot of wasted time, resources, and supplies, due in part to use of higher-priced services with no health benefits over less-expensive alternatives.
At a recent meeting on patient safety, I heard about a novel way of using a previously untapped resource—emergency medical technicians (EMTs), those courageous first responders to 911 calls. I followed up with Matt Zavadsky, MS-HSA, NREMT, who is the chief strategic integration officer at MedStar Mobile Healthcare, which provides emergency medical services (EMS) in the Fort Worth, Texas area, to learn more about it. Here’s what he told me.
For decades EMS units have been paid only to respond to emergency calls and transport people to the hospital. If they were to transport a person who needed less intense care to a lower acuity setting, like a walk in center or a clinic, they would not be paid—representing overuse of higher-priced services. In addition, EMTs, especially those based in fire departments, often spend a substantial portion of their shift waiting for emergency calls—representing underutilized human resources.