Burnout BEFORE Admission to Professional Schools?

     "... burnout is when physicians feel emotionally exhausted, depersonalised (ie, cynical & detached), and ineffective; when they feel 'an erosion in values, dignity, spirit, & will'."

        Ronald M. Epstein, Michael R. Privitera. "Doing something about physician burnout."

        www.thelancet.com Published Online September 28, 2016 

        http://dx.doi.org/10.1016/ S0140-6736(16)31332-0 

     An excellent podcast: https://resident360.nejm.org/content_items/1423

     But what percentage of students entering health-care (& other professions) have ever paid appropriate attention to their "values, dignity, spirit, & will"? How much does our society, or for that matter professional school admissions committees, actually value these self-reflective, spiritual matters? 

     I suggest that very few in our society care deeply about this: http://www.johnlovas.com/2016/11/the-power-of-self-knowledge-and-self.html

     Even within professional schools, a corrosive segment of both students & faculty ("hidden curriculum") are actively hostile even towards standard courses in the humanities: http://healthyhealers.blogspot.ca/2012/07/soft-skills-undervalued.html

     But neglecting inner poverty does become debilitating sooner or later: http://jglovas.wixsite.com/awarenessnow/single-post/2016/12/06/Delusion-of-Self-estrangement

 

Ignoring "Soft Skills" & Moral Injury

     "Soft skills" like communication, deep listening, bed-side manner, empathy, professionalism, mindfulness etc are considered a joke in the hidden curriculum and are basically ignored by students & faculty alike in university education: http://healthyhealers.blogspot.ca/search?q=soft
     When students or graduate health-care professionals are caught committing unprofessional acts, everyone is shocked. The dust settles, and "soft skills" continue to be ignored.

     Interesting lessons from the military:
     “If military practice tells soldiers that their emotions of love and grief – which are inseparable from their humanity – do not matter, then the civilian society that has sent them to fight on their behalf should not be shocked by their ‘inhumanity’ when they try to return to civilian life.”

     “… moral injury is an essential part of any combat trauma that leads to lifelong psychological injury. Veterans can usually recover from horror, fear, and grief once they return to civilian life, so long as ‘what’s right’ has not also been violated.” 
       Jonathan Shay. “Achilles in Vietnam. Combat Trauma and the Undoing of Character.” Scribner, NY, 1994.

     Parents spend less & less quality time with their children; schools are forbidden to teach kids basic manners or morals; CEOs, clergy & politicians are progressively losing respect & credibility. These are fundamental violations of ‘what’s right’ ! 
     Meanwhile rappers, reality stars & dysfunctional sports & movie stars are default role models. Young adults are explicitly exposed to & socialized by the lowest of cultural norms. See: http://healthyhealers.blogspot.ca/2013/01/larger-homes-more-exotic-trips-fancier.html This openly invites people to contravene basic, innate, implicit human codes of conduct, causing moral injury to everyone, victims & perps alike.

     When do we start taking "soft skills" seriously enough to teach them explicitly?

     "Moral Injury": http://healthyhealers.blogspot.ca/2017/01/what-is-moral-injury.html

      "Worldview - Maturity Level - Impacts": http://jglovas.wix.com/awarenessnow#!Worldview-Maturity-Effects/c17jj/56e5715b0cf27db4b02a4011

 

Experts Trying to Hide Deficiencies

     Health-care professionals strive mightily to become competent, then proudly display their competence - hence the popularity of specialization & sub-specialization. The more minutely specialized one's area of training, the more sought-after are one's services, and the less one is subject to criticism from patients & colleagues.
     Of course the more time & effort expended in gaining specialized competence, the less time & effort remains to acquire general life skills. As a result, most of us haven't lead a balanced life since we were kids. Physical exercise, sleep & nutrition are not the only areas in which we're deficient. See: http://healthyhealers.blogspot.ca/search?q=maturation
     Because we become so tightly identified with the persona of "the one who knows", we become increasingly sensitive about our ignorance of the many life-skills we've ignored. This is problematic of course, not only in our family & social life, but also professionally.
     Defensiveness of our ignorance about subjects outside of our specialized area is often manifested as swaggering condemnation of basically anything outside of our own sub-specialty - the humanities, mental-health, social work, nursing, physiotherapy, spirituality, etc - are all targets. See: http://healthyhealers.blogspot.ca/2012/07/soft-skills-undervalued.html
     Since such attitudes are politically incorrect, the condemnation happens behind closed doors - the "hidden curriculum" - it's toxic effects are part of professional socialization. See: http://healthyhealers.blogspot.ca/search?q=hidden+curriculum

     Fear of our own ignorance, hubris, and our unwillingness to step-up to acquire competence in practical wisdom, condemns too many of us to become grumbling backroom cynics - "nattering nabobs of negativity." Surely health-care professionals can rise above that!

Illusion of Control & Fear

     “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; . . . who at best knows in the end the triumph of high achievement, and who at worst, if he fails, at least fails while daring greatly.”                                             Theodore Roosevelt

     Nor do people count whose 'contribution' is consistently trying to derail improvements with their cynicism - openly, or worse, behind closed doors. Such cowardice with a swagger is referred to as "the hidden curriculum" in health-care education.

     So what makes educated, accomplished adults behave like 'chicken shits'? Fear. Not just fear of what they don't know and can't control, but fear of fear itself. We naturally want to deal only with what we know well and thus can more or less control. The greater our illusion of control, the more we fear most of real life - which is far from being knowable and controllable. That's why so many health-care professionals are workaholics and will "never retire". It's failure to mature.
     Intelligent, educated adults can learn about what they fear - "leaning into the discomfort", gaining understanding and competence, becoming more balanced, and evolving as people. At some point, we all need to learn to navigate real life's constantly shifting, changing, paradoxical complexity with some semblance of grace. This is normal, healthy evolution of character / consciousness or psychosocialspiritual maturation.

       Hollis J. “Finding Meaning in the Second Half of Life.” Gotham Books, NY, 2005.
       Brown B. "Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead." Gotham Books, NY, 2012. http://www.ted.com/talks/brene_brown_on_vulnerability#t-153143


 

Suffering, the Hippocratic Oath and ... Meditation?

     The Hippocratic Oath is our vow to relieve suffering. Interestingly, the Buddha is claimed to have said “I teach one thing and one only: that is, suffering and the end of suffering.” Could there be synergy between Buddhist-inspired secular meditation practices such as mindfulness-based stress reduction (MBSR) and modern health-care? What effect might meditation have on medical & dental students' idealism & compassion as they weather the corrosive effects of the "hidden curriculum"? See also: http://mindfulnessforeveryone.blogspot.ca/2013/11/432-i-try-and-i-try-but-i-cant-get-no.html

     "For Buddha, as for many modern spiritual leaders, the goal of meditation was as simple as that. The heightened control of the mind that meditation offers was supposed to help its practitioners see the world in a new & more compassionate way, allowing them to break free from the categorizations (us/them, self/other) that commonly divide people from one another."

     Researchers compared the reaction of a group ("meditators") who completed an 8-week meditation course, to those wait-listed ("nonmeditators") when observing a woman entering a waiting room, in pain, on crutches, finding no seats available. "... only 16 percent of the nonmeditators gave up their seats — an admittedly disheartening fact — the proportion rose to 50 percent among those who had meditated. This increase is impressive not solely because it occurred after only eight weeks of meditation, but also because it did so within the context of a situation known to inhibit considerate behavior: witnessing others ignoring a person in distress — what psychologists call the bystander effect — reduces the odds that any single individual will help. Nonetheless, the meditation increased the compassionate response threefold.
     Although we don’t yet know why meditation has this effect, one of two explanations seems likely. The first rests on meditation’s documented ability to enhance attention, which might in turn increase the odds of noticing someone in pain (as opposed to being lost in one’s own thoughts). My favored explanation, though, derives from a different aspect of meditation: its ability to foster a view that all beings are interconnected. ... any marker of affiliation between two people, even something as subtle as tapping their hands together in synchrony, causes them to feel more compassion for each other when distressed. The increased compassion of meditators, then, might stem directly from meditation’s ability to dissolve the artificial social distinctions — ethnicity, religion, ideology & the like — that divide us. 
     Supporting this view, recent findings by the neuroscientists Helen Weng, Richard Davidson & colleagues confirm that even relatively brief training in meditative techniques can alter neural functioning in brain areas associated with empathic understanding of others’ distress — areas whose responsiveness is also modulated by a person’s degree of felt associations with others. 
     So take heart. The next time you meditate, know that you’re not just benefiting yourself, you’re also benefiting your neighbors, community members and as-yet-unknown strangers by increasing the odds that you’ll feel their pain when the time comes, and act to lessen it as well." 

       The Morality of Meditation - David DeSteno - July 5, 2013

http://www.nytimes.com/2013/07/07/opinion/sunday/the-morality-of-meditation.html?_r=0

 

Child and Wave by John England   http://www.fogforestgallery.ca/bios/bio_england.html

We Embody & Teach Our Current Level of Consciousness, for Better or Worse

     "role modeling is the most common form of teaching values, ethics, and the human dimensions of care.

     Unfortunately, the demonstration of undesirable behaviors & attitudes is also effective. Such 'negative role modeling' has been documented to produce unprofessional behavior and even ethical erosion during clinical training. Sometimes referred to as a 'hidden curriculum,' such negative role modeling can be understood as a pattern of behaviors prevalent in a group that runs contrary to the desired & explicitly stated attitudes & behavior of humanistic care. Further, this hidden curriculum undermines the curricular objectives of courses on professionalism, ethics, and 'the art of medicine' that are usually taught during the first two years of medical school.

     Given the pervasiveness of negative attitudes & nonhumanistic behavior, we believe proper role modeling is an important teaching method by which to counter the hidden curriculum modeled by others. 

     How do master clinical teachers develop their teaching skills with respect to the human dimensions of care? In postencounter interviews, the faculty indicated that they use personal self-reflection to develop their teaching skills. Reflective practice has been recognized as an important element of professional development. For the faculty in our study, self-reflection was an iterative process that continued throughout their teaching careers."

       Weissmann PF et al. Role modeling humanistic behavior: learning bedside manner from the experts. Acad Med 2006; 81(7): 661-7.

      It may be safe to assume that those who manifest 'negative role modeling' are much less self-reflective, have minimal awareness of their poor intra- & inter-personal skills, and likely value technical knowledge over communication and other relational ("soft") skills.

     "Physician, Know Thyself!"

fulviavecchia   www.dpreview.com

The Sight of Blood

     In first year dentistry, medicine, and other health-care professional programs, some students feel faint or actually keel over at the first sight of a cadaver or the first sight of blood, etc.

     Some students come up with every imaginable excuse to delay seeing their first patients.
     Some students "vote with their feet" ie skip lectures and seminars that involve behavioral sciences or medical humanities.
     Too many graduate health-care professionals when dealing with medically-unexplained symptoms will tell these patients that they "found nothing wrong," intentionally avoiding the psychosocial elephant in the room.
     The "hidden curriculum" arises, at least partially, due to our personal discomfort with the full breadth and depth of our disciplines.
     Indeed, a key element of leadership in health care is the "ability to inspire people to move to areas to which they don't want to go." Hudson AR. HealthcarePapers 2003; 4(1): 4-12.
     Avoidance comes very easily to many of us, while approach is challenging. Don't health-care professionals tend to avoid continuing education courses on topics about which they feel least competent, and thus clearly need the most?
     It's hard to imagine a seasoned health-care professional remaining uncomfortable at the sight of blood, yet too many of us continue to avoid addressing the very basis of this primal fear - fear of our own death. It's impossible to become knowledgeable and competent in this important area, if we persistently avoid it.

     "If all of us would make an all-out effort to contemplate our own death, to deal with our anxieties surrounding the concept of our death ... perhaps there could be less destructiveness around us."      Elizabeth Kubler-Ross 

       Niemiec CP et al. Being present in the face of existential threat: The role of trait mindfulness in reducing defensive responses to mortality salience. Journal of Personality and Social Psychology 2010; 99(2): 344-65.

     See also: http://mindfulnessforeveryone.blogspot.ca/2012/03/65-embracing-full-catastrophe.html

Photo: Andre Gallant   http://www.andregallant.com/