09. Self Care

  • Patient suffering and death are extremely stressful events to witness and may affect both physician well-being and patient care.
  • Burnout and depression are very common, as is reflection on one’s own mortality and vulnerability.
  • Physicians working with very sick and dying patients may experience: chronic exhaustion, cynicism and detachment from work, decreased empathy, impatience, a sense of ineffectiveness/lack of accomplishment, insomnia, social withdrawal, numbness and detachment, increased interpersonal conflict, or decreased interaction with patients
  • Strategies for combating these feelings include:

Individual Strategies

  • Reflection upon work: journaling, discussion with colleagues
    • Am I burned-out/healthy?
    • Why do I do this/continue to do this?
    • What inspired/moved/surprised me today?
  • Professional supervision: regular interaction with a mental health professional with the express purpose of exploring dynamics of the provider/patient relationship
  • Establish and maintain healthy professional boundaries
    • Leave the hospital/clinic when your shift is done and try not to take work home with you
    • Try not to check the electronic medical record during your time off
    • Limit time spent with patients with whom you overly identify
  • Make time for yourself
    • Attend to health: diet, exercise, rest, regular health care
    • Plan activities that rejuvenate: play!
    • Plan vacations at regular intervals
    • Allow for “time-out” when stressors increase
    • Give important relationships priority – strengthen existing relationships with family and friends

Professional Strategies

  • Debrief with team about patient deaths or similarly challenging situations.
  • Team leaders should try to make time for these sessions. If this does not happen, suggest such a session to resident/attending.

Triggers for Professional Counseling

  • Persistent feelings of sadness, exhaustion, anger, worthlessness, hopelessness, suicidal ideation, or anxiety interfering with work or interpersonal relationships.
  • Self-prescribing sedative/hypnotic medication.
  • Substance abuse: alcohol, prescription, or non-prescription drugs.
  • Other ‘addictions’ interfering with work/relationships: gambling, exercise, eating
  • Persistent sleep disturbance: nightmares, difficulty initiating or staying asleep, early morning awakening.
  • Lack of attention to patients’ rights, safety, or autonomy.

References

Kearney, MK et al. Self-care of Physicians Caring for Patients at the End of Life: "Being Connected . . . A Key to My Survival." JAMA. 2009;301(11):1155-1164.

Meier, DE et al. The Inner Life of Physicians and Care of the Seriously Ill. JAMA. 2001;286:3007-3014.