By Michael Lee Stallard and Katharine P. Stallard
It is customary for your doctor to ask you how you are doing when he or she enters the exam room. We’ve come to expect it. Typically, it is the opening question in a conversation to assess how you are really doing. But how often do you ask your doctor the same question?
A Heavy Load
Practicing medicine these days is stressful. Demands of productivity drive increasing numbers of patient visits or procedures on a given day. In addition to caring for patients in the exam room or operating suite, physicians face challenges of navigating the reporting requirements of new payment models. Electronic medical records add extra work hours to most physicians’ days due to unfriendly user interfaces and lack of interoperability, putting information management on the list of their responsibilities. It can be disheartening to work in a broken healthcare system where patients still struggle to have coordinated care and basic needs met. Finally, in the internet era, physicians have experienced decreased societal regard for hard-won professional knowledge and experience.
The medical professionals we either know personally or as patients are well-intentioned and work very hard. Still, knowing what we do about the impact of stress, we’re concerned for all those who run the risk of lacking sufficient social connections to maintain good health for themselves. Despite all of the time spent interacting with patients and staff, a recent article in Harvard Business Review cited physicians as among the loneliest professions. The combination of chronic stress and loneliness is contributing to the epidemic of physician burnout which research has shown may be the primary cause of medical errors.
Social connection is a primal human need, as research has borne out. Biologically, it appears to improve the cardiovascular, endocrine and immune systems’ performance. Lacking sufficient levels of connection is associated with poorer cognitive performance, impaired executive control and self-regulation, lower levels of self-rated physical health, substance abuse, depressive symptoms and suicidal ideation.
This excellent article in The Atlantic, “Physicians Get Addicted Too,” provides a cautionary tale of what can happen when under pressure. It unfolds the poignant story of Dr. Lou Ortenzio, a beloved family practitioner in West Virginia who was seeing 40-50 patients a day and working from 9:00 a.m. until 9:00 p.m. or even later. His desire to serve his patients well and an unrealistic work schedule squeezed out time for family and friends. (When we saw those clues, we knew trouble was ahead.) The high stress of a demanding work schedule plus low social connection combined to make Ortenzio vulnerable to the emotional and physical consequences of stress. He began to have trouble sleeping and he gained weight. His first step on the slippery slope into unintended addiction came one evening in 1988 when he reached for a sample he had in his office of extra-strength Vicodin (which has acetaminophen and hydrocodone, an opioid) to relieve a tension headache so he could finish seeing patients on that day’s schedule. It helped. As his addiction grew overtime to taking 20-30 pills a day, he turned to writing prescriptions in his children’s and friends’ names to feed a growing habit. His life took a turn in 2004 and he “managed to taper off the drugs.” Shortly after, the prescription fraud was discovered and it led to the loss of his medical license in 2006. Today, Mr. Ortenzio heads his church’s ministry, Celebrate Recovery, to help addicts.
Effects of Trauma
Another factor that those of us on the receiving end of medical care don’t often think about is the emotional toll of caring for sick people and those with chronic conditions or a terminal diagnosis. To begin to appreciate the emotional demands people in healthcare routinely face, read this eloquent article by oncologist Dr. Martee L. Hensley, “What Do You Say When She Is No Longer Living with Cancer.” Recognizing the role of her entire team in the care of her patients, internist Dr. Holly Dahlman established a bereavement practice. When a patient or close family member passes away, the whole staff team will sign a card of condolence for the next of kin. They will pause for a moment of silence at staff meetings after patients have died.
The effects of trauma also factor into burnout, which progresses from emotional exhaustion to depersonalization to a diminished sense of personal accomplishment. Trauma makes people more vulnerable to stress and feeling threatened. People who are traumatized may suffer damage to part of the brain that can lead to emotional shutdown, as described in the insightful book Untangling the Mind: Why We Behave the Way We Do by Dr. Ted George, a neuroscientist and psychiatrist.
In Finding Heart in Art: A Surgeon’s Renaissance Approach to Healing Modern Medical Burnout, Dr. Shawn C. Jones shared how trauma experienced in his practice as a board-certified otolaryngologist-head and neck surgeon led to experiencing alexithymia. He described the condition this way: “… [I] was completely unable to identify or feel anything in the way of happiness or sadness, anger, or calm. I felt no connection to anything —myself, my family, my associates, my patients. I felt completely disconnected from the world around me.” Given the isolating effect of alexithymia, feelings of loneliness are exacerbated. Fortunately for Dr. Jones, he didn’t merely carry on in that state of “emotional numbness.” He sought professional help, recovered and returned to practicing medicine. He went on to become president of the Kentucky Medical Association and in 2016 was honored with the association’s Distinguished Service Award.
A Simple, Memorable and Actionable Model
In our work to raise awareness of the need for connection and how to infuse it in a work setting, we present leaders with a simple, memorable and actionable model that captures the important elements: Vision + Value + Voice. Put simply, communicate a Vision that inspires and unites people, Value people as human beings and not just means to an end, and give people a Voice to express their opinions and ideas. We explain how these elements meet universal human needs in the workplace for respect, recognition, belonging, autonomy, personal growth, meaning and progress.
If you are burning out or disengaged at work, you can use the 3V model as a diagnostic tool to examine your experience. Where is there a breakdown? What might you do, individually,to turn it around? Dr. Jones’ practical advice to fellow medical personnel based on his own journey includes these exhortations: “Take some time to remember what led you to choose medicine as a career and develop a way to tap into that meaning. It seems easy for that to get lost in day-to-day minutiae.” [Vision]; “Develop a cadre of friends with whom you can be real.” [Value]; and “Start a discussion group on [the issue of burnout] at whatever level you serve. That will help to build a sense of community.” [Voice].
The Need for Cultures of Connection
It’s important for those in the medical field to understand the positives of connection and the negatives of disconnection, and to act to improve and safeguard their own health. That said, there is a related piece that needs to be addressed: Healthcare is an industry that desperately needs to improve the cultures of its organizations, big and small.
The high rate of physician burnout and suicide are signs that the cultures in many healthcare organizations are not healthy cultures of connection. Instead, you’ll find cultures that tend to isolate people through unrealistic work demands combined with overcontrolling attitudes, language and behavior, or cultures that are indifferent to our human needs for connection. (It should be noted that data show that nurse burnout rates are extremely high, too.)
According to Dr. Jones, “Medical institutions are in dire need of physicians who are willing to take a stand and demand that the medical work environment improves for the good of the patient, the caregiver, and the healthcare system. It is imperative that physician well-being becomes a principal concern. It is a public health crisis that needs to be addressed now.”
We recently spoke about our work and book, Connection Culture, to more than 300 leaders at Yale New Haven Health’s Annual Directors’ Meeting. In conversations we had with several people it was encouraging to see how many leaders at one of America’s top-rated healthcare organizations are intentionally cultivating a culture that will enable physicians and staff to perform their very best work, and ultimately help maximize patient outcomes in the battle against sickness and disease.
We are also encouraged to see that education of rising professionals in healthcare is beginning to include the importance of human connection and connection culture. The new medical school at Texas Christian University, where we work as consultants to the TCU Center for Connection Culture, is intentionally developing empathic scholarsTM using an “interdisciplinary curriculum designed to build skills in awareness, listening, inquiry and engagement to foster exceptional connections between physicians and their patients, their teams and their communities.” Incorporated in the education is a Physician Development Coaching program which pairs each student with a coach and other student team members. The coaching relationship will “assist in the development of resiliency, collaboration, communication and continuous improvement for personal and professional development.”
There is evidence that it may take well over a decade for healthcare research to be applied in clinical settings. We’re hopeful that the lag time will be far shorter in the case of connection — for the sake of those who work in healthcare and for our sake, as their patients.
About the Authors
Michael Lee Stallard, president and cofounder of Connection Culture Group, is a thought leader and speaker on how effective leaders boost human connection in team and organizational cultures to improve the health and performance of individuals and organizations. He is the primary author of "Connection Culture" and "Fired Up or Burned Out." A three-time cancer survivor, Katharine Stallard is a partner of Connection Culture Group and a contributing author of “Connection Culture.”