Dr. Detachment: How physicians have learned to down-regulate their emotions

One of the big buzz words within the discussion of physician burnout is "compassion fatigue".Compassion fatigue has also been described as "secondary traumatic stress syndrome" and is characterized by the gradual lessening of compassion over time.If you have ever found yourself mocking, making sarcastic remarks about or toward a patient, it's a sign that you may be experiencing this symptom of burnout.I started my integrative medicine practice 10 years ago, and I thought I had created the practice of my dreams.I was working the hours I wanted, seeing my ideal kind of patients, and being intellectually challenged and stimulated daily. However, even with what seemed like the ideal, after 5 years I still found myself slipping back into that feeling of depersonalization… feeling short with my patients (as well as staff and colleagues), and no longer enjoying what I was doing. I began to shut down emotionally as I had 10 years ago when I first hit rock bottom.

Looking back on that time, recently, I began to wonder where the root cause of this type of compassion fatigue lies, and if there is an evolution that if interrupted early could lessen the impact or even prevent compassion fatigue altogether?As I've observed, researched, and listened to many of my colleagues over the years, my take on the evolution of this compassion fatigue boils down to the following:

1.The process starts as early as pre-medicine (and for some before) – From the moment we decide to be doctors, we began to observe our mentors.If we are observing physicians who are stoic, or portray that superhuman avatar, then as young people, we decide that this is what it takes to be a successful doctor. Of course, this is a misguided assumption, because we do not know really what is going on inside the mind of that physician. All we can see is that they are successful, saving lives and making a difference…just like we want to do.

2.The messaging we receive in Medical school and Residency reinforces the behavior.Now you are in medical school and you are eager and enthusiastic. I remember the first week of medical school being told to look to our left, then to our right; that 1 of us would not make it through the next 4 years.We were told that we needed to in essence become machines if we were going to do well in medical school.While the words may be different,this type of message (whether verbal or non-verbal) is universal in our medical education system.1st and 2nd year the messaging is more subtle, but by the time you approach 3rd year, the message of "the patient is first, and you are last" is clear.Furthermore, the hazing continues from that point through residency. Coupled with the intensity of the schedule, sleep deprivation, and the high emotional nature of medicine in general, in order to get through, you almost have to disconnect emotionally.

3.Some of us have a predisposition to being emotionally disconnected – To add to this, some of us already have a predilection for disconnecting emotionally. Let's not forget that we are human, and have all had human experiences. I personally grew up in a household riddled with violence and domestic abuse, so yeah…I'm one of those people who learned to disconnect way before medical school. It was my survival mechanism.For those who have experienced trauma in childhood, disconnecting emotionally may be natural when you become overloaded.For others, there are cultural conversations that breed stoicism even in the face of heightened emotional conditions around you.Still, for many it's simply family or even societal conversation; "Leave your feelings at the door", "What goes on behind closed doors stays behind closed doors", "Never let 'em see your sweat".

4.Medicine is already a highly emotional industry – If we haven't learned to disconnect by the time we get through medical school or residency, eventually, the repeated trauma of being exposed to illness and death; connecting with our patients then seeing them decline;losing battles with cancer, heart disease, or other chronic illnesses with our patients; dealing with patients that refuse to make the changes that could save their lives, and then seeing them fade away in illness because of it.All of these things over time weigh on our emotions, and we can become emotionally exhausted.Disconnecting emotionally is then the way we learn to cope. The sad part is that we get real no education on healthy expression or management of the emotions we feel dealing with all of this day to day, nor do we have any real outlets or support systems to help us deal with this highly emotional industry we are in.

5.Finally, The patient AND medical communities hold us to impossible standard that doesn't allow for vulnerability or even our own humanity. We often have to deal with the stigma that comes with being "too emotional" meaning that we "can't hack it" which is further indoctrination that we must be "stone faced robots" that can handle whatever is thrown at us, and bounce back from anything.The thing that is most disempowering about this is that they call this "resilience".

There are likely hundreds of other reasons that contribute to the process of compassion fatigue leading to physician burnout.And while this coping mechanism of disconnecting emotionally may have served us to a point, continuing to stuff our feelings down is part of what contributes to the high suicide rate in our community.Imagine a trash can that you are stuffing trash into; now imagine you never empty the trash you just keep stuffing the trash down, pushing it down and putting the lid on. Eventually, that trash is going to overflow. Either the stench will seep out and affect everything in it's path, or it will simply explode. So is the case with our emotions.The first time I hit rock bottom as a physician, I found myself on the edge of the proverbial cliff and ready to jump. Luckily, I didn't. However, the second time, I had done enough self development to know that I needed to not go at this alone. I chose to seek outside support through coaching however, this choice looks different for everyone. For me, that process taught me better emotional coping skills, and now no matter what situation I'm in, I always have those tools to help me manage my environment in the healthiest way possible. No more burnout for me.

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Sunday, 24 May 2020

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