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Healing Our Caregivers

Clinical burnout has become the catch-all phrase to describe clinician distress.

A person who is burnt out is physically, mentally, and emotionally exhausted. This term implies that healthcare workers and family caregivers lack resiliency. It puts the burden on them to do better and figure it out despite proving their inherent resilience in other areas of their lives and handling the grueling demands of healthcare and caregiving. In November, we observe National Family Caregivers month, which aims to recognize the sacrifices that caregivers make. 

Healthcare workers swear an oath to put their patients’ needs first. The decline in insurance reimbursements forces providers to see more patients in a shorter amount of time with little compensation for preventative care. Insurers’ requests, productivity metrics, hospital organizational demands, and endless demands for completing the electronic medical record fully often take precedence over patients’ needs.

In providing care, clinicians are forced to make choices contrary to their longstanding, deep commitment to healing. Putting the needs of their patients first is a deeply held moral belief among healthcare workers. It’s estimated that primary care physicians spend almost six hours interacting with the electronic health record during and after clinic hours. Wellness pizza Friday won’t compensate for the denial of an insurance pre-authorization for life-saving treatment. Providers suffer moral injury when, despite understanding the care a patient requires, they are unable to extend that care.

Understanding why healthcare practitioners accept working in such dangerous settings requires a deeper look at the educational system that creates them. During the 1890s, William Halsted, the first chief of surgery at Johns Hopkins and a pioneer of modern medical training, required his residents to be on call 362 days a year. Later, Halsted was discovered to have used cocaine to fuel this grueling schedule. The medical establishment, however, continued to value this work ethic. Medical trainees today are expected to work 28 hours consecutively, learning early in their careers to put patients’ needs before their own.

Psychologist Carl Jung coined the term “wounded healer.”. According to Jung, the healer is driven to treat patients or aid family members as a caregiver because he is wounded. Taking a deeper look at the healer allows us to identify maladaptive beliefs. The tendency to be extremely self-critical, a trait related to maladaptive perfectionism, is sometimes seen in high-achieving healthcare workers or caregivers. It is common for people to measure their self-worth by external achievements (grades, degrees, accolades) rather than by internal validation, one that values and loves themselves as they are without conditions.

The suicide rate among doctors is twice that of the general population. When compared to other professions, suicide deaths among female physicians are 250-400 percent higher. There are many reasons why doctors are hesitant to seek help for depression, including stigma, time constraints, or confidentiality concerns. Sometimes, healthcare workers are hesitant to seek mental health treatment to explore such beliefs, since licensing boards require all medical records, including psychotherapy session details. Depending on the findings, licensing boards can demand close supervision.

While there are many factors contributing to rising healthcare worker and family caregiver distress, it’s important to note that the battle is not exclusively fought by healthcare workers. The failure to prevent burnout is a sign of a problem with the individual, which is why strategies to improve the resilience of an individual are applied.

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