We all know the burnout phenomenon in healthcare is rampant and seemingly expanding. While burnout encompasses an important set of issues, daily opportunities remain to find ways to express kindness and demonstrate goodness toward others. Finding gratitude can also be refreshing when integrated into our daily routines. Collectively, these actions will nourish our spirits while we wrestle the burnout rates.
Most of us have heard of or seen the bumper sticker “Practice Random Acts of Kindness.” And yet, when was the last time any of us followed that direction outside of our professional environments?
I was young, maybe 12 or so, when I watched an older man stop to help a seemingly homeless woman who had been beaten and was lying still on the street. He gently shook the woman to see if she was alive, and when he got a response, asked her how he might help. He propped her up against the side of a building, organized her clothing to be more comfortable, and called 911.
He waited with her, softly assuring her that help was on the way. As the ambulance team arrived and began their assessments, he remained at her side, holding her hand while they loaded her on their gurney. The man reassured the woman that she would soon be in a place where others would help her, then spoke directly to the EMTs, conveying that he expected them to treat her with respect and kindness. The ambulance left, and he walked away without acknowledging the gathered crowd.
Whenever I remember that event or see that bumper sticker, I am reminded to practice those random acts of kindness.
What act of kindness inspired you and changed your behavior?
Being kind to others and to yourself has many positive benefits. Kindness increases self-esteem, empathy, and compassion, and improves our mood. It can decrease blood pressure and stress hormones while boosting serotonin and dopamine, which affect stress levels. People who give of themselves in a balanced way also tend to be healthier and live longer. Kindness can increase our sense of connectivity with others, which can dispel feelings of loneliness, improve depression, and enhance relationships in general.
A Troubling Situation
Unfortunately, the most recent Medscape Burnout Survey results show frustratingly high numbers (see Figure 1). Last year, 42% of physicians expressed feelings of burnout; this year the percentage has increased to 47%. Gender differences were significant, with a 56% rate of burnout for women and 41% for men.
Figure 1. Contributions to Physician Burnout and Burnout by Work Setting
The pandemic likely has contributed to these current burnout rates. Individuals in other industries also are experiencing higher than usual rates of anxiety, burnout, and stress. This presents an interesting paradox for the physician workforce — the providers of care for others.
Additionally, physicians are notoriously resistant to seeking mental health assistance (see Figure 2). We believe, and our profession has perpetuated the belief, that physicians should not demonstrate “weakness” and should be a “strength figure” for the communities where we practice. Fortunately, this is gradually changing within the profession as society recognizes that mental health should be acknowledged and managed. High-profile individuals speaking out on mental health have certainly helped in this regard.
Figure 2. Physicians’ Stated Reasons for Not Seeking Help for Burnout or Depression
With this intrinsic resistance to seeking out advice or assistance, we as physicians should reach out to one another more often these days to provide mutually beneficial peer-to-peer kindness and support. Who better understands? A simple act of goodness to another physician could have profound effects.
Mark Greenawald is one physician who recently started such an approach with an initiative called PeerRxMedTM (www.peerrxmed.com). As he states on his website, PeerRxMed is a free, peer-supported program designed to help physicians and others on the care team move toward thriving both personally and professionally. It is an interesting approach.
Goodness and Gratitude
Confucius said, “True goodness springs from a man’s own heart. All men are born good. Without goodness one cannot enjoy enduring happiness.”
Goodness is a virtue often thought to be an inherent characteristic of humans. It strongly relates to kindness, generosity, and a humane approach to life. Goodness is a positive, loving, and caring attitude revealed through our emotions and character. Being good is often thought to mean making life an enjoyable and satisfying experience for ourselves and others through moral, responsible choices.
Well, if kindness and goodness are outwardly expressed characteristics of positive human behavior that lead to a better life, how about an inwardly expressed characteristic that adds positive value in terms of improved mental well-being and a balanced approach to life?
Cicero is credited with stating: “Gratitude is not only the greatest of the virtues, but the parent of all of the others.”
In a January 2007 journal article for the British Psychological Society, “Gratitude — Parent of All Virtues,” Alex Wood, Stephen Joseph, and Alex Linley explored the concepts and current state of research on the topic of gratitude. Some of their key concepts follow:
“Throughout history, gratitude has been given a central position in religious and philosophical theories. The importance of gratitude has been a fundamental focus of religions including Buddhism, Christianity, Judaism, and Islam…. From a secular perspective, Adam Smith, better known for his economic treatise The Wealth of Nations, also wrote extensively on gratitude. He believed that gratitude was essential for society, motivating reciprocation of aid when no other legal or economic incentive encouraged its repayment....
“Gratitude can be conceptualized as an affect, a behavior, or a personality trait…. Specifically, it acts as a moral barometer, drawing attention to help received; a moral motivator, encouraging a prosocial response to help; and as a moral reinforcer, where the expression of gratitude makes the benefactor more likely to provide help in the future….
“Most recent research has focused on gratitude as a personality characteristic. Some people feel much more gratitude than others, reporting gratitude, which is more frequent, more intense, and involves appreciation of a wider range of people and events... Multiple studies suggest that people who feel more gratitude are much more likely to have higher levels of happiness, and lower levels of depression and stress….
“The first reason that gratitude may be an important personality trait is because it seems to have one of the strongest links with mental health of any personality variable…Secondly, gratitude may be uniquely important in social relationships. The ‘moral’ effects of emotional gratitude are likely to be as important in maintaining individual relationships as in maintaining a smooth-running society. People who feel more gratitude in life should be more likely to notice they have been helped, respond appropriately, and return the help at some future time.
“Empirical evidence is fast accumulating that gratitude is involved in various social processes and is an important part of mental health and well-being. Such evidence is fully consistent with traditional treatments of gratitude by theologians and philosophers.” (https://thepsychologist.bps.org.uk/volume-20/edition-1/gratitude-parent-all-virtues)
Similarly, it has been noted in several popular psychology articles that the simple act of keeping a daily gratitude journal helps us better appreciate our lives and may offer a path toward feeling more successful. Gratitude has been around since ancient times but is now being better recognized on several levels to benefit personal health and balance in our lives. Given the levels of burnout and its causes, perhaps seeking ways to find gratitude in our lives will help brighten even those darkest of days and moments of highest frustration.
A Call for Change
I am reminded of a simple parable:
“So, which wolf wins?” asked the grandson.
The grandfather responded, “The one you feed.”
Be assured, however, that I am not suggesting that simple acts of kindness, goodness, or gratitude will solve the complex issues related to anxiety, burnout, and suicidality in healthcare. Large-scale systems change is required in healthcare before the workforce can step back and recognize things are indeed better. But we all need to engage in creating that change as best we can. There is no effort small enough to ignore when thinking of how to change our complicated industry.
As physicians and physician leaders, we all need to help create the needed change and improvements. This collaboration to create change is, in my mind, a requirement for success in the next iteration of healthcare.
In the interim, sustaining a defense against the stresses and symptoms of burnout will be difficult at the best of times. Exhibiting kindness, demonstrating goodness, and being grateful for all the positive things in our lives will improve life for our families, friends, patients, peers…and ourselves!
Oh, and that man who helped the beaten woman. I learned later, by coincidence, he was the CEO of a large corporation. He followed up on her and eventually provided her a job at his company where she could get her life back on track.
It does not matter what station in life we are living; we can always be kind to others through acts of goodness. And we don’t necessarily need to be told by others how kind or good we were. Being grateful that we have had the opportunity to be kind or good is reward enough!
Remember, leading and creating significant change in healthcare is our overall intent as physicians. AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally.
We must all continue to seek deeper levels of professional and personal development and recognize ways to generate constructive influence for one another at all levels. As physician leaders, let us become more engaged, stay engaged, and help others become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach — individually and collectively.