Photo Credit: Nadya So

Andrea Austin, MD, shares her insights on resilience practices clinicians can use to improve well-being and regain focus in difficult circumstances.

Resilience is a word that may cause some physicians to recoil. Burnout has been weaponized, to some extent, to not being resilient enough. However, physicians are resilient in choosing to go into medicine, be with patients, give them difficult news, and talk with families. Inherently, people who decide to do that work are resilient.

That said, there are some next-level resilient practices that we need to bring to physicians earlier on in medical education.

Gratitude & Empathy

One example is something that I call ‘grounded gratitude.’ We know gratitude is important for fulfillment. Studies say gratitude can be as effective as an antidepressant for mild depression. But medicine is hard. How do you tell a healthcare professional to be grateful for the 30 patients they need to see today and all the issues they will see throughout their shift?

One of the practices I recommend is grounded gratitude. You’re not thankful that you have a hectic day, but you are thankful to work with great team members or that you’re going to have dinner with your family at the end of the day. Those are practices that can improve our lives.

On one hand, it’s good that compassion fatigue is being recognized. When we think about compassion versus empathy, there is an important distinction that I wish I had known as a medical student.

We are taught you need to have empathy. Certainly, empathy is important. That’s the ability to put yourself in someone else’s shoes. We do this all the time as physicians.

The problem is that it causes us to activate the pain portion of our brain, and there is functional MRI data on this. Empathy triggers the pain pathway in our brain. So, when we look at burnout among physicians, it’s not surprising that you may suffer fatigue and burnout if you’re being empathetic all day. What’s called compassion fatigue should be called empathy fatigue.

Compassion: Empathy Plus Action

The way to solve empathy fatigue is through compassion. Compassion is empathy plus action. This can be as simple as saying, “I can’t solve this patient’s homelessness tonight, but I’m listening to their story. I am offering a free sandwich and clean socks, and I’m refilling medications.” That’s a compassionate act.

We know from the MRI data that it activates the reward part of your brain. Imagine you’re going through a day, feeling like a dishrag that’s been rung out too many times from empathy, and then you change your thinking about it. It’s a mindset shift: “I’m doing compassionate acts all day.” Suddenly, your day activates the dopamine part of your brain: What I do matters and is important.

That’s a key mindset shift that we need to teach people early in their careers. But if you’re like me and you found this out mid-career, you can put it into action now.

Certainly, patients deserve the care they’re asking for, and they don’t need to worry about our well-being. We don’t want the patient to have to take care of us. We’re there to take care of them. Pause if you’re having a difficult emotion. An example would be: “I’m still sad about the last patient I saw.”

Finding Your Solution

The good news is that neuroscience shows us that a difficult emotion usually lasts 90 seconds to a few minutes. Pause, attend to yourself, and take some deep breaths. Maybe go outside, get some fresh air, or talk to a colleague and say, “I just had a rough interaction.” Then, you can show up to that next patient as your best self.

What do you need right now? Maybe you must do a call shift, and getting a full night of sleep isn’t going to happen, but you can squeeze in a nap. It doesn’t have to be huge. Little things can add up and contribute to our well-being.

Self-care has proliferated the zeitgeist. There’s so much consumerism with the concept of self-care. I would like to say that I am a self-care champion and that I’ve done every self-care thing you can think of. I have my monthly massage; I take vacations. But I realized that self-care doesn’t help me in the middle of a challenging moment—when I’m on shift, and the hallway is so full of patients that have arrived by ambulance that I must walk sideways and shimmy down because we’re so overcrowded. The massage I had the day before didn’t help me in that moment.

When I was under acute stress, I had to figure out strategies. Those challenging moments are about channeling my values. Yes, I work in a crowded ED right now, but why do I do that work? It’s because service is one of my core values, and I believe in being there, 24/7, 365 days a year. That can provide the extra boost that I need in those tough moments.