Got Satisfaction?

Each Shot of Satisfaction is related to one of the seven steps back from burnout in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on your journey to a fulfilling life of caregiving.

Originally published October 12th, 2011 – This Shot of Satisfaction relates to Step 1 – REMEMBER what you came here for. Reconnect with your desire to care. Remember what you want from your work: the feeling good that comes from truly caring for others.


Got Satisfaction?

To create satisfaction for ourselves every day, we just have to stop for just a second and refocus and remember we have the power.  By consciously injecting our care, we transform ordinary days into extraordinary ones. - Dr. Frank

To create satisfaction for ourselves every day, we just have to stop for just a second and refocus and remember we have the power.  By consciously injecting our care, we transform ordinary days into extraordinary ones. – Dr. Frank

Over the years, I have asked you what you would need to feel satisfaction at work…  If I distill all your answers, it is clear to me that you simply want to feel your care makes a difference.
 
In order for us to feel satisfied at work, we must care.  If we spend our whole day robotically getting the patient’s history or just concerning ourselves with the diagnosis, the chart, the prescriptions, the IV’s, the meds, the crutches or the splint, we will never be able to draw satisfaction. The physical tasks we busy ourselves with do not contain care.  Care is not the diagnosis, the prescription, the admission or the discharge paperwork.
 
To give the care that makes a difference we have to put all of our distractions aside and show up fully present at our patient’s bedside.  We have to make a personal connection, let them know that we understand their situation and empathize with them.  We have to stay in that connection with them until they “get” that we feel how much their situation disturbs, affects, or frightens them.  We need to let them know that we want the best for them and that we will do everything in our power to make them feel better.  This is the kind of care that our patients need and that we need.
 
There is nothing more satisfying than dispensing the milk of human kindness, understanding, empathy and compassion.  We generate these intangibles with our hearts and our minds.  The result is a blend of emotional energy and positive thoughts that make all the difference for our patients.  With this energy, we step out of the ordinary world of physical matter and into the extraordinary quantum world where we can create personal satisfaction through our effort to care for another.
 
We do this conscious act of rising above the purely physical reality and stepping into the quantum world so that at the end of the day we will know that we cared, that we made a difference for both ourselves and another, and that what we do matters.  To create satisfaction for ourselves every day, we just have to stop for just a second and refocus and remember we have the power.  By consciously injecting our care, we transform ordinary days into extraordinary ones.
 

TAKE ACTION

Today and every day, whenever you are feeling frustrated or overburdened – stop, breathe and ask yourself: What do I really want?  What really matters to me?  I came to this profession, this hospital and to this particular patient’s bedside because I want to care.  Caring makes me feel good. 

When we remind ourselves of this, we can make the connection and generate the emotional and thoughtful energy that will help our patients feel our care.  This will certainly change everything.  We will finally have our satisfaction.  Go ahead, be someone’s hero today.  What could feel better than that?
 
All the best!
Dr. Frank

Get your copy of "Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care" at amazon.com

Get your copy of “Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care” at amazon.com

Expanding our Scope of Practice

 

Emergency Care: Expanding our scope of practice

Clear2care Expanding our scope of practice

Dr. Frank Gabrin is a contributing writer to the The Pulse, ACOEP’s (American College of Osteopathic Emergency Physicians) flagship publication which provides members with the latest ACOEP news, conference updates, in-depth opinions and analysis by leaders in the field, case studies, and information for medical professionals at every level of their career. This article was originally published in July 2015.

Caring for patients and their families in the Emergency Department is one of the most challenging tasks in all of medicine today. We’re the front door for most hospitals and where much of society accesses our medical system. Most of us on the front lines have suffered some degree of compassion fatigue as a result of our practice of emergency medicine and many of us have come to accept the idea that this emotional dysfunction is an unavoidable occupational hazard. Let that idea go. Science says it isn’t so.

Modern neuroscience shows us that there’s a lot happening physiologically, in our daily exposure to pain and suffering, that lies far underneath our level of conscious awareness. This process, called automatic affective empathy, goes on automatically and there’s no way for us to stop it. It happens almost at the level of our brainstem and is why we can’t help but feel what our patients are feeling.

It causes us to inherently feel pain whenever we see pain on the faces of our patients, their family members and even of our colleagues and co-workers. When we try to ignore what we’re feeling, or distance ourselves from the source of our pain, our neurological system freezes these centers. This causes the circuits that register pain to remain activated and we experience empathetic overload, emotional exhaustion, pain and suffering.

Because we’re repeatedly confronted with more and more people who are in physical or emotional pain, these same centers are continually reactivated with each encounter and, as a result, our brains become drained and depleted of the neurotransmitters that allow us to feel good. Cortisol levels rise, our autonomic nervous system is hyper-activated, our pulse quickens, our blood pressure rises and our breathing becomes shallow. Without doing anything to deactivate these centers in our brains that register pain, we can’t help but to just plain feel awful.

Fortunately, modern neuroscience has also shown us that the cure for this problem is in the process itself. When we’re in the experience of automatic affective empathy, if, instead of trying to stop the pain, we allow our natural curiosity to lead us to wonder what’s going on within our patient and what it’d be like if we were in their situation, we begin to experience their pain as if it were our own. It’s this part of the process, where we consciously feel the pain, that we rise above the level of the brainstem and begin to use the pre-frontal and frontal cortex where we can gain conscious control.

Cognitive empathy and compassion

Being curious and stepping closer to our patient and into their pain is the beginning of the process called cognitive empathy. By choosing to feel and explore the pain, the process naturally moves us away from the painful place of affective empathy and into the next phase: compassion. Compassion is activated by our desire for things to be better for the suffering human in front of us.

When we experience compassion, all of the negative centers in our brain that register pain and suffering begin to down-regulate and the positive centers begin to light up. A whole new set of neurotransmitters are elaborated, including oxytocin and dopamine, and the centers that register pleasure in our frontal cortex are activated.

Physiologically, things change dramatically for us. Our heart rate slows and variability returns. Our autonomic nervous system is taken off alert. Vagal tone is augmented. Spatial perception is improved. Creativity is activated and we automatically become more resilient. Math and higher cognitive functions improve. Integration and diagnostic abilities improve and we become physically stronger. We almost instantly feel, and do, better.

Practicing medicine compassionately feels much different than keeping our professional distance and is much more rewarding. Not only does it relieve us from the effects of compassion fatigue, it gives us what we need to be emotionally available, emotionally competent and to feel whole and fully alive. Expressing our compassion makes our patients and their family members feel better too.

Healing the healers

Although recent modern neuroscience has shown us that compassion itself is the antidote for compassion fatigue, many physicians haven’t been made aware of this information, or haven’t yet incorporated it into their practice. Too many of us are still suffering needlessly, as Carol Peckham showed us in the Medscape Report Physician Burnout: It just keeps getting worse. The levels of burnout in physicians have actually gone up between 2013 and 2015.

I was once extremely burned out too, but today, after having incorporated the process of compassionate care into my practice of emergency medicine, I feel much better. While I now enjoy my job as an emergency physician and love caring for patients and their families, I can’t say that my shifts are stress free or that I don’t experience frustrations. But, what I’d noticed lately is that some of my most challenging and difficult encounters are not with my patients, they’ve been with the consultant physicians I need to involve in their care.

It seemed to me as if the very first word out of their mouth after I asked for their help was NO. This almost always caught me off guard. Just as society holds physicians to a higher standard, I believe that we hold ourselves and our colleagues to even higher standards, which is why it’s so frustrating for me when other physicians do not, in my opinion, behave like I believe they should.

Recently, after a series of challenging shifts and a series of difficult and unpleasant experiences with a few consultants, I was feeling angry and extremely frustrated. I found that it was affecting me after work as well. I began to wonder how and why this was happening every day that I worked as an attending physician in the emergency department. Then I remembered how I used to feel when I was burnt out. I hated going to work. I’m sure I was difficult too. I realized that I needed to do something so I began to look more deeply at the symptoms of burnout in physicians.

The effects of burnout

Burnt out physicians feel deep physical and emotional exhaustion, are irritable and quick to anger and extremely cynical, especially at work. They experience a profoundly decreased ability to feel empathy for their patients, lose the ability to make decisions and their care for their patients is impaired. Their perceptions of people are dehumanized. They lose concern or respect for others and label people or groups of people in a derogatory manner. They’ve lost the ability to enjoy their careers. They’ve lost interest in life itself.

They have very low self esteem, trouble sleeping and are hypersensitive or insensitive to emotional material both at work and at home. They lose the ability to maintain close personal friendships, develop problems with both emotional and physical intimacy within their relationships and are more likely to divorce. They’re clinically depressed. They gain or lose weight. They’re more susceptible to physical illness. They’re more likely to turn to addictions like drugs, alcohol or gambling for temporary relief and more likely than the general population to commit suicide.

Too many of our colleagues are wounded, suffering and hurting just like I used to be. No wonder they’re not behaving like I expect them to. In their current state of burn out, their ability to cope is impaired. While they are not presenting to us as patients, our colleagues need our care now more than ever.

Extending our care to each other

I tried to imagine what it was like to be in my consultant physicians’ situation. Especially the hospitalists and intensivists. Quite often these doctors are taking calls for admission from three or four different emergency physicians. They’re also getting calls from other hospitals trying to effect a transfer. These doctors don’t know the patients they’re being asked to care for. Each patient is complicated and will require a lot of medical work. There is no end to the number of patients they may be asked to care for in their 12 or 24 hour shift. Putting myself in their shoes, I couldn’t help but feel compassion for them. This changed the way that I began to interact with them.

I started by making an effort go get to know these physicians. One of them is in his mid sixties. He is boarded and trained in family practice. Early in his career he worked in the emergency department and spent decades there until he decided that he wanted to go back to an office practice. He found that he did not enjoy that either. Now he has taken on the role of hospitalist and he is not so sure this is what he wants to do either. It seems as if he’s never been able to enjoy his practice of medicine. It is stories like his that make it easier for me to understand why these consultants are so unhappy and stressed out.

It become clear to me that it’s time for me to expand my scope of practice of emergency care to include to the consultants I ask to care for my patients. Instead of being frustrated by them, I need to feel their pain and activate my compassion. When I am full of compassion it is much easier for me to say something that will make a difference for them and make it easier for them to care for my patients.

As opposed to demanding, I now start the calls to my consultants by telling them I am sorry to bother them but I really need their help. Then I attempt to paint a full picture of the person it is that I am asking them to care for before I jump right into the medical situation that requires admission. I go out of my way to make it as easy as possible for them by making sure I have everything they might need done, including a magnesium level and the patients home medicines clearly documented. I also thank them more than once for their help and let them know they are important and appreciated.

Approaching these calls this way not only helps the consultant, it’s also made my days much better. It’s been good for my patients and better for my staff, as when the consultant arrives, they are usually much less stressed since we anticipated most of their needs. What I have learned from this experience is that being a caregiver is not just about caring for patients.

I’ve also learned that expanding my practice to my colleagues does not feel so natural at first. Especially when it comes to interacting with physicians. We were trained in a culture of bullying, or at the very least, a culture of disrespect. In training, we were pressured, by others and ourselves, to be right 100% of the time. Morning rounds and case presentations, as an intern or resident, were always stressful situations. We were taught to be competitive and confrontational.

The other thing that I’ve learned is that because it doesn’t feel natural, I need to apply a more conscious effort to stay engaged with my own emotions so that I can stay emotionally healthy and competent. Being consciously aware of what is going on within and around us emotionally is not necessarily our human nature. This is why consciousness is something that I make an effort to continually invest in. It is what makes the difference between a good shift, where I generally feel happy, engaged and capable, and a bad shift, where I feel frustrated, drained and exhausted. I continually have to remind myself to pay attention to these intangibles if I really want to make a difference for others and myself.

Most importantly, I’ve learned that activating compassion for ALL others is key in our work as caregivers.

If we really want to upgrade our experience while working in the ED, we need to expand our scope of practice to include all the men and women who work alongside of us: consulting physicians, mid level providers, nurses, techs, phlebotomists, security and registration, etc. These are all hard working, intelligent and highly motivated people who, like us, are swimming in the same toxic emotions that lead to compassion fatigue and burnout. When we look closely, we will see that many are struggling too.

The culture of compassion

Recently, there was a study done involving feeling of affection, compassion, caring and tenderness among co-workers at long-term care facilities by researchers at the Wharton School (University of Pennsylvania) and the George Mason University School of Business. They examined what they call a “culture of compassionate love.” The study was published in Administrative Science Quarterly. They found that a strong culture of compassionate love predicted benefits all around. For staff there was less burnout, fewer unplanned absences, more teamwork and higher work satisfaction. For patients there were fewer emergency room trips, higher mood, elevated satisfaction and quality of life for patients. Overall, there was more satisfaction with the facility and willingness to recommend it for other families.

It’s evident that expanding our scope of practice, as it relates to compassionate care, is a process that yields many positive and sweet intangible rewards. But when it comes to extending care to the people we work alongside, it can be challenging. One of the easiest ways to do this is to remember that no one gets up in the morning, looks in the mirror and says to themselves, I am going to hold back today. I am not going to do my best. Everyone is doing the best they can.

Get your copy of "Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care" at amazon.com

Get your copy of “Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care” at amazon.com

Each and everyone of us is going through something that may make it difficult for us to do better. Extending our care to include those we work with can have exponential effects on the entire work force in the emergency department and throughout the hospital. This is how we improve the lives of patients, their family members and the very staff that cares for them. Compassion is the corner of happy and healthy where medicine and healing intersect.

Science has proven compassion works to heal compassion fatigue. Someday there may even be a pill we can prescribe to make us more compassionate people. A study at UC Berkley and UC San Francisco finds that giving the drug tolcapone changes the neurochemical balance in the prefrontal cortex of the brain and causes a greater willingness to engage in prosocial behaviors. Until then, we can do the work of generating these positive emotions for ourselves by consciously choosing to engage our compassion for others. In my humble opinion, there’s no greater work in all of medicine today!

Until next time: Go care, make a difference and change (y)our world!

Frank D. Gabrin D.O.

The Medicine of Compassion

The Pulse The Medicine of Compassion

Dr. Frank Gabrin is a contributing writer to the The Pulse, ACOEP’s (American College of Osteopathic Emergency Physicians) flagship publication which provides members with the latest ACOEP news, conference updates, in-depth opinions and analysis by leaders in the field, case studies, and information for medical professionals at every level of their career. This article was originally published in April 2015.

The Medicine of Compassion

For decades we’ve worked to keep our “professional distance” in order to maintain our “clinical objectivity” and be better doctors. Yet, in spite of our efforts, at the end of the process we’re left emotionally drained, unhappy and burned out. Our patients are also left flat and unsatisfied. It seems our current practice of medicine isn’t working on either side of the stethoscope.

The big question is why? Previously, we’ve not taken into account how our brains and bodies are hardwired to function in the context of our interpersonal encounters. This is relevant to our practice because the latest research is showing that our most basic human physiology (hardware) is in direct conflict with the current model of care (software). These two aren’t working well together and don’t produce good results, especially for us doctors. What this means is that our hardware and software are incompatible and in desperate need of an upgrade.

It’s impossible to avoid the pain of affective empathy

Science is beginning to show us, through the exploration of our own human neuroanatomy, neurophysiology, neurochemistry and neuroplasticity, that we’ve been misguided and hurting ourselves by clinging to the notion that we can distance ourselves from the pain we’re confronted with every day. What we’re trying to do is impossible.

This is because, deep underneath our cognitive awareness, when we come into contact with another human, we automatically connect to whatever they’re feeling because of our hyper-vigilant survival based MNS [Mirror Neuron System]. This connection happens automatically and, unfortunately, no matter how hard we try, there is nothing we can do to stop it from happening.

This primal “process” happens almost at the level of our brainstem. It puts our brains and bodies into a state of “affective empathy”, where we can’t help but feel what others are feeling. We have no conscious awareness of this almost instantaneous process. We inherently feel pain when we see pain on the faces of our patients, their concerned family members and even the emotion on the faces of our colleagues and co-workers.

Our brain experiences their pain as if it were our own. The same neurons fire when you are in despair as when you witness someone else who’s hurting. In our brain, imaginary is real. The same nerve bundles and circuits light up for real or imagined events. Think about the last time you saw a horror movie. Our brain doesn’t distinguish between physical, emotional or imagined pain.

The pain we feel when we’re disrespected or hurt emotionally by another is the same as when we cut ourselves with a knife while preparing dinner. Which one of us has not experienced heartache or a stomachache without out having a blocked coronary artery or a peptic ulcer? All pain is the same for our brain. It doesn’t distinguish between the pain of a broken bone or a broken heart.

It’s impossible to avoid the pain of affective empathy. By the nature of our work, we’re repeatedly confronted with more and more people who’re in physical or emotional pain. With each encounter, the more we suffer from empathetic overload.

In empathetic overload, our centers and circuits that register pain are continually activated and reactivated. Our brains become drained and depleted of the neurotransmitters that allow us to feel good. In our bodies, cortisol levels rise through the roof, our autonomic nervous system is hyper-activated, our blood pressure goes up, our pulse quickens and our breathing becomes shallow.

The resulting effects are that we feel on edge and our tempers can become short. We’re pushed to the point where one more stressful event could break the camel’s back. How can we be at our personal best when we’re stressed and suffering? Yet this is exactly what our patients need and are looking for in their doctors.

“Cognitive empathy” is how we begin to override the effects of empathetic overload

What can we do to escape from this debilitating state of affective empathy? The answer is clearly not in continuing to do what we’ve been doing. Stepping back, trying to stay clinical and focusing on performing the history and physical, ordering the tests and medicines, making the diagnosis, administering the treatment or making the disposition, doesn’t lessen the effects of affective empathy. If this were the case we would all be feeling great about the amazing work that we do each and every day, but we’re not feeling good. Good doctors are feeling bad almost all the time.

The way we override the effects is by allowing the empathetic process to evolve naturally away from the state affective empathy. By stepping back and trying to disconnect from the pain, we effectively shut down the process. If we were to let it progress, our human curiosity would lead us naturally to the next step where we begin to wonder what going on within our patients and what feels like to be in their shoes. It’s here, in this thought, that we begin to transform the painful effects of affective empathy.

By allowing our curiosity to lead us this next step, we enter into the phase that researchers are calling “cognitive empathy.” It’s from here that we move from the brainstem and lower levels of our neuroanatomy to the level of our prefrontal and frontal cortexes where we have conscious control. “Cognitive empathy” is how we begin to override the effects of empathetic overload.

The emotional frequency of compassion is different than that of empathy

We can’t possibly shut down our feelings, but we can take conscious control over them and use them to our own personal advantage and, more importantly, to the advantage of our patients. By stepping into the pain of others and allowing our curiosity to wonder what it’s like for them, we naturally begin to move away from that painful empathetic place and into the next natural phase of the process, compassion.

Compassion is defined as the emotion or feeling that arises when we’re confronted with another’s suffering and feel motivated to relieve that suffering. Although compassion and empathy are both emotional responses to suffering, they are not synonymous. They are part of a spectrum. Try to think of our emotional spectrum much like we understand the spectrum of visible light. Light is light, but some light is perceived as yellow, others as green or purple,and different spectrums of light have different effects on our physiologic system. Our perception of light as red or blue depends on the frequency of the energetic wave.

The emotional frequency of compassion is different than that of empathy. On the lower end of the spectrum lies affective empathy, which refers more generally to our automatic experience of the emotions of another person. In the middle lies cognitive empathy, which is seen as our ability to take the perspective of and feel another’s emotions in the context of their position. On the highest end lies compassion, which arises when those feelings and thoughts include our desire to help.

Compassion can’t fatigue

It’s through compassion that our system gets upgraded, as its effects are incredibly positive. Research shows that when we feel compassion, just feel it, no words or actions, our heart rate slows down, oxytocin, dopamine and other positive neurotransmitters start to be elaborated in our frontal cortex and the centers and nuclei that register pleasure begin to light up. (A similar thing happens when we eat chocolate).

Not only do we feel better, we do better. Spatial perception becomes heightened and this opens our awareness. We see more possibilities and become more open to novel solutions. Our physical strength is enhanced. Vagal tone is augmented. Heart rate variability re-emerges. Creativity is amplified or augmented and we become more resilient. Math and higher cognitive functions improve. Integration and diagnostic abilities improve.

We become more tolerant and able to see past cultural differences. We become more trusting of others and we’re able to see the interconnectedness between people and situations. It’s when we say something or act within this heightened state of compassion that we can truly make a difference and feel that what we do or say, actually matters.

The process of True Care

Imagine how this uninterrupted process fits into an upgraded model of care that I call True Care:

First, we get fully present and connected with our patient. Next, we focus on our patient’s situation and become aware of the automatic experience of affective empathy within us. Then, instead of turning away from the discomfort, we consciously step deeper into the interaction, letting our curiosity lead us into the state of cognitive empathy, where we try to feel the pain of their situation as if it were our own.

It’s from here that the feeling of compassion is naturally generated by just wanting things to be better for our patient. Our brains and bodies will begin to be flooded with the positive effects of compassion and we can say or do something that will make things better for both of us both emotionally and physically.

Although a lot is happening in this process, we actually go through these stages in just seconds. Once we’re lit up with the positive effects of compassion, we can get quickly get back to the tangible physical process of delivering the goods and services that comprise the entire spectrum of modern medicine.

With a better understanding of affective empathy and by focusing our efforts on effectively using the process of connection and compassion, we can treat the diseases of compassion fatigue and professional burnout. Compassion, this milk of human kindness, is inherit within us all. When we access it, its affect on our human physiology is more powerful than any drug mankind has ever developed. As it turns out, compassion can’t fatigue, it is in fact the ultimate medicine.

Compassion in Action

I’d like to leave you with a personal experience of compassion in action.

Clinically, I work in a busy emergency department that sees somewhere between 200 and 230 plus patients a day. Recently, on a night shift in disaster, I was put into the role of physician in charge. There were 23 patients in the lobby who’d been waiting for hours and every case was complicated and intense.

We were working as hard as we could to get it under control, but it seemed we weren’t making a dent in the number of patients waiting to be seen. At about 2:30 in the morning, I approached a consultant I needed to get two of my patients admitted to the hospital. When I asked for his attention, he put his hand up in the air and said, “Take a number, you are third in line!”

He refused to listen to me at all. In that moment, I felt defeated and deflated, and I actually became very angry! I started to feel like a victim of circumstance. As I worked to contain my anger and get back to the business at hand, I looked up at the clock and it was 3:30AM. This is the point in the shift at which we lose staff and bed space. There were still 22 patients waiting in the lobby.

As I was in charge, I was feeling pretty much like a failure. It was in this very moment of self doubt that the other overnight physician came to me to tell me how completely overwhelmed she was and how she was going to resign in the morning because it was just too hard, too chaotic, and too out of control!

When I asked what was happening, she told me the trouble she was having trying to get her infant patient the treatment she needed. This patient had been here for hours, and how no matter how hard she tried, she wasn’t getting anywhere.

Her anguish was undeniable and she broke into tears of frustration. I felt her pain. They had just placed several new patients into her rooms, and she just could not get to them. I could understand why she was ready to throw in the towel and walk away.

Suddenly, I was larger than usual

What happened next surprised even me. I had such empathy for her. I could not help but share her suffering. My connection to her lead me to that place where I understood her pain and naturally wanted to help her. My arms just automatically opened up and I hugged her.

She was caught completely off guard by my gesture. I told her not to worry, that I would go see those patients in her rooms and that she needed to focus all of her attention on getting that baby what they needed. She went about the task at hand and I grabbed my scribe and went to see all the patients waiting for a doctor.

At this point, my desire to make things better for that baby, and for her, automatically took over. I viscerally wanted things to be better for everyone. It was as if, suddenly, I was larger than usual.

Everyone seemed to be following my step. The entire staff was working even harder to help each other to get the job done. The next time I looked up at the clock, it was 6:30 in the morning. Although the squads had never stopped bringing us more and more patients, the lobby was empty.

My previously distraught physician had gotten what she needed for the baby. She was back to herself and seeing patients that were supposed to be mine. She was now helping me. She was smiling and actually seemed relaxed. Everyone was feeling better, patients and staff alike. This same shift where we’d both been feeling like a victim and a failure had transformed into a night of triumph through compassion in action.

Looking back, I see how I naturally moved through the process of “true care.” When she came to me, I was present for her and automatically felt her pain (affective empathy). I set aside my own situation and put myself in her shoes and felt, as if it were my own, her frustration with the situation (cognitive empathy). Then I made the conscious decision to move beyond the pain and into the holy grail of compassion.

There is nothing better than this

This model of true care, especially in the most challenging of circumstances, changes everything, not only for others, but mostly for ourselves. Compassion enlarges and empowers us as humans. Positive neurotransmitters begin to flow and pleasure centers in our brains begin to light up as we’re transformed from zeros to heroes. What amazed me the most, was the effect that my feeling of compassion had on the rest of the staff. Compassion is emotionally contagious.

By upgrading our model of care to one that is compatible with our human physiology, we can move past the painful effects of affective empathy and into the positive flow of compassion. We will experience the difference our care makes. This is what really matters to those of us who chose to work in healthcare. In my humble opinion, there is nothing better than this, except maybe great sex or chocolate!

Until next time, go care, make a difference and change (y)our world.

All the best-

Signature

Frank D. Gabrin, D.O

Back from Burnout:  Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

 

You Can Change Everything

SOS CLASSIC You can change everything

The amount of effort we exert to overcome our human nature and look for the good is directly proportional to the amount of goodness we will create for ourselves, our patients, our hospitals, and our communities. — SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Franks personal journey back from burnout.

Step 4 – CIRCLE BACK to the beginning. If you’re not being effective, remember what you want and execute the first five steps of REFLECT again, with this same person or situation. Regroup when the encounter is over so you can do it all again. Remember your desire is to care. Look for a fresh opportunity to care again.

 

Originally published April 13th, 2011 (edited)

If You Get This, You Really Can Change Everything!

Every day, in every situation, problem or circumstance, there is both good and bad, light and darkness.  It’s up to us to choose what we want to see. We can view our environment as though we were tourists, everything seems so charming when we are tourists.  Or we can view our surroundings like a spy, looking to see what’s wrong and searching for dirt.

The famous book, “The Secret,” taught us that opposites don’t attract, rather like attracts like. So when we see and speak the bad by complaining and trash talking, we attract the bad right to us. We actually are making things worse for ourselves.  Unfortunately, focusing on the bad is an automatic process. It’s human nature.  It’s what we do unconsciously. That’s why we are surprised when we find ourselves miserable and in pain and suffering. We don’t see how we are creating our own hell and what, if anything, we can do about it.

What the book, “The Secret,” fails to teach us is that if we want to attract the good, we have to make an effort to overcome our human nature to see the bad. We need to make an effort to see the good in every situation. Once we see the good, then it will be easier to speak the good, do the good, and attract goodness. This process of attracting good requires us to recognize our unconscious, automatic behaviour and step outside our robotic ways.

My personal hero, Albert Einstein, would have been able to help poor Justin Timberlake find his way again. There is a principle in quantum physics that has long fascinated philosophers and physicists alike. It states that through the act of watching, the observer affects what is being observed. Although Einstein was not able to prove this in his lifetime, researchers at the Weizmann Institute of Science have credibly documented its validity. Their experiment, reported in the February 26 issue of Nature (vol. 391, pp. 871-874), showed that what the observer believes will happen actually influences what happens.

In the field of social sciences, we have learned the same thing. The term, the “Observer’s Paradox” was coined by William Labov.  This concept essentially demonstrates that we will see what we expect to see.

When we expect to see the bad, we connect to the bad, and we live the bad day that ultimately leads us to more chaos. But when we look for the good and do the work of injecting positivity, appreciation and enthusiasm into every action, then we live the good day. We are incredibly powerful. Whether we are aware of it or not, we are creating our reality every day, moment to moment.  We are responsible for our experience. No one else.

There is no bargaining with the laws of the quantum world. You can be the cause, or you can be the effect. When we allow our unconscious behavior to rule our day, we will experience its effects. But if we do the challenging work of looking for the good, we take control and can become the cause. This is how we become a much happier, self-actualized, and powerful person. This is how we can feel good about ourselves and the world we live in.  This is how we become the kind of person those around you aspire to be and to be around.

The amount of effort we exert to overcome our human nature and look for the good is directly proportional to the amount of goodness we will create for ourselves, our patients, our hospitals, and our communities. This is real, lasting, quantum satisfaction.

It’s springtime. This is a spiritual time for all of us, a time for renewal, rebirth, rejuvenation and freedom.  During this time, I would like to invite you to live the words of Mother Teresa, it may not be easy, but do it anyway.

People are often unreasonable, irrational and self-centered.

Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives.

Be kind anyway.

If you are successful, you will win some unfaithful friends and some genuine enemies.

Succeed anyway.

If you are honest and sincere, people may deceive you.

Be honest and sincere anyway.

What you spend years creating, others could destroy overnight.

Create anyway.

If you find serenity and happiness, some may be jealous.

Be happy anyway.

The good you do today, will often be forgotten.

Do good anyway.

Give the best you have, and it will never be enough.

Give your best anyway.

In the final analysis, it is between you and God.

It was never between you and them anyway.

TAKE ACTION

Make a quantum leap today. Your perception creates your reality. Choose to see only the good. Be the cause of a new and better reality.

Do it because you care, because you want to be the cause of your own satisfaction, because you don’t want to lose your way, because you want to help, to care, to make a difference, change the world and save the day!

All the best,

Signature

Frank D. Gabrin, D.O

Get your copy of “Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care” at amazon.com

 

Cause Happiness

Shot of Satisfaction Quote

Each Shot of Satisfaction is related to one of the seven steps in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on your journey to a fulfilling life of caregiving.

  In this weeks Shot of Satisfaction video, Dr. Frank Gabrin, the author of Back from Burnout, shares with us how gratitude and appreciation can shut down negativity and boost happiness.

In this weeks Shot of Satisfaction video, Dr. Frank Gabrin, the author of Back from Burnout, shares with us how gratitude and appreciation can shut down negativity and boost happiness.

Step 4 – LOOK at your position within the transaction of care, and ask yourself if you are the cause of something better or the effect of another’s situation. Am I reacting or am I responding? Reframe your role (in the patient encounter, or any interpersonal encounter), and your position in regards to your goal: to understand that the obstacles to your satisfaction aren’t outside you, but within you. Make the inner transformation and shift your position in your personal, internal quantum space from a negative to a positive one.

Cause happiness

The other day, I was working clinically and the department was busy as well as short staffed.  Almost everyone was complaining.   Some were complaining about their difficult, more challenging patients or their family members. Some were complaining about the high acuity and sheer volume of medications and treatments that were necessary.

A few were complaining about each other;  “That new grad nurse is so slow. They just don’t have the experience they need to do their job. That old battle-ax nurse is so lazy and he never helps anyone else.” Others were complaining that they hadn’t had even five minutes to get some food or use the rest-room.

The negativity bias

Complaining, and the negative feelings it generates, is as contagious emotionally as the common cold is physically. There are scientific reasons why negativity spreads so easily between us. Our central nervous system has been designed by six hundred million years of planetary evolution. Solutions to survival problems that were necessary for our ancestors, and those that preceded them (other primates, mammals, ancient reptiles, primitive life and even cellular organisms) are found within the anatomy and physiology we are born with today.

Survival of the individual, and the species, evolutionarily dictated that our ancestors be hyper-vigilant and on the look-out for danger, conflict and loss.  As a result, our brains evolved a “negativity bias.” This bias causes us look for bad news, react intensely to it and and then quickly store the experience in a neural structure so that if the same threat appears again, we will recognize it and react to it even more quickly and intensely.

It’s in our DNA

Todays science helps understand our two neuroanatomical systems that work together to cause us to be naturally drawn to the negative in our environment and amplify, or augment, our awareness of it:  The limbic system and the mirror neuron system. The limbic system is closely tied to our five senses and contains the amygdala – the primary danger detector for physical threats to our personal safety, like a saber tooth tiger up ahead in the clearing.

The MNS [mirror neuron system] is responsible for the process of mimicry. Our MNS gives us the power to know what others in our environment are feeling. This system is capable of recognizing seven universal emotions and is culturally blind. These seven emotions are anger, fear, sadness, disgust, surprise, contempt and happiness. You might notice that only one of the emotions, happiness, is positive, hence the “negativity bias.”  Our MNS is constantly on the lookout for other humans in our environment who might be capable of harming us.

Because of these systems link to personal safety and survival of the human species, they are powerfully tied to our emotions and especially active when we feel threatened. The limbic system, the amygdala and the MNS work together to generate the experience we have all come to know as the “adrenalin rush” and the intensely automatic fight, flee or freeze response. These systems deal with the basest of human needs, survival, and is designed to let us know that someone dangerous just walked into the room.

We are running on default

As caregivers, we know first hand that we feel sad around depressed patients, nervous when we are around anxious or frightened patients and agitated or annoyed when we are around angry people. Mimicry, as a result of the MNS, automatically and unconsciously cause us to mimic or imitate the facial expressions, postures and voices of the people around us. Different expressions trigger certain moods, the same exact moods experienced by the person who just walked into the room displaying them. The process happens so fast that we have no cognitive awareness of the process.

These systems are buried deep within our brain and involve some of the oldest parts of our brainstem sitting right on top of our spinal cord. They can not be interrupted and we can’t turn them off. As a result we (humans) are naturally on the lookout for the “bad” in our immediate environment.

Negative experiences, such as those generated by a negative threat, generally feel especially awful. According to Rick Hanson, PhD, while our underlying bias toward negativity may be good for our immediate survival, it is very bad for quality of life, peaceful and fulfilling relationships and lasting mental and physical health. He goes on to say, “This negativity bias is the default setting of the “Stone Age Brain.” If we do not take charge of it, it will continue to take charge of us.

In other words, what Dr. Hanson is saying is that we will automatically see the bad in our environment, in our patients, in their families, and in each other. This is our automatic human operating system’s default setting.  As a result, the emotions that are generated by our limbic system actually cause us to feel bad, and we naturally begin to complain about feeling bad, and we begin to name everything that is wrong with our environment and those that we are in immediate contact with. This is lousy for quality of life let alone job satisfaction or engagement with our work.

It doesn’t have to be this way

It is not in our nature to actively look for the good in our environment or for the good in others. But have you ever noticed how happy we feel when a happy person enters the room?  This too is happening automatically and unconsciously as a result of our limbic system and MNS. The significant difference is that happiness, and our automatic emotional reaction to it, makes us better at almost everything a human can do; mathematical calculations, spacial perception, logical reasoning, physical strength, just about all of our capacities are enhanced or augmented. Not only does happiness make us feel better, we are better and we can do better!

What would it be like if we could find a simple way to be happy, at work?  By understanding how our MNS works in a negative fashion, we have the power to transform our experiences with others during our work day, especially when we are focused on generating the intangible thing called care. Awareness of our negativity bias and the effects of mimicking others through the unconscious processes of our mirror neuron system, opens the door for us to have more pleasure and satisfaction when working with patients, interacting with families and most importantly when interacting with each other. You are probably wondering how.

Fortunately for us, modern science has found an antidote for the experience of negativity we are complaining about at work and in life. Gratitude. It may sound corny, but according to Dr Sonja Lyubomirsky, science has proven that the practice or the experience of gratitude is incompatible with negative emotions and may actually diminish or deter such feeling as anger and bitterness. Gratitude dissolves negative feelings. It is hard to feel resentful or irritated when you are feeling grateful. The experience of gratitude or appreciation helps people cope with stress. Expressing gratitude bolsters self worth and self esteem. Better yet, gratitude and appreciating others actually makes us, happy.

Scientists are proving over and over again that the body and the brain operate much better when we are feeling good and are showing us what the specific costs are when we are not feeling good. Barbara Fredrickson tells us that “Positive emotions broaden our scope of attention, cognition, action and build physical, intellectual and social resources.

Activating happiness

So the trick is to recognize, when we are feeling cranky and frustrated, irritated or annoyed, that it is our limbic system and our MNS that brought us to this place automatically. With this awareness, we now have the power to change things for ourselves and others by using our free will to inject the antidote of gratitude into our system.  By understanding our unconscious physical and emotional reactions, we can consciously move into the feeling or experience of gratitude.

When we actively begin looking for something to be grateful for, we are automatically taking our limbic system, our amygdala and our MNS off-line through our effort to see the good in our environment and those around us. To activate our own good feelings, once we see one of our co-workers taking the high road or walking the extra mile to care for another, help a patient or a co-worker, we can go pat them on the back and let them know we took notice. We can ask them if there is something we can do to help them, we can help without asking or we can leave a short thank you on a post-it note and put it on their computer screen while they are in a room.

Be creative. There are countless ways to express gratitude. The last time we talked, I was so happy about the good feelings generated by the direct from the factory Krispy Kreme donuts I brought in to show my appreciation of my coworkers. Food is a great way to let those you work with know you appreciate them and the work they do. Look around, think about what you would like. The possibilities for showing appreciation to another are endless.

Gratitude changes everything

The take home point here is that, although it is automatic and natural to see the bad (it’s part of our evolution and our physiology), we have the power of free will to be able to change it. The negativity bias was very necessary in times gone by. Today, it totally wrecks our experience and diminishes our quality of life. At the very least our negativity bias steals our own happiness from us. We can stop it with simple gratitude.

Simple does not mean easy. It will take effort, heroic effort actually, to actively look for the good, especially when we are feeling let down, under-appreciated, taken for granted, taken advantage of, miffed, irritated or angry. But once you do, with the good feelings gratitude generates, this instant antidote for our uniquely human condition will energize and empower you and those around you.

We don’t have to be anything less than happy and engaged at work when there is a tool we can use to instantly make ourselves and our co-workers feel better. By using our free will to activate gratitude, we stop experiencing the effects of our negative bias to our environment and start becoming the cause of something better. Consciously establishing the feeling of gratitude within ourselves and then making an action of appreciating another causes us both to feel good, feel better, feel happy almost instantaneously.  There is not much more powerful medicine than that!

TAKE ACTION

Look at your mood and ask yourself, are you the cause of something better or the effect of another’s bad day or foul mood?  Ask yourself if your limbic system and MNS have drug you down into the mud?  Most likely you will realize that you are not feeling well and at the very least you would like to feel better.

As simple and as corny as it is, make the effort to actively look for something good someone has done to be thankful or grateful for. Next, take it one step further and actively appreciate them by using your creativity to find a way to acknowledge them publicly or thank them personally more subtly.  There is no right or wrong way to appreciate, it is just important that we appreciate each other!  This is the sort of care that is simple, practical, and extremely effective!

Care, make a difference and change (y)our world-

Signature

Frank D. Gabrin, D.O

 

 

 

Back from Burnout:  Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

The Power of Giving Care

SOS The Power of Giving Care

 

In this weeks Shot of Satisfaction video, Dr. Frank Gabrin, the author of Back from Burnout, shares with us how Neuroscience has shown that one simple act can transform us and how to use this action to change things for ourselves, our co-workers and our patients.

 

 

Each Shot of Satisfaction is related to one of the seven steps in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on your journey to a fulfilling life of caregiving.

Step 7 – Take care of yourself. Restore and renew yourself by applying the quantum skills you’ve learned to energize and elevate every part of your life. This is where we invest energy in maintaining our “equipment”—our physical and energetic caring systems. We continue to change internally, which gives us the power to transcend our present limitations and change not only ourselves but the world around us as well. We become fully realized, fully satisfied caregivers—and, better yet, fully realized, satisfied and happy human beings.

 

Shot of Satisfaction Quote

It would be wonderful

I just read Dr. Edwin Leap’s recent article in Emergency Medicine News, Elemental Human Needs for Health Care Providers. I could not agree more with his observation that it would be nice if Health Care Administrators across the land actually cared for those of us who care for their patient’s.  By the way, Dr. Leap is also the author of ‘Life in Ermergistan’, an amazing read I highly recommend.

The observation Dr. Leap makes in his article is the the fact that hospitals across the country no longer have cafeterias that are open to serve the staff or the patient’s families after regular business hours. He goes on to say that people get sick between 3pm and 7am, they have families that are under duress and that food, drink and fellowship are great comforts in these stressful situations.  He also points out that hospital staff in busy patient care areas can’t leave the hospital for their own food.  And it is even more difficult to get fed as volumes rise and staffing gets tighter.

Dr. Leap offers that would be a wonderful act of kindness, such a simple way of saying that they appreciate us, if hospitals had food available for visitors and providers whose jobs keep them in the hospital at ungodly hours, on holidays and every weekend.  While this is true and I agree wholeheartedly it would be wonderful, we all know that this act of appreciation is highly unlikely to happen in the near future. We need relief right now.

It’s up to us

If we want change, we have to “be the change we want to see” in our world. Our happiness, our satisfaction, can’t be dependent on others.  When our happiness is dependent on the actions of others, we are being, by definition, co-dependent.  This can never bring us happiness or satisfaction because we cannot control others’ behaviors.  For that matter, in the chaos filled waters of modern healthcare that we swim in everyday, it can be oh so difficult to control even our own behaviors.

So what can we do?

We are care-givers!  We can give care, not only to our patients, but also to each other.  We can appreciate each other. We can be kind to each other. Food is a universal way to share with others.  Who among us does not know what it is like to break bread with another?  It’s such a simple act of appreciation and kindness. We are hard-wired to care, and we all know deep down inside that the one who benefits the most from giving is the giver. So why not give food to each other?

We all work in departments where Amy brings homemade meatballs for the entire staff with all the fixin’s to make meatball subs.  We all know a Connie who goes out of her way to make a full Thanksgiving Dinner for the entire staff, or prepares a tailgate party in the staff lounge on Super Bowl Sunday!  How many times do Docs order pizza for the staff when the volume and acuity are high?  How many times do I stop at the local grocery store on my way to work and buy lunchmeat, cheese, bread, mayonnaise and mustard to make sandwiches for everyone?  Don’t we all find the way to organize a “Bring In” on holidays?  Doesn’t this make us all feel a bit better?

Neuroscience proves appreciation works

Modern Neuroscience research tells us that the simple act of giving a gift of candy can open our awareness, allow us some perspective and enable us to see the “big picture!” The experience of a positive emotion such as gratitude or appreciation enables us to be more creative and resilient.  We see more possibilities. We become better at math and all of our higher cognitive functions improve.

Doctors, who are given a bag of candy prior to being presented a diagnostic dilemma, reach the correct diagnosis more often than those doctors who, sadly enough, are not given candy.  Neuroscience tells us that a simple token of appreciation can help us see past racial and cultural differences.  We become more trusting of others and see the connections between people and situations.  Injecting positive emotions transforms us as individuals.  Our act of appreciation of another brings out the best in both of us.

It’s just that simple

I am crazy about coffee.  I get only the best coffee and bring special creamers that everyone likes.  The other night I had only been on the floor for ten minutes when the charge nurse came up to me and said, I had hoped you made the coffee…. to which I replied, I did but I have not had a chance to bring it out to the staff.  Our smiles broke out. A happy staff is a productive staff!   It’s just coffee- or is it? If you ask me, it’s priceless! The simple act of saying thank you can be so powerful.

After I read Dr. Leaps article, I decided to go out of my way to extra appreciate my co-workers.  I wanted to see if the neuroscience conclusions about  injecting positive emotions would make things better in the especially chaotic ER we’d been swimming in lately.  I left early for work and stopped to buy 7 dozen warm donuts at the Krispy Kreme factory.

When I walked into the Emergency Department, the smell of the fresh doughnuts walked in with me. I was met with big smiles.  The staff could hardly wait to get at them!  The waiting room was full, and things were still chaotic, but with the doughnuts and the coffee, the staff was primed!  “Positively Primed!”

With renewed energy, we worked together as one to move everything as efficiently as possible through the system. In just a few hours we had that waiting room empty. Our patients left thanking us for the care we gave them as they were headed home to bed.  We were thanking each other for a job well done.  The overall experience of the shift was better than the previous nights for everyone!!!

I know that this simple, inexpensive gift, this simple token of appreciation, changed everything for everybody that night.  Things were better for me, for my staff and my patients!  We each hold the power within us to make a difference, to make our world better!  It is just that simple!

TAKE ACTION

We can’t wait for hospital administrators to open the cafeteria at night, on weekends or holidays.  We can’t wait for others to appreciate us, care for us, or support us.  We can only be the change we want to see in this world.

Leave a half hour early for work one day this week so you can pick up something to bring in for your co-workers.  Tell them how much you appreciate them.  Try it. See if it does not change things and make a difference for you, for them and all those you all care for.  I know you will like the results!

Care, make a difference and change (y)our world!

Signature

Frank D. Gabrin, D.O

 

 

Back from Burnout:  Seven Steps to Healing from Compassion
Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

 

 

What do you want from me?

In this weeks Shot of Satisfaction video, Dr. Frank Gabrin, the author of Back from Burnout, talks about a power we all have that lies dormant with us, until we activate it.  He tells us the story of Amazing Grace, a flight attendant who changed everyone’s day for the better, and how she inspired him to go the extra mile.

REFLECT:  Step 3 – FORMULATE your plan for getting the satisfaction you crave that comes from caring.You can recalculate the transaction of care by using the Perfect Equation, by which your giving True Care and your patient’s receiving your True Care add up to the energy of satisfaction in the quantum world of thought and emotion for both your patient and yourself.

SOS What do you want from me

What do you want from me?

When you or I are working this hard and trying to be as efficient as possible and someone comes to us and says, “The patient in room 8 is very upset, they are threatening to leave.  They cant understand why they are still waiting for their results and their discharge papers when all the staff is doing is laughing and joking around;” we can definitely feel our button’s being pushed and it is hard not to automatically explode with:  “So let them leave, what do you want from me, I am already pushed to the limit of what is possible and I cant help it their results arent back!  Not one of us likes to be told by anyone that our care is not good enough, or that it appears to anyone that we don’t care.

Just the other night, I had only been at work for two hours and I already had 18 patients on the board.  It was just around this very moment in time when my department director came to me and said, “Can I see you in my office?  It will only take a few minutes.”  Well I don’t have to tell you, when your boss asks to see you, he or she is not about to give you an “at-a-boy” or “good news” of any kind.  My heart sank and I got a big lump in my throat as I said “OK, no problem.”

Between a rock and a hard spot

What he wanted to share with me was that even though that for more than six months my Press Ganey satisfaction scores were in the 99th percentile, recently, since the daily volume in our department had gone up, my scores had fallen and now I was under the microscope.  He explained to me that I had been getting all fives, but now I was getting mostly fours.

His advice to me for improving my patient satisfaction scores was to use key words at key times.  He suggested that I use scripting techniques such as AIDET [Acknowledge, Introduce, Duration, Explanation, Thank You] and ECHO [Enhanced Communication Hardwired for Outcomes].  He also felt it would be in my best interest add something new to my practice.

He suggested that I routinely tell the patients that I discharge to expect a survey to come in the mail in a few days time and to let my patients know that they would be asked to evaluate my performance as their physician.  He was directing me to blatantly ask my patients to give me the best marks possible, to rate me a “five” in all five categories:

  1. Doctor’s overall performance
  2. Doctor’s Courtesy
  3. Doctor took time to listen
  4. Doctor informative about treatment
  5. Doctor’s concern for comfort

My physician director went onto say that if my patient satisfaction scores did not improve, he may be pressured to “let me go!  My initial automatic reaction was to say, “Are you kidding me?  There is no way that I can blatantly ask anyone to rate or rank me a five.  It is to embarrassing for me.  It seems unprofessional to me.  It makes me feel like a used car salesman.  And besides, if a patient waits four hours to get brought back to a treatment room, there is no way they are going to be satisfied with their experience.  Jesus, Buddha, Mohammed, The Dali Lama, Depoch Chopra MD or even Dr. Oz could walk into the room to care for them and when the survey came those frustrated patients are not going to rate their experience with the caregiver a five.”

My director was disappointed with my resistance to his suggestions, and he was not interested in my explanations or excuses for the drop in my scores.  The bottom line is that my scores must improve or I will not have a job.  I reassured him that I would find a way to improve my scores, but I would not be able to AIDET, ECHO or Ask for Fives.

Why isn’t it working?

To be honest, this was the first I was hearing that my scores had fallen and, since I had not noticed in real time clinically that I was not having as many positive experiences delivering true care to my patients, this was my first opportunity to reflect on the situation to see where the disconnect was.  Why exactly was it that as the volumes and the chaos in the department went up, my patient satisfaction scores went down?

The biggest question, however, was how could I improve the care experience for my patients and their families so that they would naturally want to give me high marks?  Did I listen to them?  Was I courteous and did I make them comfortable?  Did I keep them informed about their treatment?  I want to say “Yes, I did” to all of these questions. To find an answer, I decided to go back to my roots, at take a closer look at the delivery process of True Care:

  1. Get fully present
  2. Connect with our patient
  3. Focus on our patients situation and needs
  4. Empathy, go deep to feel the patients pain as if it were your own
  5. Compassion, generate our desire for things to be better for our patients and their loved ones
  6. Help make our patient’s situation better or at least more tolerable

I honestly feel that I am doing all these things.  My experience of the transaction of care remains a five, but my patients are leaving feeling it was just a four.  What is really going on?  Then it dawned on me- I had another “DUH” moment!  My patient’s experience of care does not start when I enter their exam room.  It starts in the moment they decide to come to the Emergency Department, no matter how they get here.  Their experience of care, their impression of me, begins when they first arrive in “Triage.”

See it from their side

It does not matter that I was not even in the building yet.  I forget that the patient and their family were in the “waiting room” for four hours before they were placed into an exam room.  Although I am fully present and I am connecting with them and their medical problem.  I forget they have another problem.  They have been uncomfortable, frustrated, and feeling uncared for at least four hours as our “system” does not have room to accommodate them.  As I am connecting with them as people, I need to remember they have been facing another problem.  Our medical system is overwhelmed.  This same wait for treatment is going on at just about every emergency department, urgent care or clinic in the whole country.  I know this firsthand from working in other departments in other states.

So as I focus on their situation and their needs, as I begin to empathize with them, I need to include not only their medical issues, but their frustration with our medical system’s current state of overwhelm.  What would I feel if I waited in the lobby for four hours with chest pain or difficulty breathing?  Honestly, I would be very angry!  I would be frustrated and I would feel like nobody really cared.  I would feel like lashing out at someone.  At the very least, I would be cranky and annoyed.  Every shift I work I see at least one patient who was already at another ER, waited for hours, and never got back, and then come to our ED only to wait some more, after already having given up their spot in line at the other facility.

As I move through the process of delivering “True Care,” in each of the six steps, but most importantly, when I empathize with them, imagining what it would be like to walk in their shoes, as I begin to feel their pain as if it were my own; I have to include the frustration and anger they feel about the wait.  How bad would it be to be in their situation, waiting, and knowing it is not fixable, it cannot be changed.  That’s just how it is – everywhere. There is no escape.

What would it be like to have a laceration that wont stop bleeding, that needs stitches, and have to sit in the lobby holding pressure on it for two or three hours before you could get back to a room?  What would it be like to have a sore throat, fever and chills, and have to sit in the lobby for three hours before you could get back into a room?

Acknowledge the frustration

As I deliver true care, I now know that I need to recognize and acknowledge how this overwhelming situation causes pain to my patients and their loved ones.  Not that it is my fault, the nurses’ fault, the hospital’s fault, or the president’s fault, it just is the situation we find ourselves in today. It’s nobody’s fault, but, it is an awful circumstance and I need to let my patients know that I understand their frustration and I feel the pain they feel as we both find ourselves in this shared ugly conundrum.

My patients, our patients, are entitled to better and they deserve to have an apology.  While it is not my fault, I can still be the one to say, “I am sorry that you had to go through this, to endure this. I know it is really awful.”  If I really want my patients to feel better, and I really want to make a difference for them, I have the opportunity here to have a huge impact on their situation.

By acknowledging the awfulness, by connecting with them in their frustration and apologizing to them, even though the situation is out of my control, I can help them let go of all the negativity they feel about the situation so that we can both focus on their medical situation and work together to come to a diagnosis and get them started on a treatment plan.  I can promise them to work hard to control what I can and to make things go a little faster from this point forward.

Go the extra mile

Even something as simple as finding out what pharmacy they will go to and offering to fax their prescriptions there before they leave the hospital so that they can be ready by the time they get there, can make my patient feel special and leave me feeling like a hero.  Simple as that may be, walking that high road or going that extra mile is what creates satisfaction on both sides of the stethoscope.

This is not scripted, this is not patronizing, this is not lip service, this is real and amazing service- and that is what we came her for.  This is who I want to be.  I do not know if making this change will move me from a four to a five, but I do know that when I practice this way, I generate intense personal satisfaction and people do take notice.  While I am letting go of my attachment to a “five”, I am embracing the opportunity to improve my patient’s experience of my caring for them, for in the final analysis, I know this is what will make me feel better.

TAKE ACTION

Free yourself from your hidden agenda.  Free yourself from your attachment to needing a thank you, an “at-a-girl”, a “kudo” or a “five” on a patient satisfaction survey as a requirement for your giving genuine, authentic, true care to those you want to serve.

If you want to have an amazing day, behave in amazing ways!  Give more than is expected.  Move out of your comfort zone, take the high road or walk the extra mile.  Dare to be AMAZING- and see if you don’t generate amazing results!

Care, make a difference and change (y)our world-

Signature

Frank D. Gabrin, D.O

Back from Burnout:  Seven Steps to Healing from Compassion
Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

 

 

SOS Classic – The Republic of Emergistan

SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Frank’s personal journey back from burnout.

Originally published September 21st, 2012

Shot of Satisfaction Classic

 

REFLECT – LOOK at your position within the transaction of care: are you the cause or the effect? Reframe your position inside the interaction with your patient.

I Pledge Allegiance to the Republic of Emergistan

Ever since the recent study from the Mayo Clinic came out saying, point blank, that 65% of practicing Emergency Physicians are suffering from burnout, I have been reading and trying to understand more about compassion fatigue and burnout. This week I read an essay by Dr. Edwin Leap, published in Emergency Medicine News, in which he writes about a magical mystical land where the streets are paved with Oxycodone. He says that he has done missionary work in this land, which he refers to as the psychotic, overwhelming, frantic, and tragic Republic of Emergistan. You can read his entire piece here: The Psychotic, Frantic, Tragic Republic of Emergistan 

In the emergency department, this land of Emergistan, we are privileged as nurses and doctors, medics, techs and staff, to bear witness to society at it’s most raw and vulnerable moments. At the same time, there are those who would take advantage of our good nature, and those who feel entitled to our care. There are those who would disrespect us and those who demand that we care. There are those who would scrutinize and criticize us, those who want to sue us, and those that curse us.

There is no way to explain or describe fully to our neighbors and friends what it is that we are exposed to and immersed in each day. Our policymakers in government, well, they just can’t possibly know what goes on on the front lines of medicine. Our jobs are physically, mentally and emotionally demanding. As we learned from the Mayo Clinic Study, the more education you have, the more protected you are from burnout, unless, that is, you work in medicine. What goes on around and within those of us in medicine happens no where else in the world.

The call to serve

When you get down to the very heart of the matter, those of us who work in Emergistan all have one thing in common; we all know that we can’t do our jobs for money, there just isn’t enough money. We do these jobs because we all share a simple, pure and uncorrupted desire to care, make a difference, ease pain and suffering and make things better for others.

Sometimes we forget this and when we do, we experience pain and we suffer. This is what leads us to become cynical, downtrodden, and ultimately, to burn out. But when we remember why we come to Emergistan in the first place and we reconnect with our pure and uncorrupted desire to care, well, everything changes and we realize just how powerful we can be.

On the front lines

When we deliver that devastating diagnosis that makes an old man cry “You are having a stroke,” and we stand there with him, as the tears stream down his face, and let him know that we understand his pain, his suffering, and hold his good hand while we cry with him, we take some of his pain away.

When we promise to do our very best to open the clogged vessel in his brain and offer him the hope of a modern medical miracle and a reversal of his stroke, while at the same time explaining the horrible risks involved, and we not only feel his anxiety, we feel our own, we alleviate his suffering.

When we stand with him and his family while the medicine is injected into his vein and we turn on our compassion and truly want the very best possible outcome for him, our compassion affects him, and we become the cause of something better for him. When we share these vulnerable moments with him we help him feel better, but we feel better too.

Rewards of service

For us, there is nothing better than this. We crave this feeling and obviously, we are willing do almost anything to get this feeling for we are willing to work in Emergistan because this is the one republic where we get the most opportunities to create this feeling of personal and professional satisfaction, over and over again.

Perhaps Dr Leap says it best when he says:

“Here’s the thing. They can call me bitter or angry, burned out or hateful. But I love Emergistan.”

TAKE ACTION

Reconnect to your pure uncorrupted simple desire to care. Everything else is just distraction. Feel your passion for the work again and see how your compassion burns away all the negatives in your day.

Come on! Smile! You know deep down you really do love what you do. We all do!

Calling all Doctors, Nurse Practitioners, Physician Assistants, Medics, Nurses, Techs, Secretaries and Registration staff. Consider this your wake up call!   Reconnect to your simple pure uncorrupted desire to care, make a difference and change (y)our world!

Make this and every shift, the best ever-

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Frank D. Gabrin, D.O

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The Hardest Part of Caring

REFLECT:  Step 3 – FORMULATE your plan for getting the satisfaction you crave that comes from caring.You can recalculate the transaction of care by using the Perfect Equation, by which your giving True Care and your patient’s receiving your True Care add up to the energy of satisfaction in the quantum world of thought and emotion for both your patient and yourself. Here you can free yourself from your (hidden) agenda, so that you can easily create the happiness Harold Kushner is talking about!

 

“Caring about others, running the risk of feeling, and leaving
an impact on people, brings happiness.”

—Harold Kushner

Is it the winter blues or burnout?

Due to a scheduling glitch, I had an unexpected week off, and when I came back to work this week I could not help but notice that it seems as if everyone, well almost everyone I work with is down in the dumps. Smiles seemed really hard to come by. Maybe it’s the weather?  We are all sick of the cold and the snow.  Has cabin fever consumed us all or are we just plain burnt out?

Are you done with winter or burnt out?  So that you can decide for yourself what it is you are really feeling , here is a list of the symptoms of professional burnout.  Check it out and see what it is you feel!

  • Do you feel deep physical and emotional exhaustion?
  • Do you notice a profound decrease in your ability to feel empathy for your patients, your co-workers and even your loved ones?
  • Are you irritable and quick to anger?
  • Is your worldview, well to say the least, disrupted or distorted?
  • Are you hypersensitive or insensitive to emotional material, both at work and at home?
  • Are you finding it difficult to maintain your close personal friendships?
  • Are you having any problems with emotional or physical intimacy in any of your personal relationships?
  • Are you contemplating a separation or divorce?
  • Have you become cynical, especially at work?
  • Have you come to dread working with certain types of patients, or certain patients in particular?
  • Have you lost the ability to enjoy your job?
  • Are you having any difficulty making decisions at home or on the job?
  • Does it seem as if you have lost interest in life itself?
  • Have you lost your concern, or even just your respect for other people?
  • Have your perceptions of people, well, become dehumanized?
  • Do you find yourself labeling people or groups of people in a derogatory manner?
  • Are you having any trouble sleeping?
  • Are you having any problems with low self esteem?
  • Do you feel like you could be clinically depressed?
  • Are you having trouble maintaining your weight?
  • Have you felt hopeless, like nothing you do will matter?
  • Does it seem like you have had one cold or virus after another this year?
  • Have you thought about drugs, sex, alcohol or gambling for temporary relief from your boredom?
  • Have you lost your get up an go?
  • Would you rather just stay in, and relish the silence?
  • Are you having trouble getting to the gym or for that matter, doing anything to make a positive change in your life?

If you can identify with any or all of the above, then you are probably suffering emotionally from the effects of burnout. How much emotional pain are you experiencing? If you had to put a number on it, say one to ten, how burnt out do you think you are?

The hardest part of caring is the emotional part

Since burnout is an emotional condition, and we all know that the hardest part of caring for others is the emotional part, then, if we are experiencing burnout, we must be doing something wrong, emotionally, when we are caring for others. So what is it that we are doing wrong?

I believe that what prevents us from feeling the joy we crave as a result of our caring is not truly connecting to our patients.  Our training has us believing that we should not get too close to our patients, for their pain will overwhelm us and we will lose our objectivity and make bad decisions.  Our training tells us that getting close and connecting to our patients will make us bad doctors and nurses. That getting too close is bad for our patients and for ourselves. This is absolutely not true and this is precisely why we burnout and suffer emotionally ourselves.

There is a better way to care, and it is not by trying not to care. There is a way where we can use and modulate our emotions, while caring for others, that will energize and empower us, make us more resilient and allow us to feel the happiness and joy that is the result of truly caring.  I have defined this process of caring as ‘True Care.’  I believe that caring for others should be the most emotionally rewarding job on the entire planet, and for me, with True Care, it is!  Even in the dead of winter, working in the Emergency Department is the one place that I generally feel the most, and, the best!

TAKE ACTION

Please let me help you feel better now by sharing with you this better and reenergizing way to use our emotions when caring for others. You can read in more detail about this method of caring that I call “True Care” on my website, clear2care.com, or in any of my books, Care 101, Back from Burnout, or Booster Shots.  To help you right now, you can download the six step protocol here: The Six Step Protocol of True Care

In a nutshell, True Care is about getting up close and personal, making a deep connection and feeling our patients pain as if it were our own.  It is only from this place of deep empathetic connection that we can really begin to use our own compassion to make things better for our patients and ourselves.  This is how we can begin heal from burnout and become reenergized by our care.  It is a protocol of perfect synergy for both our patients and ourselves.

It is time we let go of the idea of staying clinical, distant, and professional. Holding on to this belief is slowly killing us emotionally, and over time, is the primary reason that we become burnout and unable to feel joy almost anywhere in our lives.  When we let go of this myth, caring for others really is the most emotionally rewarding job on the entire planet.

Don’t take my word for it.  Go and see it for yourself how reenergizing care can be.  For me it already is and I want more than anything for it to be for you too.

Care, make a difference, and change (y)our world,

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Frank D. Gabrin, D.O

Get your copy at amazon.com
Shot of Satisfaction
Antidotes for Burnout and Compassion Fatigue
Thursday, December 17, 2015
A Pot of Gold

Each Shot of Satisfaction is related to one of the seven steps back from burnout in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on … Continue reading