Few professions have stakes as high as in the practice of medicine, or with consequences as dire. Physicians can be confronted—every day, in certain specialties—by life’s most traumatic experiences.
Though those events cannot always be prevented, organizations and leaders can make all the difference to a physician when they respond in a way that supports and shepherds them through the tough patches, making them feel valued and reducing the chance that they will suffer long-term ill consequences or burnout as a result.
“I think of a hospice physician or intensive care physicians and nurses who may see a patient die every day at work—that's tough, that's traumatizing,” said Kevin Hopkins, MD, a family physician and physician director of health system engagement for the AMA. He is also a coauthor of the AMA STEPS Forward® “Value of Feeling Valued Playbook.”
“‘How can we best support physicians and other health care workers who face those types of challenges and repeated trauma?’ is a question that health system and practice leaders need to be asking themselves,” Dr. Hopkins added.
Physician burnout, at times caused or exacerbated by unresolved trauma, demands attention. Despite the percentages of physicians who report symptoms of burnout falling from record-high numbers seen during the COVID-19 public health emergency, the problem persists. In fact, 43.2% of physicians in the U.S. report at least one symptom of burnout, according to an exclusive AMA survey.
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
One factor proven to relate to lower burnout levels is when physicians feel valued within an organization. The feeling valued playbook both makes the case for the importance of showing physicians that they’re supported and details five strategies for reaching that goal.
The fifth and final strategy covers how organizations and leaders can best respond to stressful events that physicians face, from the more common experiences to the—hopefully—once-in-a-lifetime incidents.
Trauma is experienced differently
There are two general categories of trauma, according to the playbook, that physicians encounter: individual and group experiences.
Individual experiences, which are further divided into physical and psychological trauma, can progress to post-traumatic stress disorder (PTSD) or another mental health condition. Examples of individually traumatic events that may happen to physicians at work include:
- A patient having an adverse event.
- Witnessing a traumatic or upsetting event.
- Being the target of a physical attack.
- Being involved in a legal proceeding.
- Experiencing the death of a colleague.
Meanwhile, group trauma consists of collective experiences, in which an entire group, community or even society undergoes an event or series of events. They share commonalities including that they often—but not always—have a beginning, middle and end, can sever feelings of trust, connection, meaning or safety, and can result in a recovery that can be slow and take years to achieve. For example, war, terrorist attacks, mass shootings, infectious disease epidemics, natural disasters, economic crises or political conflicts.
Create a multipronged approach
Proper resources can help physicians find the resilience they need to get back to a state of well-being after an individually traumatic event. Important offerings include:
- A formal peer support program that uses validated methods and tools such as the stress first aid framework.
- A suicide prevention plan and suicide response plan.
- Mental health services, provided confidentially, in an internal or external assistance program.
- A credentialing process that only asks about current impairment and does not delve into mental health history or past treatment.
Organizations should aim to proactively offer resources after a stress injury and not wait for physicians to request them. Physicians also should be encouraged to check in with each other and themselves to determine when their physical and psychological batteries need to be recharged.
“When we don't have that ability to spring back to normal well-being and functioning, it's important for us to recognize that downward trend in ourselves and in others,” said Dr. Hopkins, “and to recognize when it's time to take some time off—maybe even extended periods of time so that we can fully recover and get back to our normal state of well-being.”
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Target organizational resilience
During and after a collectively traumatic event, leaders need to recognize the long-term consequences of the experience and understand that needs may evolve for those involved. Strategies should include the entire organization, creating a culture that boosts organizational as well as individual resilience.
“Having food available, water, coffee—things that people need that are just basic creature comforts—can go a long way towards showing your people that they matter, even in the midst of a traumatic event,” Dr. Hopkins said. “Then afterwards, not just dismissing it and moving on like business as usual.
“Because for those people who experience the traumatic event, coming to work will never be business as usual,” he added. “Some of them will start to call in sick. Some of them will have panic attacks every time they come to the ER or to the office. So, having a system in place of ongoing support for those people who need it most is vitally important.”
When it comes to responding to collective traumatic events such as violence in a medical setting, create and assess action plans to prevent recurrence. Even if the plans are not activated, their existence displays to physicians and the rest of the care team that their safety is paramount.
“A lot of clinical teams do mock codes to prepare for the eventuality of a patient becoming unresponsive, unconscious, no pulse, not breathing right in front of them. In my organization, we do active shooter drills,” Dr. Hopkins said. “It's very sad that we have to think about that, but it's also a very powerful tool to demonstrate to our people that they matter, and we want to keep them safe.”
Debriefing—without assigning blame—is another step in the process.
“That delivers the message that nobody wants this to happen again, and nobody thinks that an event like this is OK, particularly when it's an attack of physical violence,” Dr. Hopkins said. “How could we potentially have prevented it? How could we make sure it doesn't happen again?”
AMA STEPS Forward open-access toolkits and playbooks offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.
