Physician Health

Q&A: How haiku helps psychiatrist contend with pandemic stress

Sara Berg, MS , News Editor

Physicians can feel overwhelmed by administrative burdens, regulatory restrictions, loss of autonomy, workplace issues and user-unfriendly EHRs. Practicing physicians, residents and medical students alike can all suffer from burnout. While physician burnout requires solutions at the health-system level, there are some solutions that individual physician find helpful in the meantime.

Physician burnout demands urgent action

The AMA is leading the national effort to solve the growing physician burnout crisis. We're working to eliminate the dysfunction in health care by removing the obstacles and burdens that interfere with patient care.

For AMA member Frank Clark, MD, it’s writing poetry.

Dr. Clark, a psychiatrist in Greenville, South Carolina, started writing poetry as a way to help cope with depression during medical school. But, with the added stress from the pandemic, Dr. Clark found his passion for writing was reenergized. This time he was drawn to the art of writing haiku, a short form that originated in Japan and consists of an unrhymed poem with 17 syllables arranged in three lines of five, seven and five syllables respectively.

One of a haiku collection by Dr. Clark published in Psychiatric Times reads: “Water nourishes / Hate scorches rooted friendships / Hope is life’s beacon,” and reflects the physician’s faith in the promise of renewal despite our shared brokenness.

Another haiku collection by Dr. Clark, also published in Psychiatric Times, “Hope, Equity, and the AMA,” reflects on the November 2021 AMA Special Meeting. It reads: “Hope for the future / A dream no longer deferred / Equity ascends / Unity prospers / Voices must have equity / One AMA house.”

He took time to talk with the AMA about his practice of haiku-writing as well as how narrative and the arts can help reinforce the shared humanity of patients and doctors amid a crisis of professional burnout and the strains of the COVID-19 pandemic. Listen to more of this conversation with Dr. Clark on Apple Podcasts, Spotify or anywhere podcasts are available.

AMA: How has writing haiku helped you cope with physician burnout and deal with the added stress of the pandemic?

Dr. Clark: As a physician who has experienced burnout, I had to reevaluate a lot of things in my life and really find what gives me meaning and purpose. As physicians … we often think of ourselves, for example, as just a psychiatrist. We forget that our identity goes beyond our career, but so often, especially in this pandemic with the rates of increased depression, PTSD [post-traumatic stress disorder] and anxiety that we are seeing … this pandemic has taken an emotional toll on me in a lot of ways. I had to just do some introspection and say: OK, there's more to Frank than just being a psychiatrist. I lost sight of that with my administrative position at the time, and just the constant grind that I was doing, waking up early and getting to the hospital early, and rounding on patients, trying to be the best psychiatrist I could be. But also be the best teacher in terms of educating residents and medical students.

I was overwhelmed. I can honestly say that there were moments where—I wouldn't say I was depressed, but I was definitely unbalanced. To the point where some days I didn't really want to go to work and I'm thankful for the support of my wife, my friends and my colleagues who kept me going through all of it. I had to get back to what I know works.

There's something about putting your thoughts on paper that allows you to not internalize, but just get it out. I have found it again to be very reenergizing and therapeutic.

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AMA: Where does your inspiration come from?

Dr. Clark: A lot of the things that I write about revolve around my own personal journey—a lot of reflection in terms of burnout, depression and just how far I've come as a person of faith, as a husband, as a son, as a father.

Diversity, equity and inclusion I tend to write a lot about … because that's also important to me and looking at health inequities. I tend to write a lot about world events that are happening. One of the things that I've been writing about lately is about humanity, how I've felt we have just lost the ability to show people grace, to show people mercy and to just love one another as we navigate our lives.

It's just very sad to me that we've just forgotten how to treat one another. There's a lot of horrific things that are happening in our country, but I still believe in my heart that there are a lot of people out there that want to do good.

AMA: You also collaborate with artists who create paintings to go with your haiku. Does this collaboration also help improve your well-being?

Dr. Clark: It definitely does bring me happiness to share with kindred spirits the love for art. I'm doing a partnership with the South Carolina Philharmonic, where some of my poems have been set to music. They're going to premiere in February and are being performed by the South Carolina Philharmonic.  Collaborations like this fill my love bank.

I'm getting the opportunity to disseminate my passion, my love, what gives me meaning, to a wider audience. We have to be innovative and realize that treatment looks different for everyone. I'm not saying that medications are not important in a person who has clinical depression or clinical anxiety, but there's more to us than just neurotransmitters like serotonin, norepinephrine and dopamine. That's just one piece of the puzzle.

We have to be willing and motivated to explore the whole person. What better way to do that than through the arts and humanities?

AMA: Why do art and narratives matter in medicine?

Dr. Clark: It's the most important part of the person that's sitting across from you. One of the things that I encourage our residents who I work with—and medical students—is that who you're treating is more important than what you are treating. We have the skill set to take a detailed history and come up with diagnosis, and that's great. We want to make sure that we get the diagnosis right. With that, we can come up with a comprehensive treatment plan. But the person sitting in front of you, if you really listen to their narrative and you explore the narrative, the diagnosis will be there.

One of my mentors says there are two bags of tricks. There's the bag of management, which we do pretty well. Then there's the bag of understanding, where we don't do as well. That bag of understanding is where you explore the art of humanity and the art of who this person is sitting across from you. When we're developing a treatment plan for our patients, we have to explore all aspects of them. What's going to help get them well. Yes, selective serotonin reuptake inhibitors may be beneficial, but what about the spiritual aspects of that person? What about the person who says playing my guitar brings me happiness? Let's put all of your wellness pieces of the puzzle together so that you can be your best self.

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AMA: If a physician is interested in writing haiku, what advice do you have for them?

Dr. Clark: Don't get frustrated if you don't like your first haiku. There are oftentimes where … my first draft is not always my final draft. If you are writing a haiku, write it, come back to it, let it sit for a while, let it percolate in your mind for a while. If you want to change it, change it—and don't be hard on yourself.

I don't consider myself to be a Nobel laureate by any means. I'm not Shakespeare. I'm not Walt Whitman. I'm not Langston Hughes and that's OK. I'm Frank Clark and I want to be true to my unique and authentic self.

To anybody who wants to write—whether it be fiction, nonfiction, short stories, haikus, limericks, sonnets—be true to yourself and have self-compassion. Your writing is your thoughts. You can send it to people. You're going to definitely get feedback from others. Some people say: “Oh, I like this, or maybe you should use this word.” At the end of the day, you have to be happy with your writing. …

There are always going to be people who will give you feedback. I think feedback is important, but at the end of the day, be your true self. That's all we can ever ask for. Don't be afraid to disseminate it to the audiences. Some people say that I'm brave for putting my work out there. I don't know if I would call it brave. I'm just going to put it out there. What's the worst that can happen? Somebody doesn't like it? That’s OK.

For me, it’s not really about whether people like it or not. ... I'm doing this for myself, because it's cathartic for me and I want to share it with a wider audience. Even if one person takes something from it, one person is always better than no people at all.