Social Prescriptions for Hospitalists in Tough Times

We knew hospital medicine was challenging when we signed up for the job: the most vulnerable members of our communities facing acute health crises; competing economic interests; continuous time pressures; and the emotional labor of attending to illness and the resultant suffering. It’s easy to feel overwhelmed in the best of times. Now it feels that someone is pulling the rug out from underneath us as institutions that support our work, such as the National Institutes of Health and the Centers for Disease Control and Prevention, are under attack, and funding sources for Medicare and Medicaid are threatened. Colleagues have been asking me, as a well-being leader with Sutter Health, for tips on how to cope in these tough times.

In much the same way that I address the well-being of my patients, I have come up with a social prescription cocktail that science has shown will help us find calm, connection, and meaning as we lead our wonderfully intense and unpredictable lives as hospitalists. With the right mindset, many of the challenges of our work can provide the pathway to meeting the times with greater wisdom and a sense of conviction about the value of the work we do. So, with humility, I offer a set of prescriptions to all my beautiful, dedicated hospitalist colleagues:

From: Leif Hass, MD To: My Hardworking SHM Colleagues

Recognize that you lead a life of purpose. It is so obvious, but somehow, we lose track of this. We bring years of training, our blood, sweat, and tears to the care of the sickest and neediest members of our community. We work our tails off. We care. That’s how we roll. Yes, work can be frustrating, which can obscure that sense of purpose. So dive into the parts that engage you, that move you, and savor them. Then shout it to the sky, “I live a life of purpose!” Or at least remind yourself of it regularly. You will feel stronger and more invigorated.

Take a moment to acknowledge your patients’ suffering and then feel the compassion. Compassion is innate, and it seems we are often up to our armpits in suffering. So why are we not overflowing with compassion? We often feel too busy to acknowledge our patients’ suffering. We go straight to problem-solving and saying, “It will be ok.” Take a second to look…a human in pain, short of breath, body failing, challenging social situations. Let them know you see it: “Wow, your life is hard.” Then, notice how the compassion rises up in your body, and at the end of the encounter, notice how awesome this work can feel.

Recognize that your caring and concern can be enough. One scary part of witnessing suffering is that, at times, there is little we can do to relieve it, and that makes us uncomfortable. We trained to cure, not console. Years of caring for people approaching the end of life have taught me this: Acknowledge the suffering, then hold a hand and say, “Our team is with you on this. You are not alone.” It can be enough; enough to ease the patient to a degree and for us to feel value in our role as healers, no matter the outcome.

Life is better with a little touch. Our patients need reassurance; they need to know we care. Touch may be the fastest and least appreciated way to do so. Three seconds of fingers gently rubbing a shoulder, and you will be able to see a deeper, more trusting relationship developing by the look in the patient’s eyes. Who knows, if that works for you, you may end up like me, giving hugs to most of my patients at discharge.

Take a moment to listen to a story. It shouldn’t be just the zebras or the sepsis saves that keep us engaged with work. It should be the stories, too. The beauty that can emerge from a voice inside a blue hospital gown can be a source of wonder and deepen our appreciation of what it means to be a human being. Stories of rural life long gone, immigration and sacrifice, love enduring great hardship, grace in the face of death and loss. This is moral beauty, perhaps the most common and least appreciated source of awe. Once a day, sit down and ask a question like, “Tell me about your childhood?” or, “Your life is hard; how are you coping?” You will be surprised at how often what you hear will give you goosebumps.

Be the culture you want to be a part of. Everything we do at work creates interactions that then determine what our medical center colleagues come to expect. These expectations and how we react to them are culture. When I came to see every conversation with nursing, patients, and teammates as an opportunity to develop the culture I wanted to be a part of, my attitude changed, and my experience of work improved dramatically. Make a conscious effort to bring kindness, humility, respect, and a little love to your interactions, and we will have an even better workplace.

You always have the breath. Sick patients, the constant time crunch, and tough decisions to be made are endless. The pressure in my nervous system seems to continuously build throughout the day, and with it, the tension in my body. So, between encounters, take a couple of big, slow breaths and notice how the tension fades. Listen to hear if your inner voices saying “faster” or “poor me” or “it’s a s***show” start to quiet. With practice, we can recognize the stress building up sooner, breathe it out, and save our energy for what’s really needed. Feeling overwhelmed? Remember, a deep breath is always waiting for you.

15 minutes a day on friends and family. All our night and weekend work takes a serious toll on our social lives, and the data show it is a driver of burnout. We can make up for the time missed with friends by using the prescription suggested by our former Surgeon General. Spend 15 minutes a day on friends: text, cold call, start a group text with old pals, put talking to a friend on your “to-do list.” The quality of our life is determined by the quality of our relationships. Fifteen minutes a day can lead to a real increase in quality of life.

Spread the love. Food, water, air … what else do human beings need? Love! And the data on this is strong: Love makes people live longer. Love was not part of my training curriculum, and for some of us, thinking about it at work pushes our boundaries, but I believe if something can add years to our patients’ lives, it should be part of our practice. We can be professional, efficient, and still bring a little love to the bedside …and to our nursing and physician colleagues. Do so with tone of voice, body language, and a little touch. Do so, and the love will come back to you, and you will live a richer, more connected life.

When things go wrong, ask for peer support. When people are sick, stuff happens. Not only is that true, but people make mistakes—every one of us. We will all have cases go bad; it is inevitable, and it feels awful. I have seen it upend careers. Many of us have the tendency to keep these situations to ourselves, yet there is great data to say that talking to a peer-support colleague can ease this suffering. Over the 10 years I’ve done peer support, I have seen shame transformed into connection and a stronger institutional culture through peer support.

Research suggests that sharing these types of ideas will make it more likely that we actually do them ourselves, and getting people to talk about these ideas will almost certainly strengthen your workplace culture. So please share this with your leaders and colleagues. I would love to hear your feedback or your own ideas on coping with our challenging work in these crazy times.

With Great Respect,

Leif

Dr. Hass

Dr. Hass is a hospitalist at Sutter East Bay Medical Group in Oakland, Calif., where he is faculty in the resident training program. He is also an adviser on health and healthcare at the Greater Good Science Center at the University of California, Berkeley, in Berkeley, Calif.