How To Stop Suffering In Clinical Practice
Leading up to the recent start of my palliative medicine fellowship, I decided it would be the perfect time to complete some long-overdue remodeling on my house. I set what I thought was a reasonable deadline and, as the frugal control freak I am, got to work learning how to DIY as much of the work as I could. Several weeks in, it became clear that I had drastically underestimated the amount of time it would take to do the work. My solution? Double down and push harder. I spent most waking moments painting, staining, spackling, sanding, pruning, and pressure washing.
I started to develop an overwhelming sense of dread when I woke up each day, knowing that I would push my body and energy level to the breaking point only to still end up weeks over my deadline. Each task that I thought would be straightforward turned out to have multiple layers of complexity that led to being on a first-name basis with the employees at the customer service counter at the local home improvement store. I cursed property ownership and my own incompetence along with my perfectionistic tendencies that I knew were making things take much longer than necessary. I reiterated to myself why I had put off this renovation for so long, because living in this space (where I was constantly coated in spackling dust and tripping over power tools as I ached in joints I didn’t know I had) was starting to seem like a realistic depiction of hell.
Until one day it hit me. It wasn’t the remodel itself that was causing my suffering; it was my clinging to a particular outcome, both in terms of the aesthetic result and the timeline in which it would be completed. While it may not sound profound, it was a lightbulb moment for me that I was forcing this misery onto myself rather than being the victim of external factors outside of my control. I reflected on why I hadn’t modified my deadline, expectations, or strategy sooner and realized I had unconsciously bought into this false narrative that things needed to go this particular way, in this particular order, on this particular timeline.
Clinging In Clinical Practice
I was fortunate to be reminded of this lesson right before starting fellowship, because I can already see how clinging to particular outcomes causes suffering for me and my colleagues in our work with patients with serious illness. Many of us who choose medicine as a career are motivated by well-meaning aspirations: to cure illness and to relieve suffering. While there’s nothing wrong with holding these intentions, when we become attached to certain outcomes, we can cause spirals through doubling down and overcompensating, or conversely through detaching and becoming cynical.
While the physical demands of our profession can be brutal, such as long hours that cause sleep deprivation and our absence from meaningful milestones with family and friends, I find the emotional toll to be just as critical (if not more so) in leading to burnout. And it’s more than the suffering that goes on inside our minds - it also can put us in conflict with patients, which can lead us further into demoralization. I recently found myself to have seemingly offended a patient’s family member, and while I know how distressing it is to watch a family member die from cancer (and intellectually I know not to take that emotion personally when it’s directed at me), it did lead me to take a step back and reflect. Had I gone into that room with an agenda? Did the family member sense that I disagreed with their treatment plan? Because, in fact, I did.
My Intentions
In order to foster a therapeutic alliance with my patients and their families and in the interest of preventing my own burnout as I enter a new specialty filled with difficult situations and emotional conversations, I’m setting some intentions for the care I provide to help me avoid clinging to a particular outcome.
Ask Permission
For me, the idea of asking permission with patients is divided into two main parts: asking for permission before discussing difficult topics and asking permission before providing recommendations. This is crucial not only for honoring a patient’s sense of autonomy and control, but it also serves as what we refer to in palliative care as a “warning shot,” meaning a question or statement that indicates there is something serious to discuss, before delivering the news itself. I’ve been practicing asking for permission for a while in primary care as a result of my training as a coach, and to date I’ve not been declined when I ask permission to make a recommendation. It’s also an important way to prime my own expectations for hearing “no” if the patient disagrees with what I propose.
Connect
As a palliative doctor once quipped, there are only two things you need to know in palliative care: 1) establish the relationship and 2) build trust. While you may argue that your specialty entails different responsibilities, I truly believe that, whatever your scope of practice, you will experience more mutual satisfaction in your interactions with patients if you place building rapport as your top priority. If I notice myself going into a room with an agenda that’s driven by my own values, my intention is to leave my desire for a particular outcome at the door so that I can meet with the patient and family right where they are and partner with them as someone who sees and validates their unique needs. This doesn’t mean that I’ll prescribe a treatment that I think is dangerous or unnecessary, but I’ve found that it’s much easier to explain my rationale once I’ve listened, reflected back the patient’s words to show that I’ve heard them, and offered empathy.
Conclusion
In the beautiful documentary End Game, palliative care physician Dr. BJ Miller says that suffering is “the gap between the world you want and the world you got.” Whether it’s remodeling my house or helping someone make decisions about their care at the end of life, I don’t want my life to consist of pining for a different reality instead of accepting the one I have right now. This doesn’t mean that I won’t strive to help someone or try to improve a challenging situation, but I need to frequently reconcile what is within my control and what isn’t. It’s only by recognizing and embracing our limitations as physicians that we can practice free from burnout.
How do you reflect on these ideas within your own work? Would you like to explore how to release yourself from harmful narratives and unrealistic expectations? Please click the link below to schedule a free coaching consultation with me.