Part II: Yes, There is Such a Place: Healing Work Environment Allowing the Healthcare Team to Be True Caring Healers
Randall M. Levin, MD, FACEP
In our Spring newsletter, I wrote (Part I) about my personal journey through the medical system as I was being evaluated and treated for idiopathic peripheral neuropathy. It dealt with what can happen to patient care when there is a disconnect between the provider and the patient. This disconnect (real or patient perceived, it does not matter) can lead to overlooking potential worsening of a treatable co-morbid condition. In the case, I described how this disconnect interfered with the normal communication between myself and my provider, ultimately blocking critical thinking. The provider was not sensing/seeing/hearing my concern with the one question that I was repeating - tell me why my condition (peripheral neuropathy with increasing radicular symptoms) was not related to a treatable worsening of a co-morbid condition (spinal stenosis). Please see the 2014 Spring Wellness Section Newsletter for Part I.
I have been promoting wellness and healing work environments to bring out our strengths throughout my practice years and now afterward. I still believe that professional skills (the Art of Medicine) and work environments can and do exist allowing for the healing connection between patient and provider.
The purpose of the essay was to highlight the potential for misdiagnosis or missed diagnosis when we are not present and well. I have been championing along with many of my colleagues to continue to help create those work environments which allow us to be present and connected to our strengths, while improving inter and intra-disciplinary communication to avoid medical errors.
Let the healing journey begin. We hear about how the changing medical culture is moving away from empathy and compassion, but I know that it is JUST being blocked. The medical care team members have gone into the field because of their altruistic beliefs exercised through their empathy and compassion. Indeed, recent studies find that, in some individuals (Tony Buchanan, Stephanie D. Preston; Stress Leads to Prosocial Action in Immediate Need Situations, Frontiers in Behavioral Neuroscience, Frontiers Media SA), stress actually can lead to altruistic behavior through neurophysiological pathways. If this is true, then when those pathways are blocked due to internal and external “antigens,” we are blocked from being who we are and the reasons why we entered the medical field - leading to UnWellness and Burnout.
Though the emphasis of my comments in Part I was related to how multi-tasking and unhealthy work environments and demands can negatively affect our true connection with our patients and ultimately not “being there” for the patient during the exact time we need to be present, to be actively listening and to never stop using our critical thinking. In emergency medicine, this is critical if we are to be the “Heroes” whom our patients, the team, and indeed we need in order to be caring and healthy providers - enhancing the healing process in our patients even when there is no cure. I purposefully used this “Hero” term, because it is a segue to the main theme of this edition of the Wellness Newsletter - What is a “hero” and how does it fit into the definition of what we strive to be. Are there “good” heroes and “bad” heroes? I will address this further a bit later.
Part II: THERE IS SUCH A PLACE (THERE IS NO PLACE LIKE HOME)
I needed to have trust that those individuals on the care team caring for me “WERE” my Heroes (my definition of someone WHO is there for me) during my pre-surgery evaluation, pre-surgery care, the surgery and the dreaded post-op care. I elected to choose the one hospital within the system where my surgeon had privileges, because I knew that the hospital had been built based on both a healing physical work environment and patient-centered care. I needed to believe that what I have been championing for could actually exist.
I started on my healing journey (YELLOW BRICK ROAD) on my first visit to the physician's office based on his reputation and skills. He and his staff were THERE for me, whether by having eye-to-eye contact in the his office, or by the doctor saying that he understood my concerns and saying that he could help me with my progressing symptoms and ongoing concerns. Yes the EHR was being utilized, but before “typing” he sat back in his chair face-to-face and interacted with me, he actively listened to me. I needed to know that someone was acknowledging my concerns that someone was there and would be there for me during my care. Again, I had been previously cared for by a specialist who progressively became less interactive and more the “typist” - leading to missing important verbal and non-verbal cues of my increasing concerns. The surgeon said that he would be there for me during all of the stages of care. His words: “I look at myself as a shepherd as “we” go through your care.” He started my “healing” right there and then. Indeed, his approach to his practice was that he scheduled himself so that he could spend as “much time as it took” for the patient (an unfortunately rare concept in today's medical environment). The philosophy of the medical center (the office was on the campus) allowed this to happen.
The hospital setting itself also provided for the type of team members who were empathetic and compassionate at all levels. The nursing care provided was at the level of compassionate care on the weekend as occurred during the week; the same type of care that was provided during the third shift as it was during the first shift. The ancillary team members also exhibited the same level of human interaction and compassionate care. I couldn't believe it, there indeed existed the type of provider, medical-team care and hospital care which I have been championing for throughout my career. I was receiving it, it did exist. As I was going through the healing post-op process, the post-hospital care and follow-up exhibited the same understanding and compassion in an environment which always answered my concerns and questions.
Communication was such that I never felt that I was being unreasonable or over concerned about my post-op course and symptoms. The surgeon would say when some of the paresthesias were exacerbated after surgery, “that is expected, that came from the work and dissection I preformed and it is all part of the healing.” My physical therapist also was very supportive and reinforced that my progress was all within what was normal. They were actively listening and didn't belittle my concerns.
I contacted the hospital administrator afterwards and complemented the administration (and him specifically) for having the mission for creating a work environment and supporting the staff to allow them to be “true caregivers” - allowing all of their staff to excel and be connected to their altruistic traits of empathy and compassion. When I asked how this was accomplished, he mentioned it was easy. Since it was a new hospital (built on the concept of a creating a non-toxic, healing work environment combined with patient centered care) and not an existing hospital with imbedded toxic behavior and interactions. Therefore, when the staff was hired, it was based on their personalities, emotional intelligence and intra/interpersonal professional skills. He hired applicants based on their “Art of Medicine” traits which they exhibited, knowing that the manual and technical skills were already present. And, those manual skills, when needing to be reinforced or new ones learned, that could easily be done.
Another hospital within the same medical system with long history of its medical culture, struggles to obtain the same thresholds of staff and provider satisfaction. Changing an existing culture is much more difficult than creating a new culture. Our challenge is not to give up on the old guard (attrition, pre-mature retirement, burnout), but to support and assist them as we regain our connection to our empathy and compassion. Changing medical culture doesn't mean becoming only left-sided brain robots, but helping us to stay connected to or to reconnect to the reason we chose to become medical care providers. Create the processes for healthy work environments to through addressing the extrinsic and intrinsic factors which affect staff well-being.
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