From the Editor and Author Interview with Dr. Frank Gabrin, DO

Randall M. Levin, MD, FACEP

Review of: Gabrin F. Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care, Clear2Care Inc, 2013.

Like stress, can there be good and bad heroes. I have previously reviewed Dr. Brian D. Wong's book on Heroes Need Not Apply, where the emphasis was on creating healing work environments and patient-centered heath care teams in order to change medical culture, improving communication competencies, decreasing medical errors while moving away from the “I can do everything” philosophy. (Please see accompanying essay by Dr. Wong regarding his distinction between a good and bad hero in medicine). In the following book review of Dr. Frank Gabrin’s, Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care, we find another definition of the word “Hero.”

As I started to read his story, I personally was wondering why would a seasoned emergency physician who appeared to “have it all” (manual competencies, staff connection, loving to be “in the emergency,” etc.) find himself burned out. Dr. Gabrin's journey from an efficient, well-trained and competent emergency physician to burnout and back is a personal story of triumph over those “antigens” which block us from being ourselves. Some of us, who have gone through burnout, know all too well, that there are many reasons why we are no longer connected to our true purpose. Some of those obstacles are external and some our internal. This is a story about internal barriers. How can you fix that which is not known to be broken?

He describes his epiphany as he relates a most unsettling experience in the department which almost cost him his life. What followed afterward was most moving as he realized that he was not a “true caregiver.” Something was missing, something was blocked. He was not the “hero” he thought he was and that he wanted to be (see Dr. Gabrin’s accompanying essay of being a hero). You are invited into his world, as Dr. Gabrin describes his personal journey, epiphany and the ultimate healing which allowed him to truly connect to that part of himself which was being blocked, that part of him which patients were really looking to being connected to when they came to receive their care.

There was something else beyond the science of medicine. He movingly takes us through the steps of his recovery as he develops his unique approach to wellness through his R.E.F.L.E.C.T. concept, allowing him to return back to practice. The story evolves from one which could describe any of our daily practices, through the “crash of burnout,” and ultimately to healing with an altruistic approach to helping others to heal in their professional and personal lives.

There is a light at the end of the tunnel and Dr. Gabrin’s acts as our mentor. He guides us through the doorway to a healing pathway. He gives us tools to achieve true caring and wellness. This is a must read for those of us who are finding our connection to our true purpose being challenged or blocked.

Author Interview with Dr. Frank Gabrin, DO

Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care

To help members benefit from his message, in this section of the newsletter I would like to post some questions and responses from Dr. Frank Gabrin, author of the book Back from Burnout. I will use excerpts (bolded), from his book, as a background for the questions being asked.

Back from Burnout: “We want to be someone’s hero. What is so great about this is that our patients want and desperately need someone to be their hero too… Better yet, when you return home at the end of your incredible day, you can look into the same mirror and say: What I did today mattered. Today was a good day.” 

Question: What is your definition of “being the hero” and do the patients want us to be their heroes? Or do they want us to be humane and be connected to our healing spirit, our empathy, our compassion, our honesty, our caring. Dr. Wong in his book, “Heroes Need Not Apply,” would suggest that being the wrong kind of “hero” is one of the root causes of medical errors and hostile work environments.

Editor’s Note: In every encounter you have, there is an opportunity to make a difference in someone's life (personal and/or professional), and to say, I did make a difference; I did matter to someone else. We never know when our journey opens doors to complete our connection with another human being. Whether that person is the patient you are seeing, the family of the patient, the co-worker, or another team member.

Example of this occurred recently as I was a recent provider for healthcare assessments and physicals in the homes of new members to the Medicare Advantage. I was working with the plan members in the city of my first “gig” (37 years ago) as an emergency physician. As a way to connect with the members, I usually mentioned that I was one of the ED docs at the old hospital down the road. Most people just recognized the name of the hospital and mentioned that it was interesting that I worked there. But on one occasion one member actually worked at the hospital in the housekeeping department and remembers tidying up in the docs’ sleep room (24 hour shifts). When I realized that, I thanked her for being “her” for being there for the docs and making it “tolerable and welcoming.” It made a difference for us; it made it a healing welcoming environment. She indeed made a difference for me. She was definitely my hero. She mattered. She couldn't thank me enough for those comments. The words truly made a difference to her, as I saw a smile come to her face.

Dr. Gabrin: My definition of a hero is counter to, or diametrically opposed to the sort of personality Dr. Wong speaks of. The part of the hero that I am speaking of is the basic altruistic desire to care for others. That personality that is driven to help where help is needed not for the accolades, the admiration or the fame. Unlike doctors, patients have no desire to be patients, but doctors, have the desire to be a doctor, to be the one who comforts, consoles and heals. Patients are looking for this when they find themselves in need of help.

The type of heroes I am thinking of all have two things in common. They are all just people (their special powers lie dormant, they have yet to reach their full human potential) and they come with a built in unselfish desire to care. These people then go through a process like the intense pressure that is applied to coal that causes the production of a beautiful diamond. Heroes have to go through a process to realize their powers.

These heroes only want to care and make a difference, in the process of caring, they change the world, they make the world a better place, and they save the day. They are not victims, they never say, hey, what about me- you did not say thank you, you took me for granted, you did not give me a pat on the back or an accolade. Heroes don’t have a hidden agenda! That is the reason we all love them, for they can do what we cannot do. They can do what we really want to do. It is the selflessness. It’s all about the other guy. It’s the heroes, YOU YOU YOU, mentality, that fascinates us, inspires us, motivates us to do better, be better, feel better by using our thoughts, words, and deeds, to care, change things, and save the day for another.

Becoming a hero is a process, and that process has a predictable series of steps. From the time that humans could tell stories, one of their very favorites, is the heroes journey. There are examples of the heroes’ journey that cross all cultures, backgrounds, and religions. We are fascinated with real life and fictional heroes off all shapes, sizes and varieties. Who has not heard of Superman, Spiderman, Wonder Woman, or the Hulk?

Batman is one of my favorites because he, like all of us in medicine, does not possess any superpowers; he makes use of intellect, mental and physical skills, science and technology and his indomitable will to wage war on criminals. All this occurs after he was forced to witness the murder of his parents as a child. All heroes have a personal experience they have to overcome on their journey.

All of these stories follow a cycle of sorts and that cycle has been named the heroes journey. We can see the journey in George Lucas’ work on the Star Wars Trilogies. Who of us is not familiar with Luke and Anakin Skywalker, Yoda, Obi-Wan Kenobi or Princess Leah? Each of these characters was a hero of sorts and each takes their own journey.

It depends on what source you use, but when you do the research you will find that there is a predictable series of steps on the hero's journey, and that any of us can use this archetypal formula to find whatever it is we are looking for in life. In my case, I was looking for a place where being a doctor was rewarding and emotionally fulfilling. I just knew it had to exist- and where I found it became my seven step R.E.F.L.E.C.T. process.

The hero's journey actually refers to a basic pattern found in many narratives or stories from all times and all places in/on our earth. This pattern is universal and contains many fundamental principles and moves through very prescribed stages or transitions. The one thing that has us all hooked into this story, is that, the hero is always triumphant. In other words, things become way better once our hero moves through all the stages of the cycle or pattern.

The most curious or paradoxical thing about the process is that frequently heroes end up right where they started, just as I have. In the end, everything is better, and everyone in that place benefits. It is clear that moving through the cycle, improves us, transforms us and changes us permanently and forever.

When we actually walk the steps on the heroes’ journey, we return from the journey as better versions of our former limited selves. Probably the best example for us of this phenomenon is the individual story lines contained within the “Wizard of Oz.” The tin man realized the power of his heart, the lion realized the power of his own courage, and the scarecrow realized he always had a brain! I looked at my situation, our bleak situation in medicine today, and saw my own journey as the health care hero's journey.

Once I took that journey, I realized that I always had the power to care, but I did not really know what care was!

The classic hero's journey always starts with the hero in the ordinary, mundane, world. For me this was the land of compassion fatigue, burnout and generally not enough satisfaction in health care. Heroes receive a call to enter an unknown world of strange powers and events. That world for me was none other than Einstein’s quantum world of unseen intangible energies; the energies of human thought and emotion.

The hero, who accepts the call to enter the strange world, must face tests and trials, either alone or with assistance. In the most intense versions of this narrative, the hero must survive a severe challenge, often with help. In my case, after nearly being killed by one of my patients, I had to put that stethoscope around my neck and walk back on to the floor of the emergency department and ask- how can I help, how can I make it better? My friends or allies, those that helped me in the beginning were: kindness, compassion, tolerance, sharing, caring, giving, love for no reason, grace, and most importantly, human dignity.

If the hero survives the challenge, the hero may receive a great gift or power. The hero must then decide whether to return to the ordinary world, with their new found power. Going on the journey by itself causes an internal change within the person taking the journey, the would-be hero. If the would-be hero does decide to return, he or she will face challenges on the return journey. If, and only if, they can return successfully, then they are privileged to use their special power to improve their ordinary world. In my case, I received the power to focus squarely on the intangible of care, no matter how toxic the tangible situation or physical clinical environment.

My call to action was the intense emptiness and emotional pain I felt after I was wrestled to the ground and nearly choked to death by my emotionally distressed psychiatric patient. It was a sad cold day in you know where when I realized that after 20 years of the practice of medicine, I did not really know what care was.

The first thing that I realized was that long ago when I decided to become a physician, I said in the simplest of terms, that I wanted to care and have that care make a difference for someone. Next I had to define care for myself. Only by knowing exactly what care was would I be able to find it or create it. Giving care was why I went to medical school, and I will bet, if you are really honest with yourself, it is why you did the same. What I learned was that, what you and I really want is to become our patient’s hero. Being our patient’s hero, caring, making a difference, saving the limb, the life, or the day, well, this gives us intense satisfaction.

That is why my desire to feel better in the process was the driving force, the primary reason I went on my own journey. When it was all said and done, when I came back to the ordinary world, I found that the land that I left where fatigue, frustration, burnout and emptiness are the norm that unhappy landscape was still there. The difference was that I now had the power to transform that place into the land where we, as doctors, nurses, mid-level providers, care givers of all stripes and colors, can find ways to always get what we wanted in the first place.

But rising above our stress-filled environment does not happen automatically. It requires intense effort and real tools to work with the blends of quantum energies that can lift us, and those we care for out of that bleak and sometimes even toxic physical reality. For me, I have discovered there is always a way to care for others, no matter who, what, or when. I now find there are no limits to the amount of satisfaction I can create in this new land where Einstein’s Quantum rules of energy apply. The seven steps I describe in Back from Burnout, when used consistently, allow me to do what I came here to do in the first place.

When I realize that what I really want to do is to care for my patients, I am empowered regardless of the circumstance or the clinical environment. The seven step R.E.F.L.E.C.T. process helps us remove the barriers that keep us from reconnecting with our pure and simple desire to care. With these steps we can all learn how to overcome these obstacles to become our patient’s hero.

Our clinical environments do not naturally support this process, except on those special occasions where we are invited to step inside the emergency. But we do have the power with the steps of the R.E.F.L.E.C.T. framework to overcome these obstacles and generate true care. This is what will make everyone involved, including ourselves, feel like they matter.

Back from Burnout: “…I was passionate about being a doctor, but I was even more passionate about being an emergency physician. I so LOVE the EMERGENCY. Caring for cases that aren’t emergencies can be frustrating, especially when the patient is needy or demanding. But inside the emergency, the angel of death is in the room. The pressure is intense, yet there is a calm, a peace, like being in the eye of the storm. Everything becomes crystal clear to me, and the problems and priorities are obvious. I know exactly what needs to be done and the order in which it needs to be done.” Page 21-22

Question: It appears (prior to your epiphany) that you chose this career for the science of medicine and what it can do for your patient, yet you haven't mentioned the Art of Medicine of caring (as of page 22). What would you advise young students about the importance of the Art of Medicine, the Art of Being?

Dr. Gabrin: I chose medicine as a career because I wanted to care. The science and technology I learned in medical school were what I thought I needed to care. I started down the path to burnout because I had become confused as to what care was. Today I define the art of medicine as reconnection to the compassion that originally brought me to the field. I believe that it is this compassion that is the soul of the art of medicine. By connecting young residents to the process of true care, I am helping them stay connected to their own primary desire and focus more on the healing art of medicine.

My decision to go to medical school came shortly after I had spent the summer of my freshman year of college working as an orderly. I loved what I did; bathing patients, taking vitals, grooming, walking and feeding the elderly. I thought I could do so much more as a doctor than I could do as an orderly. Through the years I forgot how much I was able to do as an orderly, and actually did less caring as a doctor- especially by the time I was suffering from the devastating effects of burnout.

I tell students now, that care has nothing to do with the diagnosis, the chart, the prescription or the treatment. All of those things are tangible and care is not a tangible thing. Care happens at the bedside within the interpersonal interactions we have with our patients, their family or loved ones. Care, first and foremost, requires that we get present and we connect. Once we are connected, we have the opportunity to move deep into the experience of empathy where we actually feel what our patient is feeling. We suffer with them, and from there we can mindfully move into the experience of compassion.

Our compassion- our desire that things be better for our patient- is where we actually get the juice we are looking for. It is within the experience of compassion that our patients actually get that we care. It is here, in our compassionate connection to our patient, that we find the antidote for empathetic overload and burnout. It is here that we make the difference that saves the day.

These are the stories we need to tell, the stories that make what we do worthwhile. For this is where we get to feel, on a visceral level, that what we do matters, that what we are doing is significant, and that what we do on a daily basis - is healing for others and ourselves. This is the Holy Grail that everyone is looking for in health care today.

Back from Burnout: “…Call it compassion fatigue, call it burnout, call it secondary PTSD, but whatever you call it, the fact is clear that our humanity is being taken from us as a result of our working in healthcare today.” 

Question: You, as I have, experienced the practice of medicine when it was a rewarding, self-satisfying field where you could connect with your healing spirit on a regular basis - even within the most difficult case scenarios. In your opinion, what has changed in medicine so that the above statement is heartbreakingly true? Has the metamorphosis of the practice of medicine from a caring, compassionate and empathetic field into the business model been the root cause?

Dr. Gabrin: In my opinion, Dr. Levin, what has changed in medicine is our focus. Our industry has become so driven to diagnose and cure, and we have added so much in the way of diagnostic laboratory tests, imaging and procedures, that we have given more priority to the science of medicine and nearly forgotten about the art, the emotional processes and the intangibles. While the emergence of compassion fatigue and the development of burn out is personal and complex for each physician, the root cause of the epidemic of burnout we are seeing in medicine today is that the things we focus on and measure, productivity, accuracy, speed, and so on, are not the components of the job that feed the doctor’s soul, and they are not the “care” our patients are looking for.

Healthcare is unique and different from any other business or industry. Healthcare is not a pure business in the fact that dollars are not exchanged solely for goods and services. Dollars are exchanged for goods, services and most importantly the intangible commodity of True Care. In the beginning of my practice, we did not have so much technology. We did not even have CT scanners.

Over the years we have become fascinated with technology and as a result, we have focused on the technology and the science and we have all but forgotten the core of the healing art. While science is generally tangible, art is intangible, art is emotional and dare I say sometimes spiritual. If I have said it once, I have said it a million times; they did not come for the x-ray, the splint, the crutch, the prescription or the referral; they came for care!

To illustrate this point, when I began to practice, when one of my patients was having a heart attack, I would spend lots of time at the bedside, watching the monitor, listening to their heart and lungs, giving them nitroglycerin intravenously and working hard to keep them pain free. And, that was pretty much all I had to offer them. They suffered damage to their heart muscle, and they left the hospital with compromised cardiovascular function, often being prone to congestive heart failure, and did not have the physical endurance or capacity they had prior to their heart attack.

These patients never complained. As a matter of fact, they brought gifts to the office when they saw their cardiologist and were happy that we were able to save their life, give them a second chance, even if they had physical challenges now. Today, when my patients are having a heart attack, we activate the STEMI pagers, and we alert the heart cath lab. Our goal is to get our patients to the lab quickly, open up the cardiac vessel, remove the blockage and prevent any damage.

This process happens so quickly that the patient often does not even realize that they are having a heart attack, or that I am their doctor. They sail through the process of moving to the Cath Lab, having the vessel opened, recovering in intensive care and generally they are home in a day or so, with no heart damage and able to enjoy the same level of physical health they had before their heart attack.

These patients often complain and are unhappy with their care. Often times they do not even realize how much we have done for them, or even how much pain and suffering we have spared them. I find however, that just sitting down with my patient, and telling them, look, you are having a heart attack, and I am your doctor and I am going to do everything I can to reverse this process for you and prevent any heat damage from happening to you.

I then quickly tell them what to expect to happen over the next couple of days, while my nurses and the interventional cardiologist work quickly to execute the technical details of the process. But just taking a moment empathize and express compassion; to say to my patient “you are in a very bad situation, but we have the technology that can help you and I am going to see to it that you get the very best possible treatment” allows my patient and their family to feel my care- and this changes the whole experience for both of us.

To feel good, especially while working clinically, I need to remember this. I have to make the effort to focus on the intangibles and realize that only I can create and deliver these intangibles within the transaction of care with our patients, their families and loved ones. Practicing this way transforms our shared experience, on either of the stethoscope!

Back from Burnout: “…If you give only so that you can get, you will never ever allow yourself to be the superhero you are destined to be. Think about what motivates a superhero: a new cape, front-page coverage in the Daily Planet, the bonus that pays for the exotic vacation, a raise so that they can afford the latest model of the Batmobile? None of these would matter to a superhero. The superhero knows that ultimate satisfaction lies in caring, making a difference, changing the world and saving the day. We will come to find that it is in the process of our giving that all of our needs and wants will be fulfilled.” Page 87

Question: Are you asking us to be perfect and ignore the imperfect world?

Dr. Gabrin: No Dr. Levin, I believe that we live in an imperfect world, and unfortunately I don’t see imperfection disappearing anytime soon. I believe that we want things to be better, for ourselves and our patients. Once we have a desire for something better, then we will have to activate the will to do whatever it takes to achieve it. This will require us to have a keen appreciation for the irony of life, the paradox of being human.

We may not be able to change our external environment, but we can change internally in ways that allow us to overcome our external environment. It is always true that if you do the work of inner change, what seems to be the biggest curse can be transformed into the most awesome blessing.

I believe that if you find yourself in a place where you have less than you desire, you can chose to refuse to be a victim of circumstance. See the better situation you want for yourself and commit to doing whatever it takes to get there. This will require you to do something different. You will need to take action to become someone different.

I believe that there is a disparity between what we have and what we want, and who we are and who we want to be. This is a disparity between who we are now and who we would be if we were to actualize our full potential. Almost all of the sadness, depression or emptiness we feel in our lives exists because of this disparity—because of the fact that we are not yet who we aspire to be.

Humans have known about this for quite a long time. There is a Native American legend about a grandfather speaking to his grandson who is angry because a friend hurt him. He tells his grandson that he has been angry too. This wise elder goes on to tell the boy that there is a “fight” going on inside of him, a terrible fight between two wolves. One wolf is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego. The other wolf is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith. He tells his grandson that the same fight is going on inside the boy and each and every other person too. His grandson asks him, “Which wolf wins, Grandfather?” He replies, “The wolf you choose to feed.”

None of us wants to feed the wrong wolf. We all want to be great doctors, great nurses, great mothers, great fathers, great brothers and sisters. We all want to be great people. We all want to be the best possible version of ourselves in any given moment. No one gets out of bed in the morning, looks in the mirror and says, I am going to hold back today, do less than I am capable of.

Man as a species is evolving. The times they are a-changing. To many, it is becoming obvious that the purpose of our lives is to bring these two selves, the present limited self and the best possible self that we aspire to be, closer together in any given moment and over time. This is the process of becoming self-actualized, happy, and powerful and satisfied with who we are.

We all know we should exercise, but we don’t. When it comes to exercise, then, we have fallen into the knowing-doing gap. Simply talking about it does nothing, changes nothing and definitely creates nothing. Brooding about how messed up things are, or how messed up we are, fat, unhealthy, stuck in a bad job or relationship—this is not action. Thinking or dreaming about change is not change. Action is the only way out of where we are now. Action is the only way out of who we are now.

Our dissatisfaction comes from the fact that we are not living our highest life, that there is still a disparity between who we are now and who we want to be. We have the opportunity to ask ourselves: Who is it that I want to be and what actions do I need to take to get me there? It is in engaging in the process of becoming our best self that we find our joy and satisfaction.

Back from Burnout: “…What blocks us from being “able” - the silos that we build to protect ourselves from our spirit from being battered as we try to survive - the me who allows me to be me (my healing soul). This is not about putting the blame onto others. This is about having me recognize that part of me that needs healing to open the door to true soul healing - that is my work. Having the support and empathy from the group and the hospital will help my own work...” Page 82

Questions: What happens when you have the “right” neuro-pathways already in place but you are not able to open the door to them. What happens when an empathetic and compassionate care giver is working in an uncompassionate and caring work situation. Is it only about getting our act together; or, when do we feel that there are too many blockages which we can’t control, before we reach the next fork in the road - to the left is the path to destruction, to the right is the path to our true healing soul but not in active medical practice?

How can we support ourselves and our colleagues and team members to maintain their active careers before that final fork in the road? How do we keep those clinicians in the work force, the ones which the patients are looking to being there for them? It is more than “are we willing to,” the real question is “are we able to;” are we being taught the coping skills in training and are we refreshing them in our practicing years?

Dr. Gabrin: Dr. Levin, the answer is no. We are not being taught the coping skills in training and we are not refreshing them in our practicing years the way that we are taught the scientific information with required CME, certification and re-certification. We pretty much ignore the art of medicine in our training and in our practice. The reason I wrote Back from Burnout was to create a platform to support my colleagues and team members. My mission is to save those clinicians from ever getting close to that final fork in the road, where they leave medicine all together.

The good news is that I believe that we are born hardwired to care. I believe that our caring software is flawed. One of the other concepts included in Back from Burnout is my idea of what the software for generating true care might look like. I describe a six step process that includes: Presence, Connection, Focus, Empathy, Compassion and Action: Each stage of the process depends on successful completion of the preceding stage. While this process we go through is the verb, the substance generated is the noun, True Care. The best part of this concept is that this is a win-win solution for both the patient and the caregiver.

It turns out, that caring for others is in our own best interest. I believe that humans are hard-wired to care. Actively engaging in and moving through each of the six stages of this process changes the neurochemistry in our brains and our bodies. The new neurochemical state that we create for ourselves, actually feels incredibly good. The experience is emotionally rich and rewarding for us. Turning on our own compassion for our patients makes us happy! Compassion does not fatigue. Compassion energizes, empowers and enlarges us as human beings.

This process is fully human and actually quite natural – as it automatically happens when we step “inside the emergency.” Look at some eloquent, exciting neuroscience from researchers Matthieu Ricard and Tania Singer. They clearly show that practicing compassion generates the experience of happiness. It should be obvious from this and from the images they produced in the real time MRI scanner that humans like us are hardwired to care.

It is our software that is flawed and contains a bug. That virus puts up an error message each time we are invited to come close and connect with our patients. Stop, don’t do it! You will die! Connection will destroy you, consume you and impair you. Stay professional, stay clinical, stay objective, stay detached; but whatever you do, don’t connect!

We need to debug our program and get rid of that virus, “Medicine’s Big Lie,” for we can now see that the logic that generated it is flawed. Engaging in the process of true care is the only way we can take advantage of our human hard wiring so that we can once again become fully alive and emotionally competent.

This process of internal change allows us to become the heroes of healthcare that our patients so desperately want to show up at their bedside when the unthinkable happens. When we employ this six-stage protocol for generating and delivering the intangible stuff of True Care we cure our own dis-ease of compassion fatigue and wipe burnout from the face of our professions and our healthcare system.

I believe that we will be amazed at the effects that incorporating the intangible process of True Care will have on us personally. We will once again find our own passion for the profession we felt called to. We will no longer be stuck and feel bad about all the suffering we see.

We won’t be overloaded by stand-alone empathy; our own compassion will erase all of the negative effects of resonating with another’s suffering on our own emotional system. We will no longer feel like or behave like a victim of circumstance. We will find our way back to a full and emotionally rich, wholesome, rewarding experience of life itself.

Question: How has your approach to the residents helped them to deal with their everyday practice and stay connected to the reasons they entered into the medical professional.

Dr. Gabrin: My approach to the students and residents is to remind them that they are spending these few hours working with me to learn how to care for patients, so there is no time like the present to jump right in. I tell them that they already know how to write a note and does an exam, but today we are reconnect them to their desire to help people, the reason they entered medical school in the first place.

I talk to them about the six step process I go through to generate true care and ask them to immediately begin to apply it to the next patient they evaluate for me. I ask them to connect, to establish a partnership with the patient, and let the patient know they will do everything they can to make things better for them. I have found that when they begin to use the true care process these young doctors are now smiling and excited to tell me what they have found at the bedside.

I can see that they are emotionally engaged with the work they are doing with me. They suddenly feel emotionally energized rather than depleted. I let them know that they have physically changed the mix of neurotransmitters in their pre-frontal cortex, and they have done the same for their patient. They think that is really cool.

In my experience, even medical students, interns and residents are all feeling some degree of burnout. When I start to talk about connecting to patients, they get really excited. I believe most of the time, students especially are too afraid to get connected with their patients. Afraid they may say something wrong. When I encourage them to get involved and just be honest, tell the patient they don’t know but they will check with me and get right back to them- suddenly they are empowered and feel like what they are doing matters. I find this means the world to them and it changes their entire experience of the rotation.

Dr. Frank Gabrin received his medical degree from the Philadelphia College of Osteopathic Medicine. He is a certified Emergency Physician, having practiced for 29 years. In addition to his classic medical training, he has also been trained in alternative therapies and spiritual healing completing the four year curriculum and receiving certification in Professional Healing Sciences from the Barbara Brennan School of Healing.

While serving in the Medical Corps of the United States Navy, he received a Navy Achievement Medal, as the Director of the Emergency Department at Millington Naval Hospital. Besides being a resident trainer for the NEO Consortium Emergency Residency Program, he has served at the Cleveland Free Clinic and as a clinical professor of medicine for Case Western Reserve University and Ohio State University. Dr. Gabrin is a two time cancer survivor. His personal journeys have helped him help others. He has authored three books on the topic of burnout and it's recovery.


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