COMMENTARY

Healers in Need of Healing Cannot Heal

Herdley O. Paolini, PhD; Mark H. Greenawald, MD

Disclosures

May 20, 2016

In This Article

The Hidden Curriculum

Medical training includes a hidden curriculum from which physicians often learn such things as valuing expertise and reductionism over whole-person care; embracing independence and invulnerability as opposed to teamwork, collaboration, wholeness, and compassion; and saying nothing in order to survive rather than expressing concerns when deviations from care quality occur, when communications with patients are inadequate, or when team members are treated with disdain, disrespect, or dismissal.

Many physicians carry emotional scars from the tension of these opposing experiences. At best, the formal curriculum of medical training often lacks any process for gaining the emotional intelligence skills of self-awareness and self-management, with most of the feedback focused on the mastery of the technical and cognitive skills of becoming a physician rather than the intra- and interpersonal skills necessary to be a healer. This education system takes young students who score higher on important measures of emotional wellness than their equivalent peers pursuing other academic endeavors and statistically ends up lowering their emotional wellness (compared with their peers) by the end of medical school.

The culture of medical practice must also change if provider wellness is to be effectively addressed. The present system produces a suicide rate that is the equivalent of losing an entire class of medical school students every year; a culture that advocates self-sacrifice at the expense of self-care; a culture that aspires to and talks a lot about teams, collaboration, and interprofessionalism but often invests little time or resources in the development of these; a culture that often models leadership as a command-and-control function; a culture that can drive physicians to ignore their own humanity and disconnects them from their own experiences, which is the very self-awareness they need to function in a high-complexity environment.

Additionally, the current dysfunctional and overly stressful healthcare work environment must change. This environment is a byproduct of the gradual shift in healthcare from a service to a business model without accounting for the complex, highly intimate relationships involved in physician-patient relationships. We cannot afford to reduce clinical work to transactional tasks that focus on productivity and efficiency at the cost of these very relationships and at the same time hold the aim of improving care quality and the patient experience of care as a desired outcome.

Indeed, this rapidly changing healthcare environment, with increased demands, regulations, mandates, payment models, and care delivery structures, is also contributing to this burnout. These alone have caused many compassionate, dedicated physicians to exceed their burnout threshold. Given all of this, it is no wonder that the medical infrastructure is cracking under the weight of the accelerated change and the resulting stress on individual physicians. We are demanding more from a group of professionals who are not prepared for the pressures that require skills that in many ways are just the opposite of how and for what they have been trained.

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