Guest Opinion: From the ground up - Physician self-care amid burnout, loss
As we navigate the epidemic burnout and moral injury, particularly among physicians and health care professionals, let us remember and prioritize a few key principles of self-care.
I have deep roots in the Benedictine tradition at St. John's University.
I took my first steps in Guild Hall, graduated from St. John’s Prep School and University, and later married my wife Ashley at The Abbey church. My understanding of the biopsychosocial and spiritual aspects of the human condition grew from these formative years at St. John’s and inspired me to become a physician and leader. I’m grateful to work for a health care organization with shared values of respect, justice, joy, and stewardship, which are fundamental to the care of others, and to oneself.
My family and I often return for St. John’s football games and to visit my parents, who live on a ranch nearby. A visit there last fall visit yielded an epic St. John's victory, with a goal-line stand on the 1-yard line among thousands of Johnnie faithful.
Following the football game, I sauntered around campus. After returning from a walk to Stella Maris Chapel I arrived at the gravesite of my maternal grandmother and former nurse, Nancy Moran. I would not be the person or physician I am today without her inspiration and guidance. She remains a model of what it means to be a lifelong learner, a steward of the earth, and a lover of humanity.
I explored the area a bit further, down the hill towards Lake Sagatagan, where I came upon the gravesite of Jacob Wetterling. Many of you know Jacob's tragic story. He was abducted on Oct. 29, 1989, at the age of 11. I grew up just down the road from Jacob and was 6 years old at the time of his abduction. On the back of Jacob's headstone are his "11 Beliefs" — be kind, fair, understanding, honest, thankful, a good sport, a good friend, joyful, generous, gentle, and positive. Jacob was incredibly precocious in his wisdom.
Just steps from Jacob's resting spot is a fresh grave without a formal headstone. Here lies my friend, Dr. Gretchen Butler. Gretchen graduated from St. John’s Prep in 2003. She was a mother to three young children, wife to a primary care PA, and sister to three other physicians. She was top of her class throughout all her training levels, teacher of the year at HCMC Radiology Department, a former Rocky Mountain ski patrol member, and was passionate about women’s rights and racial justice.
Essentially, she was “world-class” at fulfilling Jacob's 11 beliefs to others. Gretchen, however, struggled to share the same generosity and compassion with herself. She died by suicide on March 5, 2021, at the age of 37, in her home — the “dream home” she and her husband Mike moved into just months prior.
As we navigate the epidemic of burnout and moral injury, particularly among physicians and health care professionals, let us remember and prioritize a few key principles of self-care.
Self-compassion: This is the best antidote to shame and its notorious sidekick perfectionism. Brené Brown teaches us, “Your level of belonging can never be greater than your level of self-acceptance because believing that you're enough is what gives you the courage to be authentic, vulnerable and imperfect.” In order to impact and inspire others, we need to learn to lead, love and trust ourselves.
I challenge you to write down the most shameful narratives you tell yourself, “take off the armor” and toss this in the trash bin. It is all junk. Love your imperfect self, remember you are good enough, and embrace the fully lived spectrum of human experience.
Boundaries: Clarify what is expected while living with integrity. Or say, “This is what I’m OK with, this is what I am not.” Mike, Gretchen’s husband, told me that her reward for being top of her class throughout all levels of training, including as an attending, was, “You are so good, here, take on more.”
Consider the exercise of journaling on personal or occupational responsibilities that are deserving of more boundaries. Follow-up on these to implement necessary changes.
Gratitude: The best medicines for hedonic adaptation, isolation, and depression. Let us consider living each day as if it were our first, with deep wonder and curiosity, as well as our last, with relentless gratitude.
Start a daily gratitude journal, create a “gratitude wall” in your department workspace, mix in random acts of kindness (“pay it forward” at a local coffee shop, clean the neighbor’s yard, etc.). The impact on happiness is much greater and longer-lasting for those who give than receive.
Curiosity: Viktor Frankl, a concentration camp survivor and psychologist who wrote one of my favorite books titled “Man’s Search For Meaning,” famously wrote, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom."
Think of a person you constantly find yourself judging. What is driving your judgment? What would it mean for you, in that space, to assume they are trying the best? Choose wonder over judgment, choose to ask over telling. This will lead you through portals into expanded states of empathy — feeling with someone instead of for someone.
Meaningful relationships: Loneliness is one of the greatest predictors of mortality. Human connection is one of our most essential needs.
How many "4 a.m." friends do you have? People you could call on at any hour of the day? How many people would you be willing to pick up the phone for? I am guessing the latter number is much greater than the former.
Prioritize intentional time with those with whom you can share mutual listening and joy, especially outside in nature. Lean in. Time is our most precious non-renewable asset, spend it wisely.
For the physician and health care professional community to transition from a state of surviving to thriving, it is imperative that we stand on solid ground upon the self-care principles above while also advocating for compassionate and sustainable health care systems.
Do you have a friend or relative who works as a health care professional? Take a minute to text or email someone who you are grateful for and haven’t connected with lately. Tell them how much they mean to you, then remind yourself that you are enough. Grandma Nancy, Jacob, and Gretchen would be proud.
Dr. Jeremiah Eisenschenk is chief of hospital division and director of Medical Weight Management at Essentia Health in Brainerd.