Patient and Provider Wellness and Wound Care

My name's Deb Roman. I'm an integrative family physician. I work in Boise, Idaho. And for the last several years I've been very involved in local and national initiatives that are addressing the wellbeing of physicians and medical school students.
 
How is the landscape in healthcare contributing to a decline in wellbeing among physicians?

So over the past several decades, or maybe the past couple of decades, there have been dramatic changes in healthcare. At this point most physicians are employed, whereas it used to be that most physicians were in private practice. So physicians are more in a corporate structure now. The number of administrative demands that physicians are asked to take on has increased dramatically, as have the regulatory policies. A lot of that has changed as well.

But what has happened throughout that is that the pace of medicine has changed so dramatically that I think it's really starting to interfere or has interfered with the relationship that physicians can make with their patients, the time they have together and even the time they have with their peers. So there's a lot of isolation and a feeling of disconnect. And then we added the pandemic on top of all of that, which caused a lot of stress for physicians and other clinicians. And then we had the consequences post pandemic where there was so much division politically that there's actually been this very uncomfortable situation where a lot of the times patients are not even comfortable asking their physicians for their opinions. So, that relationship has been compromised in so many ways that it's really starting to impact the wellbeing of physicians nationwide.
 
What does research in neuroscience tell us about cultivating wellbeing?

The nervous system is dynamic. It's always changing. In terms of even its connections and production of nerve cells based on our experience, and experience never used to be a factor in nervous system transformation. So this is very new.

And so with that, there are models now that have looked at scientifically validated components of wellbeing that are actually linked to parts of the brain that are neuroplastic, that can change. And what that says is that we can cultivate wellbeing as a repertoire of skills and enhance our own wellbeing. So it really is incredibly empowering that we actually can do intentional practices that actually will enhance our wellbeing. And so I wanted to talk about that with everyone and share some of that science and talk about how we do that.
 
How does the wellbeing of physicians affect patient care?

The components that I'm talking about include things such as awareness, connection, insight, and purpose. So awareness is our focus, our attention, such a critical piece when you're working with patients in order to listen to their story. Connection brings in things like empathy and compassion, positive outlook. Also, very important qualities that enable us to do the work that we do when we're working with patients. Insight helps us to look at our own self narratives, perhaps our own biases, and see how they're affecting how we're relating to patients and dealing with certain circumstances in medicine. And then purpose, purpose and meaning, our sense of meaning in our work is so critical to our level of engagement. So those kinds of factors have such a dramatic impact on the work we do with our patients and the care we can provide.
 
What's an actionable step that physicians can take to improve their wellbeing?

So I'm going to be talking about something that I think is really important at the conference, which is the distinction between empathy and compassion. Because when empathy is not regulated it actually can decrease our wellbeing in significant ways. But if we can move ourselves to compassion, which is actually an active process, we actually enhance our wellbeing. So I hope to share with people a model to do that.

For today, I would say one of the more important things is a small thing that people can do is to learn to just pause between transitions. So I often think about this when I'm going into a patient's room and it's practiced before I put my hand on that door handle to open the door, I just take a moment and pause, I put my feet on the ground and I take a breath. And often if you take a breath where you breathe in, let's say for a count of two and out for a count of four, longer exhalation, you'll start to quiet your nervous system. You'll start to kind of calm down that sympathetic charge.

So if I'm leaving a room where a patient has a very severe wound or an issue that's very severe, where, let's say, they require very aggressive treatment, and it's been very difficult to work through that with them, as of course it would be. But now I'm going into a room with someone who is actually healing very well and is in a completely different place. I don't want to bring my feelings and my stress that I got from the other room into this room. So I take that time just to put my feet on the ground, take a breath, get myself back to balance, and that will increase wellbeing. And so that's one way.

I actually have a surgeon who does that every time he is washing his hands before each surgery, so that each time you're kind of going in fresh with a baseline and a level of awareness.
 
I'm very concerned about the health and wellbeing of our physician community. And so what I'd hope to do is just spend a little bit of time sharing the science, but then much of the time I hope to share practices that people can walk away with. And then most importantly, I want to hear what people have to say. I want to be able to hear the participants' insights and their questions.