Working daily in the trenches of the healthcare industry, physicians are required to show compassion and engage emotionally with patients during the delivery of care. At the same time, the expression of emotions can be perceived as unprofessional. This has led many physicians to suppress their feelings to the detriment of their own mental health and well-being.1

What is Self-Compassion?

According to occupational health psychologist Kevin Teoh, of the University of London, “Self-compassion is about recognizing that you deserve, and need, to put yourself first, because if you don’t look after yourself then you won’t be able to look after others.” It can be difficult for physicians to cultivate self-compassion in an environment that Dr Teoh noted “typically requires individuals to be hardy and resilient.”

Indeed, in the medical environment, as expected, the patient’s well-being is given priority. This can lead to the neglect of physician well-being, particularly the impact that medical work has on physicians’ mental health. “In the medical environment, the focus is typically on being objective, correct, and scientific, which leaves little room for emotions and reflection,” Dr Teoh added.

Despite showing compassion in their work, many physicians do not experience self-compassion — a tool that could help doctors deal with the stresses of work and improve their emotional well-being.

How Can Physicians Develop Self-Compassion?

According to Dr Teoh, “Fundamentally, it’s the adage that you have to put the oxygen mask on yourself before you can put it on others.” So, what might an oxygen mask look like for physicians? “It can be anything from going out to watch a movie or eat a nice meal, to even giving yourself some extra hours sleep,” said Dr Teoh.

Mindfulness is growing in popularity as a way of promoting self-compassion among physicians. “This is all about being aware and in tune with yourself, learning to listen to your body and your mind so you know what you need and can give that to yourself,” Dr Teoh added.

In one study evaluating the effectiveness of a mindfulness training course for primary care physicians using the Mindfulness Based Stress Reduction program, significant improvements were reported in stress resilience, self-compassion, and self-reflection.2 After training, participants showed greater awareness of their feelings and emotions and were better able to handle stressful situations at work. This was after undergoing weekly group training sessions for 8 weeks, which included formal exercises such as yoga and meditation, and informal exercises such as focusing on daily tasks.

Training programs on emotional resilience and Acceptance Commitment Therapy can also cultivate self-compassion. Acceptance Commitment Therapy is a psychological intervention that uses mindfulness strategies to help individuals accept their thoughts, emotions, and situation. It teaches us to be kind to ourselves and to recognize, accept, and address our own needs.3

“In the workplace, Schwartz Rounds, support groups, mentors, and colleagues can help,” noted Dr Teoh. “Other more formal approaches, such as peer coaching or supervisory practice, can also be used to help individuals become more aware and reflective, model good practice, and identify personal strengths.”

Time to REVAMP?

A model proposed to promote flourishing — where positive emotions and functioning are experienced most of the time — among physicians is REVAMP. The model focuses on 6 key elements4:

  • Relationships
  • Engagement
  • Vitality
  • Accomplishment
  • Meaning
  • Positive emotions

Specific interventions to improve each of these elements include:

  • Developing positive personal and workplace relationships
  • Practicing mindfulness
  • Boosting vitality through physical activity, nutrition, and sleep
  • Building resilience

The interventions under REVAMP contribute toward developing self-compassion, which is essential for physicians’ flourishing. These proactive approaches can be adopted as early as medical training school or by practicing physicians.

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Emotional Detachment vs Emotional Engagement

Another tool for better mental health is emotional detachment, which enables physicians to maintain medical objectivity when handling stressful situations, particularly where attachment may affect clinical judgment. Such a situation may arise when providing care for terminally ill patients who continue to experience pain without hope of improvement. Treating family members is another situation where overattachment can be emotionally draining for physicians, which is why the American Medical Association Code of Medical Ethics advises physicians to avoid treating immediate family members.5

Detachment is difficult to maintain in the clinical setting because physicians encounter different situations that can elicit a range of emotions. For example, delivering bad news to a patient may cause emotions such as guilt, sorrow, distress, and even feelings of failure. Engaging with a difficult patient may evoke anger, frustration, and feelings of being unappreciated. In such situations, physicians may struggle to find a balance between empathy and detachment.

Clinicians at Boston Children’s Hospital were surveyed to determine how emotions influence their delivery of care.6 The majority (61%) of participants admitted that emotions such as empathy and anxiety may affect the care they provide. Empathy can help clinicians to better understand a patient’s perspective; however, when physicians over-identify with patients, the impact can become negative — for both the patient and physician.

According to Dr Teoh, “The challenge is to create psychological boundaries that separate the doctor from their work. I’m not saying doctors should depersonalize or detach from their patients when they are interacting or dealing with them. It is after that, when moving on to other tasks or when they are off work and need to switch off. It’s about having healthy work and home boundaries that you respect.”

Taking Care of the Healers

Self-compassion and detachment are crucial factors for the maintenance of physicians’ mental health. It is also important to maintain a balanced perspective; although detachment may help with maintaining objectivity in clinical practice, suppressing emotions may cause distress and burnout. Physicians must practice self-compassion and take good care of their own health and well-being so that they can better care for others. Self-compassion can be learned through various interventions that promote practices such as mindfulness, emotional regulation, and resilience. On a larger scale, it is ideal for self-compassion to be promoted in medical training.

References

  1. Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care.BMC Med Ethics. 2016;17:8.
  2. van Wietmarschen H, Tjaden B, van Vilet M, Battjes-Fries M, Jong M. Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed methods study.BJGP Open. 2018;2(4):16-21.
  3. Pakenham KI. Training in acceptance and commitment therapy fosters self-care in clinical psychology trainees. Clin Psychologist. 2017;21(3)186-194.
  4. Feingold JH. Toward a positive medicine: healing our healers, from burnout to flourishing. Master of Applied Positive Psychology (MAPP) Capstone Projects. 206;107:1-176.
  5. AMA Code of Medical Ethics. Treating Self or Family. https://www.ama-assn.org/delivering-care/ethics/treating-self-or-family. Accessed February 22, 2019.
  6. Martin EB Jr., Mazzola NM, Brandano J, Luff D, Zurakowski D, Meyer EC. Clinicians’ recognition and management of emotions during difficult healthcare conversations. Patient Educ Couns. 2015;98(10):1248-1254.