college connection
PROFESSIONALISM
FIVE FUNDAMENTALS OF CIVILITY : TAKE CARE OF YOURSELF
The Spring 2016 issue of College Connection provided an introduction to “ The Five Fundamentals of Civility for Physicians ,” a series of articles that examines the impact of incivility to a profession and strategies to foster civil behaviour . This article , written by Dr . Michael Kaufmann , focuses on looking after yourself as well as your patients .
“ That ’ s not how my mentor puts it ,” said the resident . Young and eager , he was sitting forward in his seat , following me closely , challenging . “ Surgery is a demanding specialty . If you ’ re not tough enough to stand it , you should get out ,” he added — or words to that effect . Oh no , I thought , he ’ s swallowed the poison !
That happened during my lecture to a group of residents at a university in Ontario . I was speaking about physician health and risk , burnout and substance use disorders , our vulnerability , and self-care as an imperative .
Later , I found out the resident who spoke up — which I appreciated — was just beginning his surgical training . I could see his process of professionalization was well underway , and it didn ’ t seem like he was going to be much exposed to a vital message : our health is just as important as our patients ’ health .
It seemed to me that he was at risk of following a traditional path of self-sacrifice ; denial of his own basic physiological and emotional needs in the name of surgical training and practice . And worse , he would believe that it was a good idea to do so , that it would make him a great surgeon . Maybe .
Certainly he ’ ll have plenty of exposure to all of the amazing opportunities his training will provide . But one day , taut and exhausted , I wouldn ’ t be surprised if he lashes out at a colleague or co-worker in a most uncivil way . Tightly wound , he will , as they say , shoot the first thing that moves .
Civility and self-care are linked . As Spath and Dahnke said , “ Civility is claiming and caring for one ’ s identity , needs and beliefs without degrading someone else ’ s in the process .” I ’ m in a position to interview doctors who have forgotten that . Burned out and perplexed , they ’ ve drifted away from the awe of medical practice . Instead , they see their patients as problems , their colleagues and co-workers as irritants , at the very least , and sometimes as the enemy . I even see that transition in the faces and mannerisms of learners : eyes wide with amazement as students ; spent and jaded by the final years of schooling . They are already shouldering a load that is difficult to set down .
Civility And Burnout
What happens when a person has to perform day after day under demanding conditions beyond their personal comfort zones , unable to unburden themselves ? Yes , there is learning and growth , to a point . After that , there is fatigue , exhaustion , distress , burnout , illness and , for some , incivility .
We are learning that choosing civility isn ’ t always easy . Sometimes we have to dig deep to find the respect and awareness required to communicate in a civil and effective fashion . This is especially true at times of prolonged stress , when we ’ re most likely to fall back on more deeply ingrained modalities of fight , flight , or aggression .
Burnout can impact upon an otherwise healthy individual , and looms as one of the greatest challenges to the veterinary profession . We can examine burnout in more detail . Maslach described the dimensions of burnout as exhaustion ( physical and emotional depletion ), depersonalization ( a cynical detachment from work and coworkers ), and a sense of ineffectiveness and lack of personal accomplishment .
Major antecedents of burnout include excessive workload , perceived lack of control , insufficient reward , poor professional community support , a sense that fairness is absent , and a mismatch between one ’ s personal and occupational values with those perceived in the workplace .
Highly motivated veterinarians with intense investment in their profession are at risk . Treating co-workers badly has negative impacts upon patient care . Chronic stressrelated irritability , impatience with others , and failing empathy all predispose to workplace conflict and low morale .
The “ Self Versus Service ” Dilemma At the Physician Health Program ( PHP ), we regularly receive calls from individuals who are stressed and feel like they are burning out . Their account often reflects the following pattern : they are feeling overwhelmed by their workload and under-appreciated . Maybe they ’ re drinking a bit too much , or perhaps a client has complained about their manner . When they have sought support and relief , it ’ s been met with a message pushing the problem back upon them — something like , “ These are tough times and we all have to work harder .”
Veterinarians are often being pushed to respond to unlimited demands . I ’ m sure those in positions of responsibility are also stressed by these systemic pressures . Still , a compassionate , active listening response to a colleague in distress would , all by itself , offer a measure of relief . And in the end , how is
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