With burnout on the rise and so many competing demands, cultivating a healthy sense of empathy can be a struggle. Dhruv Khullar, MD, a resident physician at Massachusetts General Hospital in Boston and contributor to the New York Times Well blog, shared insights following a special AMA tweet chat.
AMA Wire: How can a resident work to maintain pragmatic empathy over the long term?
Dr. Khullar: We go into medicine to help others, and empathy is at the core of what we do as doctors. But as enriching and inspiring as medical training can be, it can also be demanding and overwhelming. Maintaining our empathy and compassion throughout it all can sometimes be challenging.
Recent studies show that one-third of residents experience depressive symptoms and burnout. This can make it hard to care for patients in a way that’s good for them and good for us. When we’re not at our best, patient care isn’t at its best.
There are tangible steps that trainees can take to maintain their sense of purpose during residency. The first is to recognize you’re never alone. If you’re struggling, if you’re feeling down, it’s likely that others are too. Opening up to colleagues, family members and significant others is critical. I’ve found that when one person discusses what they’re going through, others inevitably do as well. This creates a supportive environment for everyone.
Another important step is to carve out time to reflect. This can be done alone, with friends or through facilitated discussions within training programs.
It’s important that medical schools and residencies have appropriate support systems in place to help trainees transition from one step to the next. We should invest in wellness programs like mindful medication, narrative medicine and facilitated group discussions. Research shows that these programs work—they can improve well-being, job satisfaction and professionalism, while reducing burnout and exhaustion.
AMA Wire: How can value be put into quality, when so much effort has gone into reducing and managing quantity for residents?
Dr. Khullar: So far in residency reform, the focus has been on reducing the number of hours worked, rather than improving the quality of hours worked. There’s a perception that resident and student wellness depends on separating work and life—that well-being will grow out of limiting duty hours. This may be partially true, but there’s much that needs to be done to improve the quality of time trainees spend in the hospital.
We should reduce the time residents spend on administrative tasks and non-clinical activities to allow them to focus on direct patient care and education. First-year residents spend just eight minutes with each patient per day—about a quarter as long as they do behind a computer screen. That’s unacceptable. We need to find ways to ensure residents spend more time with patients and families and less time with phones and computers.
Some initial steps include improving the ease of communication with nurses and consulting medical services; enlisting medical scribes to assist with documentation; and employing administrative assistants on medical wards to help with paperwork, obtaining medical records, and coordinating discharge appointments. Small changes would go a long way. Most importantly, I think better supported residents will lead to better cared for patients.
AMA Wire: What should spouses, family and friends expect as new residents adjust to the emotional strain and requirements of work?
Dr. Khullar: We all adjust to new situations differently, so there’s a lot of variability in how residency training affects relationships with friends and family. Some people compartmentalize their home and work life; for others, it’s helpful to talk about work at home. Ideally, over time, there’s a synergistic relationship between the two—so that one makes you better at the other.
But everyone approaches these things differently. Loved ones should recognize that residency can be a uniquely stressful experience, even if it’s an extremely rewarding one. It’s important to be understanding and supportive in ways and at times you may not have anticipated.
AMA Wire: How does a more analytical person learn to practice compassion—and how does a more empathetic person curb their emotional side as needed?
Dr. Khullar: We all exist on a continuum of rationality and emotionality at various times. The most important thing is being aware of where you are—and where you need to be. Just monitoring and understanding what’s going on inside you can help you more effectively manage and express it. These skills are honed over time, but not naturally or effortlessly. They require dedicated practice and constant evaluation.
