If you are in the business of healthcare – whether as a direct care provider who is doing their best in an increasingly complex system with an increasingly complex panel of patients, a hospital medicine group leader who is trying to keep a group afloat and lead people through this rocky terrain or a hospital system leader or CMO dealing with the arcane and ever-changing landscape – there is one universal truth. This business is hard. You can call it “challenging”. You can say there are “opportunities for improvement”. You can put all kinds of sugar on top, but at times, it is a bitter drink to drink.
So why, as hospitalists, do we keep doing this?
I always joke that I’m going to open a froyo stand on the beach, but of course, I never do. And that constancy is one huge reason why I love hospitalists. We are always trying to decode, unlock and solve some of these seemingly unsolvable problems. But at the same time, this plethora of constant change and instability at all kinds of levels can be a bit, well, impossible.
How do we do it every day? You can change jobs, change patient panels and change medical systems, but no matter what, you will be confronted on some level with a gap of clearly defined solutions to your “challenges”.
One thing in my arsenal of coping, beyond my froyo fantasy, is simply this: compassion. When one of your providers comes to you and is complaining about their workload, don’t tell them about how you used to see three times as many patients at your last job. Instead, put your hand on their shoulder, look them in the eye and say “It is hard. It is.”
When the CEO of your hospital tells you that the already tiny margin of the hospital is shrinking, and she has to cut a service you feel is indispensable, reflect her pain. Believe me – she feels it.
To practice compassion in hospital medicine is to accept that medicine is hard on everyone. It’s not “us” versus “them.” It’s not just “us” that hurts and “them” that are immune. We all struggle.
We need – I need – to acknowledge the pain this profession often elicits. It can be burnout, resentment, overarching grief or incredible frustration with broken systems and sometimes broken people. When we deny it, when try to shove those feelings deep down, then people – good people who feel these things – perceive they are flawed or somehow not cut out for this profession. So they end up leaving. Or imploding.
Instead, if we practice compassion for ourselves and each other, we may find strength and restoration in these relationships with others. We will normalize these very normal responses to the challenges we face every day. And we may then survive all these “opportunities for improvement”.
I challenge everyone to practice this simple compassionate meditation. It will take less than five minutes. As you lay in bed at night, your mind racing, concentrate on feeling compassion for four different people. Start with the person you don’t know well, such as the person that works at the dry cleaner. Breathe deeply. Pick a sentence – a gift to give. I always think, “I wish you happy and healthy, wealthy and wise”. Do this for three or four deep breaths.
Next, using this same technique, choose someone that is hard to feel compassion for – perhaps that difficult family member, or the co-worker that gets under your skin.
Then feel that compassion. Breathe deeply – for yourself, with all your human frailties. You don’t have to be perfect to be loved or lovable. Feel that.
Finally, take a deep breath, feel your chest opening, expanding. Feel that compassion for the whole world – the whole crummy mixed up world that’s just doing its best. The world needs our compassion, too.
Now, finally, while you’re at HM18, look into the eyes of the others you see. These are your fellow hospitalists. People who feel your joys, your frustrations. Some of those eyes will be bright and excited; others will be worn and tired. But revel in this shared and universal knowledge.
It is hard. But with compassion and understanding, we can make it a bit better. For all of us.