Taking Care of Oneself: For Yourself, Your Fellows, and Your Programs


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Joint presentation by Christian Sinclair and David Giansiracusa at the 2007 AAHPM Fellowship Directors Conference in Chicago, IL

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  • 2 nd bullet is worded oddly Detachment and Depersonalization Which Leads to Poor Patient Care
  • WHAT CHARACTERIZES JOB ENGAGEMENT? Vigor: -energy and resilience -great effort in one’s job -not easily fatigue -persistence in face of difficulties Dedication: -strong involvement in one’s work -feelings of enthusiasm and significance -sense of pride and inspiration Absorption: -pleasure with total immersion in one’s work
  • I. Exhaustion Experienced, but also  Prompts action to distance oneself emotionally and cognitively from one’s work as a way to cope with work overload II. Cynicism/Depersonalization Coping mechanism to put distance between oneself and recipients of service-ignore qualities which make recipients unique and engaging people (cast them as impersonal objects) (Distancing occurs among people working in a wide range of organizational and occupational settings) III. Inefficacy/Reduced Sense of Personal Accomplishment May develop in parallel, rather than sequentially with exhaustion and depersonalization Contributor: Lack of relevant resources rather than work overload and social conflict (Institutional factor) Distinction Between Burnout and Depression Burnout only involves person’s relationship to his or her work Depression globally affects a person’s life (Maslach 1996)
  • Item # 2 - time, role on health care team Item 4 - (“get the DNR’)
  • Changed numbering/wording Resident Self-Reports of Suboptimal Care “ Discharged patients to make the service ‘manageable’ because the team was so busy.” “ I did not fully discuss treatment options or answer a patient’s questions.” “ I ordered restraints or medications for an agitated patient without evaluating him or her.” “ I did not perform a diagnostic test because of desire to discharge a patient.” (Shanafelt, AIM , 2002) Resident Self-Reports of Suboptimal Patient Care Attitudes Experienced “ I paid little attention to the social or personal impact of an illness on a patient.” “ I had little emotional reaction to the death of one of my patients.” “ I felt guilty about how I treated a patient from a humanitarian standpoint.” (Shanafelt. AIM , 2002)
  • (Orientations-UC Berkeley and MSKCC) Bueraucratic fxns - (conflict with individualistic spirit and values)
  • Workload (emotions inconsistent w/ feelings) Control (responsibility without capacity) Reward (lack of social-not appreciated) Community (unresolved conflict w/ others) Fairness (unfairness  upsetting and exhausting; fuels cynicism) Values (in conflict with ones values) (Maslach and Leiter. The Truth About Burnout.)
  • Complexities of Roles of Mismatches Not clear how much of a mismatch people are able to tolerate: May depend on: -Particular area -Pattern of other areas For example, with meaningful rewards, enjoyable working relationship with colleagues, feeling that work is appreciated, people may tolerate much greater workload (Maslach and Leiter. The Truth About Burnout)
  • Item # 2 when family are not present, when patient not fully awake
  • Enrich ourselves through relationships ∙ Family ∙ Friends ∙ Patients and their Families ∙ Colleagues ∙ Experience of others
  • Frank Ostaseski: “Find quiet amongst the midst of things.”
  • #2 - and new learning
  • Enahnce our skill
  • Commonweal: Institute for the Study of Health and Illness (ISHI) retreats with Rachel Naomi Remen Item 3 changed from: One way may be just looking differently at the work we do and the people we care for
  • of Patients, Their Families, and our Colleagues
  • Ask about emotional stamina Attend to your own neds/lossess Set appropriate goals Personal support system Who’s your mentor
  • Ask about emotional stamina
  • Ask about emotional stamina
  • Cases are after this slide….make screen blank
  • Preventative medicine
  • Taking Care of Oneself: For Yourself, Your Fellows, and Your Programs

    1. 1. Taking Care of Oneself: For Your Self, Your Fellows, and Your Program <ul><li>March 13, 2007 </li></ul><ul><li>David F. Giansiracusa, MD </li></ul><ul><li>Pain and Palliative Care Service, Department of Neurology </li></ul><ul><li>Memorial Sloan-Kettering Cancer Center </li></ul><ul><li>Christian T. Sinclair, MD </li></ul><ul><li>Fellowship Director, Associate Medical Director </li></ul><ul><li>Kansas City Hospice & Palliative Care </li></ul>
    2. 2. Objectives <ul><li>Define and recognize burnout in the health care professional </li></ul><ul><li>Optimize a fellowship program to include teaching areas of self-care </li></ul><ul><li>Learn to address situations where self-care has been avoided/ignored </li></ul>
    3. 3. Personal Consequences of Burnout <ul><li>Stress, anxiety, anger, depression </li></ul><ul><li>Substance abuse </li></ul><ul><li>Family disruption </li></ul><ul><li>Stress-related health problems </li></ul><ul><li>(Maslach 2001) </li></ul>
    4. 4. Job-Related Consequences of Burnout <ul><li>Decreased job performance (Parker 1995) </li></ul><ul><li>Reduced commitment to work (Leiter 1998) </li></ul><ul><li>Low career satisfaction (Goldberg 1996, Lemkau 1994) </li></ul>
    5. 5. Clinical Consequences of Burnout <ul><li>Prolonged hospital stays </li></ul><ul><li>Patients’ and family members’ preferences for and goals of care are not discussed </li></ul><ul><li>Patient and family feeling a sense of abandonment </li></ul><ul><li>Excessive use of technological interventions </li></ul>
    6. 6. Burnout: Erosion of Engagement <ul><li>Vigor: </li></ul><ul><li>-energy and resilience </li></ul><ul><li>-increased stamina </li></ul><ul><li>-persistence in face of difficulties </li></ul><ul><li>Dedication: </li></ul><ul><li>-strong involvement </li></ul><ul><li>-feelings of enthusiasm and significance </li></ul><ul><li>-sense of pride and inspiration </li></ul><ul><li>Absorption: </li></ul><ul><li>-pleasure with total immersion </li></ul><ul><li>(Maslach 1997 ) </li></ul>
    7. 7. What Characterizes Burnout? <ul><li>Imbalance of professional demands and rewards </li></ul><ul><li>Caused by: </li></ul><ul><ul><li>Overwhelming emotional/interpersonal job stress </li></ul></ul><ul><li>Defined by three dimensions: </li></ul><ul><li>I- Exhaustion </li></ul><ul><li>II- Cynicism </li></ul><ul><li>III- Inefficacy </li></ul><ul><li>(Maslach 2001) </li></ul>
    8. 8. Compassion Fatigue and Burnout in Trainees <ul><li>Care for patients with severe illness and suffering </li></ul><ul><li>Have limited relationships with patients and families </li></ul><ul><li>Need to rescue, fix-it </li></ul><ul><li>Difficult communication challenges </li></ul>
    9. 9. Burnout in Trainees <ul><li>76% out of 115 of internal medicine residents met criteria for burnout: </li></ul><ul><li>-More likely to self-report suboptimal patient care </li></ul><ul><li>-Report of suboptimal care associated only with depersonalization component and in dose-responsive relationship </li></ul><ul><li>(Shanafelt 2002) </li></ul>
    10. 10. Burnout in Trainees <ul><li>Major depression self-report and screening rates  significantly increased </li></ul><ul><li>Career satisfaction  strong inverse relationship to burnout </li></ul><ul><li>No significant increased risk of alcohol or substance abuse </li></ul><ul><li>(Shanafelt 2002) </li></ul>
    11. 11. Health Care Professionals’ Vulnerability to Burnout <ul><li>Work closely with patients and families who are intensely suffering, </li></ul><ul><li>In crisis, and often in conflict  </li></ul><ul><li>“Lightening Rod Effect” </li></ul><ul><li>Conversations require time, focus, and emotional and intellectual energy </li></ul><ul><li>(Meier 2006) </li></ul>
    12. 12. Our Vulnerability <ul><li>Work under institutional pressures: </li></ul><ul><li>-workload </li></ul><ul><li>-bureaucratic frustrations </li></ul><ul><li>-interprofessional conflicts </li></ul><ul><li>- “Culture of Medicine” </li></ul><ul><li>(Meier 2006) </li></ul>
    13. 13. Our Vulnerability <ul><li>We may experience feelings of guilt, insecurity, frustration, inadequacy. </li></ul><ul><li>( A sense of “not being enough”) </li></ul><ul><li>Identification with patient or family members may heighten our own sense of grief </li></ul><ul><li>Conflicts over goals of care or “agendas” </li></ul><ul><li>may cause frustration </li></ul><ul><li>(Meier 2001) </li></ul>
    14. 14. Workload Control Values Fairness Community Reward Work
    15. 15. The “Match/Mismatch” Theoretical Framework of Burnout: <ul><li>Of six domains of job: </li></ul><ul><li>Mismatch = Burnout </li></ul><ul><li>Match = Engagement </li></ul><ul><li>(Maslach 1997) </li></ul>
    16. 16. Individual and Organizational Interventions <ul><li>Individual interventions (coping skills): </li></ul><ul><ul><li>may alleviate exhaustion </li></ul></ul><ul><ul><li>unlikely to alleviate cynicism, depersonalization and inefficacy </li></ul></ul><ul><li>Need to create a “matched” profile: </li></ul><ul><ul><li>sustainable workload </li></ul></ul><ul><ul><li>feelings of choice and control </li></ul></ul><ul><ul><li>recognition and reward </li></ul></ul><ul><ul><li>supportive work community </li></ul></ul><ul><ul><li>fairness and justice </li></ul></ul><ul><ul><li>meaningful and valued work. </li></ul></ul><ul><li>(Maslach 2001) </li></ul>
    17. 17. Recognizing Burnout/Compassion Fatigue in Oneself <ul><li>Wish to avoid work </li></ul><ul><li>Avoidance-rounding </li></ul><ul><li>Feeling sense of anger and frustration towards patients, families, colleagues </li></ul><ul><li>Resisting evaluation for disease progression </li></ul><ul><li>Not communicating serious information </li></ul><ul><li>Over-dependence on technology </li></ul>
    18. 18. So what is Self-Care? <ul><li>Strong boundaries </li></ul><ul><ul><li>Work versus Life </li></ul></ul><ul><li>Burnout identification </li></ul><ul><li>Physical, emotional, spiritual arenas </li></ul>
    19. 19. Self-Care Activities <ul><li>Exercise and nutrition </li></ul><ul><li>Avoid excessive alcohol and caffeine </li></ul><ul><li>Meditation </li></ul><ul><li>Take/make time to laugh/relax with friends </li></ul><ul><li>Enjoy meaningful solitude </li></ul><ul><ul><li>walks, reading, writing </li></ul></ul><ul><li>Other hobbies </li></ul>
    20. 20. Returning to Work <ul><li>Awareness of satisfaction </li></ul><ul><li>Finding rewards </li></ul><ul><li>Accomplishing renewal </li></ul><ul><li>Experience wonder </li></ul>
    21. 21. Satisfaction from Work <ul><li>Sense of dealing well with patients, families and staff </li></ul><ul><li>Intellectual stimulation </li></ul><ul><li>Sense of mastery and contribution </li></ul><ul><li>Enjoying adequate resources </li></ul><ul><li>Obtaining professional status </li></ul><ul><li>Limiting demands </li></ul>
    22. 22. Renewal: Professional <ul><li>Growth experiences in skill building, self-discovery and networking </li></ul><ul><ul><li>Practical Aspects of Palliative Care Conf </li></ul></ul><ul><ul><li>Palliative Care Education and Practice </li></ul></ul><ul><ul><li>E ducating Physicians in End-of-Life Care </li></ul></ul><ul><ul><li>Annual Assembly AAHPM </li></ul></ul><ul><ul><li>Being Here…today. </li></ul></ul>
    23. 23. Renewal: Personal <ul><li>“ Spirituality and Meaning in Medicine” Conference </li></ul><ul><li>Other organizations offering group discussions, conferences, retreats: </li></ul><ul><li>∙ “ Renew” </li></ul><ul><li>∙ “ Doctor to Heal” </li></ul><ul><li>New outlook </li></ul><ul><li>Experiencing how others have dealt with adversity and illness </li></ul>
    24. 24. Experience the Wonder <ul><li>Love in a family </li></ul><ul><li>Resilience </li></ul><ul><li>Courage </li></ul><ul><li>Values </li></ul><ul><li>Way patient views his own life and death </li></ul>
    25. 25. Applied Self-Care: Director/Faculty <ul><li>Starts at interview; ends…never </li></ul><ul><li>“Open Door” Policy </li></ul><ul><li>Get in their shoes </li></ul><ul><ul><li>Ask them questions about themselves </li></ul></ul><ul><li>Share your own experience </li></ul><ul><li>Be a good example </li></ul>
    26. 26. Applied Self-Care: Director/Faculty <ul><li>Scheduled check-in’s (3-4x/year) </li></ul><ul><li>Dismantle the ‘tough it up’ attitude </li></ul><ul><li>Watch for the October-February slump </li></ul><ul><li>Service vs. education </li></ul><ul><li>Connection with other fellows </li></ul><ul><li>Participation in traditions/rituals </li></ul>
    27. 27. Applied Self-Care: Director/Faculty <ul><li>Address the ‘affect’ in difficult situations: </li></ul><ul><ul><li>death of a patient </li></ul></ul><ul><ul><li>identification with a patient or family </li></ul></ul><ul><ul><li>challenging patient or family </li></ul></ul><ul><ul><li>being “fired” by patient or family </li></ul></ul>
    28. 28. Part of the Curriculum <ul><li>Add self-care sessions to weekly talks </li></ul><ul><li>Experiential and knowledge-based </li></ul><ul><li>Planned and spontaneous </li></ul><ul><li>Look to other disciplines for assistance </li></ul><ul><li>Informal debriefings after tough clinical cases </li></ul><ul><li>Talk about other staff </li></ul>
    29. 29. Obstacles <ul><li>Faculty or friend? </li></ul><ul><li>Looking for acclaim </li></ul><ul><ul><li>Best mentor ever </li></ul></ul><ul><ul><li>Best boss ever </li></ul></ul><ul><li>Breaking bad news </li></ul><ul><ul><li>Why is feedback harder than death? </li></ul></ul><ul><li>The small fellowship program </li></ul>
    30. 30. Conclusions <ul><li>Burnout occurs when self-care is neglected </li></ul><ul><li>Burnout can come from many sources </li></ul><ul><li>Self-care should not be an afterthought </li></ul><ul><li>Self-care can be nurtured: </li></ul><ul><ul><li>in your self </li></ul></ul><ul><ul><li>in your fellows </li></ul></ul><ul><ul><li>In your program </li></ul></ul>
    31. 31. Contact Information <ul><li>David F. Giansiracusa, MD </li></ul><ul><ul><li>giansird@mskcc.org </li></ul></ul><ul><li>Christian T. Sinclair, MD </li></ul><ul><ul><li>[email_address] </li></ul></ul>
    32. 32. References <ul><li>Maslach C, Goldberg J. Prevention of burnout: New perspectives. Applied and Preventive Psychology , 7:63-74, 1998 </li></ul><ul><li>Zapf D, Seifert C, Schmutte B, Mertini H, Holz M. Emotion work and job stressors and their effects on burnout. Psychology and Health, 16:527-545, 2001 </li></ul><ul><li>Zapf D, Holz M. On the positive and negative effects of emotion work in organizations. European Journal of Work and Organizational Psychology, 15:1-28, 2006 </li></ul>
    33. 33. References <ul><li>Maslach C, Schaufeli WB, Leiter MP. “Job burnout”. Annual Reviews of Psychology. 52:397-422, 2001. </li></ul><ul><li>Maslach C, Leiter MP. The Truth about Burnout , San Francisco: Jossey-Bass, 1997. </li></ul><ul><li>Leiter MP, Maslach C. Preventing Burnout and Building Engagement: A Complete Program for Organizational Renewal , San Francisco: Jossey-Bass, 2000. </li></ul><ul><li>Maslach C, Goldberg J. “Prevention of burnout: new prespectives. Appl. Prev. Psychol . 7:63-74, 1998. </li></ul>
    34. 34. References <ul><li>Meier DE, Beresford L. “Preventing burnout”, Journal of Palliative Medicine . 9(5):1045-1048, 2006 (October). </li></ul><ul><li>Zalenski RJ, Raspa R. “Maslow’s hierarchy of needs: A framework for achieving human potential in hospice. Journal of Palliative Medicine. 9(5):1120-1127, 2006 (October) </li></ul><ul><li>Schapira L. “Stress, burnout, and renewal”, Chapter 4. Conversations in Care ( www.conversationsincare.com ) </li></ul>
    35. 35. References <ul><li>Gundersen L. Physician burnout. Ann Intern Med. 135:145-148, 2001. </li></ul><ul><li>Rabow MW, McPhee SJ. Doctoring to heal. West J Med. 174:66-69, 2001. </li></ul><ul><li>Freudenberger H. Staff burn-out. J Soc Issues 30:159-165, 1974. </li></ul><ul><li>Mount BM. Dealing with our losses. J Clin Oncology . 4(7):1127-1134, 1986. </li></ul><ul><li>Remen RN. Recapturing the soul of medicine. West J Med. 174:4-5, 2001. </li></ul>
    36. 36. References <ul><li>Meier DE, Back AL, Morrison S. The inner life of physicians and care of the seriously ill. JAMA. 286(23):3007-3014, 2001. </li></ul><ul><li>Jenkins V, Fallowfield L. Can communication skills training alter physicians’ beliefs and behaviors in the clinics? J Clin Onc . 20(3):765-769, 2002. </li></ul><ul><li>Block SD. Psychological considerations, growth, transcendence at the end of life: The art of the possible. JAMA 285:2898-2905, 2001. </li></ul><ul><li>Cassell E. The nature of suffering and the goals of medicine. N Engl J Med. 306:639-645, 1982 </li></ul>
    37. 37. References <ul><li>Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 136:358-367, 2002. </li></ul><ul><li>Ramirez AJ, Graham J, Richards MA, et. al. Burnout and psychiatric disorders among cancer clinicians. Br J Cancer 71:1263-9, 1995 </li></ul><ul><li>Kilfedder CJ, Power KG, Wells TJ. Burnout in psychiatric nursing. J Adv Nurs 34:383-96, 2001 </li></ul><ul><li>Leiter MP, Harvie P, Frizzell C. The correspondence of patient satisfaction and nurse burnout. Soc Sci Med 47:1611-7, 1998 </li></ul>
    38. 38. References <ul><li>Cherniss C. Beyond Burnout: Helping Teachers, Nurses, Therapists, and Lawyers Recover from Stress and Disillusionment , New York: Routledge, 1995 </li></ul><ul><li>Goldberg R, Boss RW, Chan L. et al. Burnout and its correlates in emergency physicians. Acad Emerg Med 3:1156-64, 1996 </li></ul><ul><li>Lemkau J, Rafferty J, Gordon R Jr. Burnout and career-choice regret among family practice physicians in early practice. Fam Pract Res J 14:213-22, 1994 </li></ul>
    39. 39. References <ul><li>Sherman DW. Nurses’ stress and burnout. Amer. J Nursing. 104: 48-56, 2004. </li></ul><ul><li>Redinbaugh EM, Sullivan AM, Block SD et al. Doctors’ emotional reactions to recent death of a patient: cross sectional study of hospital doctors. British Medical Journal 327:1-6, 26 July 2003. </li></ul><ul><li>Rando T. Grief, Dying and Death: clinical interventions for caregivers. Campaign, IL: Research Press, 1984. </li></ul>
    40. 40. References <ul><li>Figley CR ed. Compassion Fatigue: Coping with Secondary Traumatic Stress in Those Who Treat the Traumatized. London: Brunner-Routledge, 1995 </li></ul><ul><li>Groves JE. Taking care of the hateful patient. N Engl J Med . 298:883-887, 1978 </li></ul><ul><li>Novack DH, Suchman AL, Clark W, et al. Calibrating the physician: personal awareness and effective patient care. JAMA .278:502-509, 1997. </li></ul><ul><li>Zuker A. Dissatisfaction with medical practice. N Engl J Med . 350:69-75, 2004. </li></ul>
    41. 41. References <ul><li>Eric Cassell. The Nature of Suffering and Goals of Medicine. New York: Oxford Press. 2004. </li></ul><ul><li>James Hallenbeck. Palliative Care Perspectives. New York: Oxford University Presss, 2003. </li></ul><ul><li>Nouwen H. The Wounded Healer , Garden City, NY. Doubleday, 1972. </li></ul>
    42. 42. Suggested Readings <ul><li>Ken Wilber, Grace and Grit: Spirituality and Healing in the Life and Death of Treya Killam Wilber, Boston, Shambhala, 2000. </li></ul><ul><li>Wallace Stegner, Crossing to Safety , 1987, Modern Library, 2002. </li></ul><ul><li>Wallace Stegner, All the Little Live Things , Penguin Books, 1967 </li></ul><ul><li>Jean Vanier, Becoming Human , Paulist Press, 1999. </li></ul><ul><li>Michael Kearney, Mortally Wounded . New York: Simon and Schuster, 1996 </li></ul>
    43. 43. Suggested Readings <ul><li>Jean Shinoda Bolen, Close to the Bone , New York: Touchstone, 1996. </li></ul><ul><li>Christine Longaker, Facing Death and Finding Hope: A Guide to the Emotional and Spiritual Care of the Dying, New York: Doubleday, 1997 </li></ul><ul><li>David Kuhl, What Dying People Want , New York: PublicAffairs, 2002. </li></ul>
    44. 44. Suggested Reading <ul><li>Reynolds Price, A Whole New Life: An Illness and a Healing, Schribner, 2003. </li></ul><ul><li>Christopher Reeves, Still Me , Ballantine Books, 1999. </li></ul><ul><li>Christopher Reeves, Nothing Is Impossible, Ballantine Books, 2004. </li></ul><ul><li>Martha Weinman Lear, Heartsounds, New York: Simon and Schuster, 1980. </li></ul>
    45. 45. Suggested Reading <ul><li>Morton Kondrake. Saving Milly , New York: Ballantine Books, 2001. </li></ul><ul><li>Reeve Lindbergh. No More Words: A Journal of My Mother, Anne Morrow Lindbergh, New York: Simon and Schuster, 2001. </li></ul><ul><li>William Bridges. The Way of Transition: Embracing Life’s Most Difficult Moments. Cambridge, MA, Perseus Publishing, 2001. </li></ul>
    46. 46. Suggested Reading <ul><li>Ram Dass, Still Here: Embracing Aging, Changing, and Dying, Riverhead Trade, 2001. </li></ul><ul><li>Viktor Frankl, Man’s Search for Meaning , Pocket Publishers, 1971 </li></ul><ul><li>Ira Byock. Dying Well: Peace and Possibilities at the End of Life. New York: Riverhead Books, 1997. </li></ul><ul><li>Kotter J. Leading Change , Harvard Business School Press, 1996 </li></ul>
    47. 47. Suggested Reading <ul><li>Bill Bazan. Medicine In Search of Meaning: A Spiritual Journey for Physicians , Caritas Communications, 1999. </li></ul><ul><li>Kirk Byron Jones. Rest in the Storm: Self-care Strategies for Clergy and Other Caregivers Judson Press, 2001 </li></ul><ul><li>The Dalai Lama. The Art of Happiness , Riverhead Books, 1998. </li></ul><ul><li>William Bridges. The Way of Transitions: Embracing Life’s Most Difficult Moments , Perseus Publishing, 2001. </li></ul>
    48. 48. Suggested Reading <ul><li>Kubler-Ross E. Death: The Final Stage of Growth, New York: Touchstone, 1975. </li></ul><ul><li>Kabat-Zinn J. Wherever You Go, There You Are. New York: Hyperion, 1994. </li></ul><ul><li>Santorelli S. Heal Thy Self: Lessons on Mindfulness in Medicine, New York: Bell Tower, 1999. </li></ul><ul><li>Arthur W. Frank. The Wounded Storyteller: Body, Illness, and Ethics . University of Chicago Press, 1997. </li></ul>
    49. 49. Suggested Reading <ul><li>Brian Sibley. C.S. Lewis through the Shadowlands: The Story of His Life with Joy Davidman, Grand Rapids: Spire, 1999. </li></ul><ul><li>Henri J.M. Nouwen. Our Greatest Gift: A Meditation on Dying and Caring, San Francisco: HarperCollins, 1994. </li></ul><ul><li>Harold S. Kushner. The Lord is My Shepherd: Healing Wisdom of the Twenty-Third Psalm, New York: Anchor Books, 2003. </li></ul>
    50. 50. Suggested Reading <ul><li>Daniel Sulmasy. The Healer’s Calling: A Spirituality for Physicians and Other Health Care Professionals. Paulist Press, New York, 1997 </li></ul><ul><li>Daniel Sulmasy. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care , Georgetown University Press, 2006 </li></ul><ul><li>Arthur W. Frank. The Wounded Storyteller: Body, Illness, and Ethics . Chicago, University of Chicago Press, 1995. </li></ul><ul><li>Milton Lewis. Medicine and Care of the Dying: A Modern History . Oxford University Press. 2006 </li></ul>
    51. 51. Suggested Readings <ul><li>{Risking Everything}, Roger Housden (ed), New York, Harmony Books, 2003 </li></ul><ul><li>Jane Kenyon. Let Evening Come (Poems), Saint Paul: Graywolf Press, 1990. </li></ul><ul><li>Jane Kenyon. Otherwise: New and Selected Poems. Saint Paul: Graywolf Press, 1996. </li></ul><ul><li>Donald Hall. Without. (Poems), New York: Mariner Books, 1998. </li></ul><ul><li>Mary Oliver. West Wind (Poems and Prose Poems), New York: Mariner Books, 1997. </li></ul>
    52. 52. Websites <ul><li>www.commonweal.org/ishi/ </li></ul><ul><li>www.zenhospice.org </li></ul><ul><li>www.hospitalchaplain.com </li></ul><ul><li>www.erperc.mcw.edu </li></ul><ul><li>www.pallimed.org </li></ul>
    53. 53. “ I had never heard of caregiver burnout raised as a possible temporary insanity or diminished capacity defense, so it sort of caught my fascination a little bit and off we went exploring the idea. ” -David E. Kelley TV Writer/Producer
    54. 54. <ul><li>“ Curing: </li></ul><ul><li>Making the problem go away. </li></ul><ul><li>Healing: </li></ul><ul><li>Giving people the resources to enjoy life when they cannot make the problem go away.” </li></ul><ul><li>__Rabbi Harold Kushner </li></ul>
    55. 55. <ul><li>“ There are two ways of </li></ul><ul><li>of spreading light; </li></ul><ul><li>To be the candle </li></ul><ul><li>Or the mirror that reflects it.” </li></ul><ul><li>__Edith Wharton </li></ul>
    56. 56. <ul><li>“ Be appreciative of your limited </li></ul><ul><li>successes, more tolerant of your </li></ul><ul><li>limited failures…..I strive to do the very best, but I am pleased with </li></ul><ul><li>“ good enough”. </li></ul><ul><li>__J. Andrew Billings </li></ul>
    57. 57. <ul><li>“ Man is not destroyed by </li></ul><ul><li>suffering alone, </li></ul><ul><li>But by suffering without meaning.” </li></ul><ul><li>__ Viktor Frankl, Man’s Search For Meaning </li></ul>
    58. 58. <ul><li>Look within yourself: </li></ul><ul><li>“ What is hardest for me in doing my work?” </li></ul><ul><li>“ What brings me the most joy and meaning in doing my work?” </li></ul>
    59. 59. <ul><li>Pursue a personal quest to find meaning and purpose in life and a relationship to something greater than oneself.... </li></ul><ul><li>The shift from ourselves to caring for others. </li></ul><ul><li>__Michael Kearney, Mortally Wounded </li></ul>
    60. 60. <ul><li>“ Healing requires recognition of the human face of each person one sets to heal and of the message that both the healer and the healed share a bond that ties them to each other through their humanity, their mortality, and the God-given spark of grace that lives in each of them.” </li></ul><ul><li>__Daniel P. Sulmasy, The Healer’s Calling </li></ul>