Burnout among healthcare workers. Presented to the Texas Medical Association Wellness Conference

1. How to Reach Your Audience in
an Emotional Manner.
"Being a good doctor requires an
understanding of people, not just
science."

2. Reaching Your Audience in an (Positive)
Emotional Manner
u So what does that mean?
u We All Have A Gamut Of Emotions . . .
u Aggression
u Assertion
u Non-Assertion
u Compassion Vs. Empathy
u What’s the Secret Sauce of Success for You?

3. 3
OMG…

4. Emotions
u Emotions play a significant role in human interactions, yielding communicative
intentions, modeling behavior, promoting attachment, influencing information
processing, and even determining choices.
u Physicians’ emotions in professional settings, traditionally considered to be
unprofessional and a taboo, have increasingly been addressed in medical education
as a result of the recognition that physicians often deal with emotions arising from both
the patient and themselves.
u Even if feelings of moderate intensity are manageable or unnoticeable in medical
encounters, physicians’ intense emotions constitute particular challenges that are more
difficult to ignore and possibly to manage at the moment.

5. On average,
doctors interrupt
patients within 18
seconds. One
study found

6. Explainaholics
u Doctors are “Explainaholics”
u “Our answer to distress is more information, that “If a patient just
understood it better, they would come around.” In reality, bombarding a
patient with information does little to alleviate the underlying worry.
u “Every patient wants their doctor to be academically prepared—to know
the medicine that they need to know,” says Darrell Kirch, president and
CEO of the Association of American Medical Colleges (AAMC). “But
equally important, they want their doctors to have personal attributes that
contribute to their professionalism—what a patient might call their
‘bedside manner.”

7. Physicians with higher empathy levels
u Indeed, according to recent studies, patients whose doctors listen to them and
demonstrate an understanding of their concerns comply more with those doctors’
orders, are more satisfied with their treatment, and enjoy better health—for instance,
they get over a cold more quickly and show physiological signs of a stronger immune
system. And patients who rated their surgeons as highly caring during their stay in the
hospital were 20 times more likely to rate their surgery outcome as positive.
u In addition, evidence suggests that physicians with higher empathy levels—meaning
that they are aware of their patients’ emotional needs and respond appropriately to
their concerns—experience less stress, cynicism, and burnout than those with less
empathy.

8. Physicians Experiencing Intense Emotions
While Seeing Their Patients: What Happens?
u Fifty-two physicians (43.0%) reported experiencing intense emotions frequently.
u Although most physicians (88.6%)tried to control their reactions, several reported not
controlling themselves.
u Coping strategies to deal with the emotion at the moment included behavioral and cognitive
approaches. Only the type of reaction (but not the emotion’s valence, duration, relative
control, or coping strategies used) seemed to affect the physician-patient relationship.
u Choking-up/crying, touching, were significantly associated with an immediate positive
impact.
u Withdrawing from the situation, imposing, and defending oneself were associated with a
negative impact. Some reactions also had an extended impact into future interactions.
Joana Vilela da Silva, MD; Irene Carvalho, PhD (2016)
Results

9. Physicians Experiencing Intense Emotions While
Seeing Their Patients: What Happens?
u Although the display of emotions in medical encounters may be considered
unprofessional, the experience of intense emotions by physicians in the
presence of patients seems frequent.
u Experiencing intense emotions in the presence of patients was frequent
among physicians, and the type of reaction that affected the clinical
relationship.
u Because many physicians reported experiencing long-lasting emotions, these
may have important clinical implications for patients visiting physicians while
these emotions last.
Conclusion:

11. Solutions/Opportunities

12. Story of a surgeon
“The surgeon had 2 routes to the operating room---one took
him through a dark hallway filled with empty boxes. The other
more time consuming route took him through the main hospital
where he passed windows plants and coworkers…
Powered by Feel: How individuals, teams and companies excel (2008) Clawson, J. & Newburg,
D.

13. Story of a surgeon
“…the latter gave him
energy, the former did not. If
he were your heart doctor,
ask yourself what route you
would want him to take
before he operated on you!
Fast and discouraging or slow
and uplifting?”

14. Patient Satisfaction/John Dent, MD
Displayed by Discharge Date
Overall
4EAST Inpatient Overall

15. Possible Solutions
u More training in “Cognitive Empathy”—an understanding of experiences, concerns, and
perspectives of the patient and the ability to communicate that understanding.
u Mohammadreza Hojat, PhD distinguishes cognitive empathy (which he just calls “empathy”)
from “affective empathy,” which he calls “sympathy,” or the emotional response that a
physician might experience in response to a patient. Several of his studies have shown positive
correlations between physicians’ cognitive empathy and improved patient outcomes,
including one study in which diabetic patients had better control over their illness and fewer
diabetes-related complications requiring hospitalization if their physician scored high on
cognitive empathy.
u While Hojat says that you can never have too much cognitive empathy, too much affective
empathy can be detrimental to good healthcare—and to a physician’s well-being.

16. “Should family physicians be empathetic?”
u We are saying yes to empathy as it is defined by Mohammadreza Hojat, PhD
u Hojat et al., states that the concept of empathy must be limited to its cognitive and behavioral
dimensions.
u They define it as “a cognitive attribute that involves the ability to understand the patient’s inner
experiences and perspective and a capability to communicate this understanding.”
u He distinguishes cognitive empathy (which he just calls “empathy”) from “affective empathy,”
which he calls “sympathy,” or the emotional response that a physician might experience in
response to a patient. Several of his studies have shown positive correlations between
physicians’ cognitive empathy and improved patient outcomes, including one study in which
diabetic patients had better control over their illness and fewer diabetes-related complications
requiring hospitalization if their physician scored high on cognitive empathy

17. Compassionate Care of Self and Others
Reducing human suffering by
cultivating compassionate people and
systems

18. Compassion
…experiencing a trembling or quivering of
the heart in response to another’s pain
Sharon Salzburg

19. Empathy
Putting yourself in the shoes of another
A necessary precondition for compassion

20. Spiritual care
Time to reclaim the soul of health care

21. Compassion starts with …
Awareness
and an
Open heart

22. Being Present…Fully Present
What Counts
“It is the human touch after
all that counts for most in our
relation with our patients.”
Robert Tuttle Morris, 1857-1945,
American surgeon and author

23. What do people see when they see
you?
We live in a time when
science is validating
what humans have
known throughout the
ages: that compassion
is not a luxury; it is a
necessity for our well-
being, resilience, and
survival.
Roshi Joan Halifax

24. Thank you!
Bill M Wooten, PhD
billmwooten@gmail.com