Ep. 3: Well-being at work: What doctors do for self-care

3 Sanford providers swap lessons on adversity and growth for patients and themselves

Episode Transcript

Alan Helgeson (host):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building sustainable workforce, and discovering innovative ways to deliver high quality, low cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic focuses on caregivers in the medical community and the importance of well-being in order to provide the best care to those in need. Our guests are Dr. Brian Gatheridge, psychologist with Sanford Health Detroit Lakes Clinic, and Dr. Heather Spies, OB/GYN, and physician director of clinician experience and well-being. Our moderator is Dr. Luis Garcia, president of Sanford Clinics.

Dr. Luis Garcia (moderator):

I’m very grateful to be joined today by Dr. Heather Spies and Dr. Brian Gatheridge. Heather, Brian, thank you for being here today. And, you both are champions of this kind of work and you both are leaders in these type of topics. And I have a question to both of you. Tell us a little bit about yourself, your personal background, your journey, and how did you get involved and passionate about clinician well-being?

Dr. Heather Spies (guest):

Well, thank you for having us here, and I have the privilege of working with both of you in this work, and so I know that we all care a lot about it, so I think this will be a fun conversation to have today together. I started in OB/GYN 20 years ago now, actually, if you think about residency, and then have been 16 years at Sanford practicing OB/GYN. And, most recently in the physician director role for the enterprise for clinician experience and well-being.

Just really feel fortunate to have this opportunity to serve in this role. It’s a new role and it’s been identified as a need because, just to really make sure that as clinicians we’re looking out for each other and making sure as an organization that we’re providing resources and that sort of thing, which we’re gonna talk more about today.

Um, but as far as my journey, I think I’ve always had a passion for well-being, although I think part of the reason I love talking about it and focusing on it is because I never practiced what I preached for a very, very long time. Still probably don’t do it as well as I should, but I think that’s where we all kind of fall somewhere on a spectrum of our well-being, our intentions of looking out for ourselves or looking out for well-being, and it needing to be more of a priority for all of us. So I think just continuing on that journey throughout my whole life is fun to be a part of this work.

Dr. Luis Garcia:

Well, thank you, Heather, and we appreciate what you’re doing and your new role. And you’re right. I mean, as clinicians, we often forget about our own well-being, so thank you for sharing that with us. What about you Brian?

Dr. Brian Gatheridge (guest):

Yeah, I would just say thanks again for the opportunity to participate in what is a very important conversation. So myself I guess I could say I’ve always had a bit of an interest in human behavior, you know, as well as emotional and cognitive processes, you know, how people interact in their environment and with others. In school, I was primarily interested in sports and hanging out, but for whatever reason, psychology was always something that was interesting to me. I also grew up in a really rural area, and I saw how you know, people struggled with mental health and how folks didn’t really understand mental health problems people were experiencing. There certainly was not an encouragement to discuss those problems or acknowledge them, and there really was not help available. And so I always felt like there was a bit of a calling for me that I felt to get into that field, to serve in so far as, you know, clinician wellness.

Like many of us who serve, I’m a clinician who cares about the people that I work with. And as I entered into the field of health care, I began to learn more about, you know, the unique pressures that, you know, clinicians face and the impact that our work has on our health. And sadly, again, that stigma that often prevents people from seeking care. And so, I guess over time, you could say I became increasingly motivated to serve in a way that could hopefully improve the health and welfare of my fellow health care providers. And again, really work to reduce that stigma that still keeps people from acknowledging that there is a concern and seeking care. So again, it’s a privilege to be here and to serve.

Dr. Luis Garcia:

Well, Brian, thank you. And I want to thank you personally for answering to that calling because you do phenomenal work and you’re a great asset to our organization. And, you know, you’re talking about the stigma. And Heather, I’d like to ask you a question about that. As a clinician, why do you feel that’s so important to talk about that stigma about well-being? And what’s your perspective on that?

Dr. Heather Spies:

This is really important for us as clinicians to focus on because we’re all working and living in very stressful environments. Medicine’s always been stressful, but even more recently, I think we’re all acknowledging that not only at work, but just everywhere in our communities and our culture and politics, everything is a little bit more intense and stressful lately. So no matter your specialty or your location, many of us are feeling more and more a sense of feeling devalued – maybe the culture, the public perception of health care has had so many changes lately.

I think all clinicians have invested so much time, energy, really sacrificed relationships sometimes just to be clinicians and to be that person that people trust. You know, traditionally we are the people that everyone looked to and trusted and valued, and the way that that’s happening now is being challenged more and more recently.

So as we dedicate ourselves to knowing the latest clinical information and trying to do the best we can for patients. The media sometimes challenges what a clinician says, and that makes it really hard for us to keep going, I think harder lately than it was in the past where we could always just say that we were the experts in things. And so I think it’s important that we talk about this because we’re all feeling fatigued and we’re all feeling burnt out at times, and what can we do to help with that?

Dr. Luis Garcia:

Thank you, Heather. And it’s just one more challenge for clinicians, right? As if medicine was not difficult enough right? Now, deal with all that devalue part that you’re talking about. Brian, you know, Heather touched a little bit into concepts like burnout, compassion fatigue, but maybe folks, maybe do not know exactly what those term terms mean. From your standpoint, can you define for us, the meaning of these terms? And maybe describe how can we recognize signs of burnout and fatigue on either in ourselves or others?

Dr. Brian Gatheridge:

Yeah, that’s a really important question Dr. Garcia. You know, we hear those terms a lot, but I’m always surprised by the folks who really don’t understand what those terms mean and whether or not they may be experiencing those concerns themselves.

So, you know, compassion fatigue and burnout are two types of stresses that can bring about, you know, psychological, physical, and emotional impacts. If we think about burnout, you know, specifically, it’s important to recognize that it’s not necessarily a psychological disorder. You know, I think the World Health Organization designates it as a syndrome which is a measure of chronic distress that we might feel at times if we’re talking about burnout specifically. Christine Maslow, Dr. Christine Maslow is a psychologist, researcher who’s really studied burnout for decades. And her research has concluded that burnout is characterized by three factors.

So one is emotional exhaustion. So these are folks who are just feeling depleted. They may be irritable, they might be down, and they just can’t seem to recharge. You know, a lot of us can feel pretty heavily, heavy or emotionally depleted at the end of the day, but we go home and we engage our family, or we exercise and we come back the next day and we’re ready to do our work again. And we feel like we have the emotional energy to do that. Folks who are burned out have a hard time recharging.

Depersonalization is the second component of the syndrome, and that’s this cynical or detached approach people may feel to caring for patients. This is where folks, you know, we start to see people as, you know, they’re presenting problem as opposed to, you know, the human that they are.

And then the last is a loss of personal accomplishment, and this is often the last symptom to develop where we just don’t feel like our work has any value or meaning anymore. And we know that, you know, burnout is bad for physicians and clinicians.

You know, it’s really proven, by increased rates of anxiety, depression, and chemical use rates, not to mention suicide, which is a significant problem within the field of health care burnout. It’s also bad for patients because we know that it’s associated with lower quality of care, lower patient satisfaction, higher turnover rates for clinicians, and increased chances of medical errors. Some research has shown that between 40 to 61% of physicians are burned out and additional research shows that about up to 60% of psychologists struggle with burnout. So it, it’s a very significant concern.

Those are things that people need to look for. Compassion fatigue is a little bit different in that it’s a bit more acute. Burnout is often caused by a number of work-related stressors, where compassion fatigue is pretty much directly related to exposure to the stressful and traumatic things that we’re exposed to within the field of health care. It has a much more rapid onset. It can also be a lot of the signs that you see are very consistent with what we’d see with post-traumatic stress disorder – you know, psychological distress, muscle tension, nightmares, cognitive shifts. Again, it’s much, there’s much more of a rapid onset and it really is impacted by helping others. There’s much more of a quicker recovery time than for burnout if we manage it early. So, again, there’s a lot of similarities between these two things but also some pretty profound differences as well.

Dr. Luis Garcia:

Brian, thanks for educating us on that. I mean, I’m gonna be honest. I personally didn’t know the difference, so thank you for that and those are striking statistics, right? The ones that you just shared with us. You know, Heather, Brian talked a little bit about the multifactorial etiology of this. So from your perspective, what things in medicine do you think have contributed to burnout or clinicians struggling to achieve that sense of well-being?

Dr. Heather Spies:

I think that we all know, from the very beginning of our training, we go into medicine and we’re really excited about it. You know, studies have shown that medical students actually have really low burnout. They’re energetic. They are ready to go and excited about things.

And then as we progress through training and residency, the number of us that begin to show symptoms of burnout or compassion fatigue really start to increase at an alarming rate actually. And then as we get into practice. And so I think it’s the time that we invest, the money that we invest. A lot of times, we enter our practices in quite a bit of financial debt, and we feel like we don’t have any other choice other than to do the work that we signed up to do 10, 20, 30 years into our practices.

So that’s one big factor I think that’s contributing. I think to organizational factors, I think sometimes the cultures get stuck kind of in that traditional way. And luckily we’re seeing that culture change and evolve across you know, Sanford and the country luckily to just really say, you know, we don’t have to have things the way that they’ve traditionally been.

We need to be looking out for each other as human beings and as people that need rest, and people that need to take turns and maybe not work for 36 hours straight all the time that, you know, we did in our training.

So I think too, it’s really been in our nature as clinicians to always put other people first. We always, I mean, that’s why we went into medicine. That’s just by nature what most of us are like. And so, you know, traditionally that really contributes, you know, over time, especially, you might do fine for a while, but over time, when you always put others first in every scenario, it’s going to take its toll. And so we’re seeing that definitely with our clinicians.

Dr. Luis Garcia:

Yeah. Not to count the expectations that we need to be perfect, right? And you know, a medical error can have significant consequences. Unlike any other job or industry and all that stress contributes to all that. So thank you for that answer, Heather.

You know, Brian, I think that we all are very aware of how all these stressors and all these factors have been heavily pronounced in the last couple of years. And I think the last couple of years can be easily be defined as full adversity. And from your perspective talk to us a little bit about the power of facing adversity and the relationship to personal growth.

Dr. Brian Gatheridge:

I guess what I would challenge all of our listeners to really pause and think about a time where you experienced adversity in your life. Think about an experience that you know, you didn’t enjoy or that was particularly challenging at the time that you faced it. And then I want you to reflect upon how that experience shaped your life in a positive direction.

You know, most of us are at the point in life where we can reflect upon experiences that at the time were quite challenging, or we didn’t appreciate for what it was. But looking back now, we may not change that because it did have a powerful effect on our life in a positive manner. And what we know is that, you know, for all of us adversity is an OK thing to experience in life. In fact, psychological research shows us that folks who have experienced adverse life events report higher overall levels of satisfaction in their life.

They’re more resilient, and people report fewer symptoms of trauma. They report overall levels of impairment and overall lower levels of emotional distress when compared to individuals with very little or no lifetime adversity. So again, lifetime adversity shapes us in a very positive direction. And, you know, hopefully, we’re all going to see that, through the last couple of years, certainly we’ve all experienced adversity. And on some level, even now, you may be able to look back and reflect upon how life has changed for the better as a result of the pandemic.

For some of us, we maybe haven’t seen that yet. And that observation will only materialize down the road. But this idea of, you know, growing from adverse experiences is also related to this concept of post-traumatic growth, which is another area of psychology, which describes the positive psychological changes that take place as a result of struggling with a highly challenging or stressful life circumstance.

Post-traumatic growth involves, you know, these psychological shifts in thinking and relating to the world and the self that contribute to a personal process of change that’s really deeply meaningful. This is when like the old normal is no longer an option.

And there’s five domains of psychological, post-traumatic growth that have been identified. And the first is, you know, people often experience a development of deeper relationships with others. The second domain that we often see is that people are open to new possibilities in life. This is related to identifying one’s overall purpose and meaning in life, what’s most important to them. The third domain is a greater sense of personal strength and ability. We have a greater idea of that. And the fourth is a stronger sense of spirituality, which is important in people’s life. And the fifth domain that we see as a result of post-traumatic growth are improvements in our overall appreciation for life. And so, again, we’ve all been through pretty tough times, you know, particularly over the past couple of years. But with time, hopefully we’ll see positive changes in our life as a result of this adversity that we’ve faced.

Dr. Luis Garcia:

Well, thanks for sharing that with us. That’s really profound Brian, and the appreciation of life and what we have in life, right? And I think that whether it is at home or at work, these last two years have really unified us as a workforce. And the way that we cared for each other in times of real adversity was just fascinating to watch. I’m highly appreciative for that.

Heather, I think that this conversation is showing us that it’s not a matter of if, but when you or I or anybody else could go through a difficult time, and most of the times very likely you could overcome that adversity alone, maybe without even sharing it with somebody, but there are times in which you’re gonna need help, right? And there are times where you need to accept that help. Can you talk to us a little bit about the wellness initiatives that we are putting in place in Sanford and how do we preserve that well-being at work?

Dr. Heather Spies:

Yeah, absolutely. I’d love to share. I think, you know, looking back on my personal journey that we kind of started with, you know, I think there’s always gonna be a gap in your well-being, but it’s whether you recognize it yourself or if you have the good fortune of a colleague or a friend, maybe saying something, you know, “Hey, I’ve noticed that maybe you’re not doing OK.” And so if you look at the – we have a wheel of well-being that we utilize through our Vital WorkLife resources that are available to all our clinicians at Sanford.

And the Vital WorkLife wheel of well-being has six dimensions. So it’s got your relational, your emotional, your physical, professional, spiritual, and financial well-being components. And I think at any given time, no human being can feel like or say that they’re optimally well in all those areas. It’s just not possible.

And it’s normal. I mean, we’re gonna sacrifice a little bit in one area to focus on one at different phases or seasons of our life. Like when I, when I had young kids, I would, I sacrificed some of my physical workouts some days because I would’ve rather, you know, taken the time to read a story to my kids at night because I had been at work longer that day or whatever. And so that’s OK, you know.

But I think overall we have to encourage people to pause and be just periodically checking in on those six different areas and saying, “Where, what area have I really let lag and is that affecting how I am doing overall?” And sometimes we see that. And so some of the resources that we have available to support those things are everything from counseling both internally, with our CAPS program here at Sanford, where we have counselors that we provide free of cost to all of our clinicians, that they can meet with and talk with.

So whether it’s emotional things or, you know, at work or personal relationship stressors, whatever it might be. So just to kind of get that relationship with the counselor started and see what else the needs might be that we can help provide resources for. We also have external counseling, so if somebody would prefer to have it be a little bit more external so that they don’t have, you know, a potential overlap of that colleague they can do it through our Vital WorkLife resource as well.

And just to go back a little bit, if they do want the internal coaching, we can do it across network too. So, say you do want it within Sanford, but maybe not the person that’s down the hall from you. We can connect our colleagues with people in another area of Sanford.

But everything from, you know, back to that wheel of well-being, everything from financial, you know, so say you just really need to meet with someone because you are feeling stuck and you just have this vision of, “I have no choice but to do this for 20 years. I can’t even see two less patients a day or anything because you just feel such a pressure.” We can provide you a meeting with a financial advisor to say, “OK, no, let’s pause and actually look at this.” I just had a colleague recently who, when she actually met with her financial advisor, she had no idea how much she had in her retirement fund, or how much, you know, what her long-term plan was. And it was actually really refreshing and freeing to her to just, you know, have that meeting and take a moment to look at that. So I think just awareness and knowing where you’re at is helpful to a lot of people.

And then physical, I mean, of course we can help with resources for our wellness programs, so all those kind of things.

And then if it’s relationships that we’re looking for I think that we have so many opportunities in Sanford to pair clinicians up with others. So we have a mentor program. We are now automatically pairing every new clinician with a mentor when they start but we’re also able to, if someone mid-career would really like us to help do that through our clinician experience office, we can help pair those people because really it comes down to relationships. And if you know that someone is listening to you and understands what you’re going through, because they’re also a clinician, maybe even in the same specialty or kind of in the same type of situation it just really does well for our well-being.

So those are a few of the things we have. I could probably talk for an hour on all different resources, but bottom line is, if you are looking for anything, all of our clinicians can contact their clinician experience specialist in their region, and we can lead you to hopefully what you need.

Dr. Luis Garcia:

Thank you for that, Heather, and I think that we have been very proactive at expanding those resources across the enterprise. And to your point, any need for our clinicians should be channeled through that Office of Clinician Experience. We have multiple resources available for them. Thank you for sharing some of them.

You know, Heather, you talk about that wheel of well-being and prioritizing some of these aspects of the wheel. Question for both of you, and I’ll start with you, Heather, again, what is one thing that you personally prioritize and why?

Dr. Heather Spies:

One thing that I’ve gotten much better at doing is my schedule. So I don’t know exactly which wheel that would fall into, but probably all of them, because what I do every Sunday is I intentionally, this is kind of, you know, embarrassing to admit, but I still write it out on a calendar. So I have my Outlook calendar, but I write out on paper – what does my week look like? And if I’m looking at my Outlook calendar and I see absolutely no white space on there, I go through and say, OK, can I move a meeting? Can I you know, move a kid’s appointment that isn’t, you know, urgent? Because if I don’t find time to at least go for a walk or do something like that, have 30 minutes to myself, I really can tell the difference, especially if I’m gonna be on call that week or I just have a really busy week.

It’s almost a necessity that I have some fresh air. So I write that in and then I see too, like, where can I delegate things? What can I ask my husband to do? What can I ask, you know, my 15-year-old to do and things like that. And so, that’s changed completely over the seasons in my life.

I look back to being new in practice and having two little kids, and I did this terribly. And if I could go back and maybe just do this one simple thing of spending literally 10 minutes on a Sunday mapping that out, I would realize that on Tuesday I’m going to be drowning, and I need help that day and just reach out to somebody or cross something off or cancel something but I never did that. I just kind of kept my head above water each day until I, you know, fell over. So that’s the one thing that is making me feel more well at this season in my life than I used to be.

Dr. Luis Garcia:

And it’s amazing how, if you’re not on your A game, how that impacts your family and your patience. Right? Let me share with you something. And, one time I asked my son, how do I make you feel when I’m not on my A game? And his answer was, “You make me feel scared.” And I can tell you that was not easy to hear. Right? You know, when you’re making one of your loved ones feel scared because of your actions that strikes your chord. So, thank you for sharing that Heather. What about you, Brian? How do you prioritize wellness in your life?

Dr. Brian Gatheridge:

That was a great statement that you made there Luis and I appreciate you sharing that story. You know, for me, the thing that resonates the most with me when I think about this question is at one point I learned not to confuse selfishness with healthy self-interest. And we know that many of us who work in health care feel like if we’re not there for others all the time, then we’re somehow acting in a selfish manner. And for me I’m constantly, I guess, checking in with myself to be aware of my stress signals and how I am feeling. As a parent, I guarantee you, my children have also, you know, experienced me at my worst. And, you know that’s something that we want to work to prevent as much as we can.

For me, I’m active in making sure that I participate in activities that ultimately promote wellness in my life. I can just tell you that to be healthy, I exercise quite a bit, and when I can, I am outdoors engaged in all kinds of different activities depending upon the season. And if I can do that with family and friends present, I’m all the better for it. I mean, those types of activities that are physical and outdoors are those that ultimately rejuvenate me and help provide me with the energy I need to be the best clinician and leader that I possibly can be.

Dr. Luis Garcia:

Appreciate that, Brian. And that’s so meaningful in impact of relationships, right? At all levels. So thank you for sharing that. I have one last question for both of you, and maybe Brian, I’ll start with you. What is your call to actions for those that are listening right now, our colleagues, our Sanford family members that are taking the time to listen to this podcast? What would you tell them? What’s your call to action?

Dr. Brian Gatheridge:

My ultimate call to action, and again, I just, I’m so proud of our organization and proud of the leaders within our organization who have made wellness a priority, who understand the importance of this, who understand that you can’t separate the mind and the body, and we need to take care of each other. And so I think if there’s one call to action, I would say is talk to each other. I mean, the research is pretty clear that within a culture, if we want to change the paradigm, if we want to reduce the stigma associated with acknowledging that we’re struggling and promoting people taking steps to get help, we need to acknowledge and share our struggles. We need to share our mistakes. We need to, you know, oftentimes people feel like, you know, they’re the only one feeling overwhelmed or in doubt or unsure but you’re not alone.

And it’s so empowering when we can speak up. You know, one of the wisest people that I’ve ever met shared three simple words with me, who, which will always stick with me. And it’s “never worry alone.” And so again, it’s just that message that if you’re struggling speak up. Don’t be too, don’t be afraid to acknowledge that you might be struggling. Let others know.

And if you’re not the one that’s necessarily struggling, don’t be afraid to lean in and check in with those colleagues of yours who you might observe to be struggling. Oftentimes we’re reluctant to ask because we don’t want to impose or we’re worried about the response that we may get. But if we don’t ask the question, we miss the opportunity to potentially improve the welfare of one of our close colleagues. And so those would be the things that I would encourage for now.

Dr. Luis Garcia:

Well said, Brian. Thank you. Heather?

Dr. Heather Spies:

Yeah, I think my call to action is simple as well. I love everything Brian said. I think the biggest thing is, you know, making sure we’re giving each other grace. Assume good. You know sometimes we tell ourselves a story that is not reality. You know, we assume someone is, you know, trying to make us work harder than them, this, that, whatever. And I think if we just assume good, that we’re all in this together, we all have the same intentions of caring well for our patients and doing a good job, and if we assume that it just makes the day go better and we end up treating each other so much better.

It’s OK not to be OK. We say that a lot, and I think we need to make sure to keep reminding ourselves that. So if you’re having a day where you’re not OK, like Brian said, reach out to somebody and ask for help who, you know, write down who is your one or two go-to people at work that you trust that you can just say, “Hey, I need you to you know, encourage me a little bit right now.”

And, you know, I’ll tell you, they’ll be happy to. I know if someone reaches out to say that to me, it actually lifts me up then, because I feel happy that they trusted me that they said something, and then I walk away thinking, OK, you know, now next time I need something, I might just ask them too. And I’m sure they’ll return the favor. So doing that for each other.

I think too, just taking one day at a time, be intentional about each day. Sometimes, like I said, when I look at my week, I don’t know how I’m gonna fit it all in. But then you break it down and you do one day at a time, and you just pause and make sure you’re intentional about spending some real time listening to your kids or listening to your spouse. I don’t think we talked about that much on this podcast, but spouses sometimes really get the brunt of things from their physician partner and I think we just need to make sure we are intentional each day. Just take one day at a time and focus on relationships, work, personal, all of those things.

Dr. Luis Garcia:

Well, thank you, Heather. I’ll tell you, Brian, Heather, it has been a pleasure for me to sit down with you today. Thank you very much for your time in this podcast. But more importantly, thank you very much for everything that you’re doing around this topic for our clinicians every day. And to our clinicians that are listening, I mean, what better way to conclude what we just heard? Never worry alone and always assume good. Please remember that we need you. Sanford is the greatest organization because of you. Our patients deserve your talent. And we, and you deserve our support, and we will continue to work on your behalf on this topic of well-being. So thank you for listening.

Alan Helgeson (host):

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

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Posted In Leadership in Health Care, Physicians and APPs, Rural Health