Action Needed: Colleague Care for the Wellbeing of Medicine

This week we are rounding out the Action Needed for the Wellbeing of Medicine Series regarding physician wellness by addressing our colleagues' well-being. We first addressed organization and structural actions, then self-actions, and now we move on to our colleagues. 

I will open with a quote from Dr. Mukta Panda, MD, MACP, FRCP, the Assistant Dean for Well-being and Medical Student Education and Professor at the University of Tennessee College of Medicine.

“We cannot talk about well-being unless we talk about self-care, colleague care, and belonging together.”

We reviewed some tips on self-care and connection last week. Let’s look at how colleague care could be incorporated. 

Routine check-ins – These can be as often as feels right for you. It takes little time to foster connection.  How are those you work with experiencing life?

1. Intentionality is key in finding out.
2. You may be the only one to reach out.
3. We all know if we ask, “How are you doing?” or “How is it going?” the answer won’t convey our level of concern or even uncover how they really are doing. Which coworkers do you want to check in on routinely? Some suggestions from the US Surgeon General's Advisory include, “What was the hardest part of your day?” and “What went well today?” Sometimes, asking “How are you, REALLY?” while making it obvious you’re stopping to listen is helpful. 
4. Consider a daily or weekly team check-in. Doing so creates a psychologically safe space and offers a judgment-free zone for the shared human experience.
   1. You could use the stress continuum type model for everyone to rate themselves.
   2. Or, you can apply the Brené Brown Relationship Percentage concept as a team. What percent does each member have to give at the beginning of each day? Think of it as each person contributing a percent to the team's energy and effort which adds up to 100% total for the team. When one team member is drained down to 15% but their usual share is 25%, what other team members make up the effort deficit? Who has more than their usual share to give? When the individual totals don’t add up to 100%, then you have a gap. What’s the team gap plan? What gets deprioritized or outsourced, or postponed? What extra team care measures or recruits will be added?
   3. I also love Dr. Panda’s questions to her rounding team at the end of the day. “What surprised you today?” “What inspired you or gave you hope?” Using appreciative inquiry to battle the negativity bias can be effective.

Awareness check-ins. - It’s essential to recognize when our coworkers act out of character. Do they seem withdrawn or more irritable? Has their appearance changed? Does it seem their level of engagement or clinical judgment has declined? Do they murmur about quitting?  Are they excessively using alcohol or other substances? Are they talking as if they are hopeless? You may be the only one to notice - so reach out.

Check-in checklist – it’s essential to consider the following

1. Setting. Find a private location that will foster honesty and be free of distraction.
2. Mindset. Getting yourself to a place of being unrushed because you know the time will be worth it. You also allow them to share their experience of the day/situation/work/life without judgment.  
3. Ears and body language. Active listening allows for uninterrupted time for your colleague to reflect out loud. Eye contact and other non-verbal cues demonstrate your willingness and concern and are helpful.
4. Words. We want to avoid empathic failures. Choose words that demonstrate compassion and shared experience without dismissing their unique perspective and experience of it. Take care to stick with understanding how difficult their experience is without making it about you. Choose words that offer hope without platitudes. Don’t go into “fix-it mode.” A common empathic failure is for us to try to make them feel better by playing down the situation. Ask their take-homes as they are processing rather than being directive or turn it into a bidirectional venting session.
5. Proactive support. Instead of only “Call me if you need anything” (which is good for them to know), perhaps saying something such as, “What actions can I do right now for you?” will be more helpful.
6. Acknowledge the suffering and remind.  They may need to remember that comparative suffering is not helpful or accurate. Many may feel that they’re not suffering as much as “so and so” right now, so they don’t want to whine or ask for “special favors.”
7. Normalize. If they are shying away from needed self-care so as not to put more burden on their colleagues, remind them that by doing so, they not only are being a good role model, but they are also halting the cycle that heaps shame and guilt on other physicians when they need time off or assistance. Let's ditch the perception of "weak" team players and trust that everyone is doing their best, and that it is enough.
8. Suicidal ideation check. Don’t shy away from inquiring about suicidal thoughts. Asking does not increase the risk.
9. Know your resources. Have an accessible list of local and national professional resources.
10. Follow up. In his presentation a few weeks ago, Dr. Lex Von Hafften reminded us that after the initial conversation in which our coworkers open up, it may lead to mixed feelings and ambivalence about having shared. That, in turn, can lead to more withdrawal or denial. By circling back a few hours to a couple of days later to check-in, you're helping mitigate that reaction.

To learn more, the AMA has a wonderfully put-together module for helping others with intense stress.

Have a joy-filled week! Tonya

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