It’s a VUCA Time in Healthcare

I don’t have to tell you that these are complicated times in the world. The pandemic. Global warming. The war in Ukraine, and violence in many other parts of the globe. Inflation. Growing levels of inequity. The Great Resignation.

In healthcare, in particular, these are very complicated times. The pandemic has brought to light many of the problems that were already brewing below the surface. Under resourcing. Shortages in staff. Negativity and discord. Burnout.

 It’s no surprise that the term VUCA is being used more and more to describe what’s occurring in healthcare. It’s a term that first arose in the military following the 9/11 attacks, and the same term is all too applicable to healthcare, everywhere on the globe.

What Is VUCA

We can think of VUCA as a big, tangled mess. A mess that is occurring in healthcare and elsewhere.

V is for Volatility

Upon an already stressed healthcare system, the pandemic brought with it many rapid and challenging changes in healthcare. Volatility is at bay in many ways but is most evident in the high levels of attrition and turnover we’re seeing — in physicians, nurses, technicians, therapists, and even in those who clean patient rooms.

Indeed, a recent article in the Mayo Clinic Proceedings shed light on this issue. Looking at more than 20,000 respondents at 124 institutions, the study revealed that one in five physicians are planning on leaving their position in the next twelve months. For nurses, intent to leave was present in 40%. For advanced practice providers, 33%. This means a great deal of turmoil in hospitals and outpatient medical settings. It also raises questions about the sustainability of the entire enterprise.

This “Great Resignation” in healthcare is something I was quoted in earlier this year in over half a dozen major news venues. While I was happy to be involved as an expert on the topic, I, like others in the field did not have a lot of tangible solutions to stem this tide.

U is for Uncertainty

With all this change, there is a massive sense of unpredictability and uncertainty about what will happen next.

When will the pandemic end?

What difficulty will come next?

How will we do our jobs without adequate staff to support our efforts?

What will the new normal be?

C is for Complexity and Chaos

The level of complexity in healthcare these days is almost inconceivable. So many moving parts. So much dissatisfaction and burnout. So much chaos. And the complexity and chaos have contributed to what can only be thought of as a giant vortex of negativity pulling all of healthcare into its hold.

Additionally, there is so much change occurring that it has the makings of a dark joke:

You work in a major urban area where you are in competition with the other major medical practice across town. You leave for a well-needed vacation on a Friday and return a week from Monday only to find that your health system has been acquired by your that practice. Guess what? Now you have to work side-by-side with the clinicians who were just 2 weeks ago, your biggest adversary.

I hate to say it but, it can seem that, with all this VUCA, the joke may be on all of us in healthcare…

A is for Ambiguity

At the end of the day, we don’t know what all the changes in healthcare mean.

What does all of this mean for my current situation?

What does it mean for my future?

If this continues, who will be left to take care of me and my loved ones?

It is truly an ambiguous situation.

Since many of us are experiencing a VUCA reality, it’s important to understand the impact it has.

Certainly, a VUCA environment is both a disrupted and a disruptive one. It impacts all of us, doctors, nurses, technicians, therapists alike. Patients are certainly not spared. It can leave us:

  • Feeling unstable and ungrounded
  • Unsure of how to react to all the changes that are occurring
  • With lack of clarity on what our role is in a rapidly changing system
  • With reduced motivation to take actions that contribute to the greater good

Most importantly, living and working in a VUCA environment can leave us fearful, reactive, and feeling out of control. This means that our limbic system is frequently activated, taking us into a fight/flight/freeze state. Unfortunately, in this state, we’re trapped in survival mode. And survival mode means that our world narrows, and that we are reduced to looking out for #1, ourselves. When we’re looking out for #1, we invariably have less left over to give to others. And yet, perhaps VUCA times require a greater degree of leaning into connection and shared community than ever.

So, what can you do? 

Let’s Look At 4 Ways To Overcome Uncertainty

While the challenges of a VUCA world can seem inescapable and insurmountable, there are a number of steps you can take to manage yourself so you still show up in ways that you feel good about. So you can look back and feel proud about yourself and your actions.

A mindful approach can help you hold steady amidst these challenging times. Here are 4 mindfulness strategies you can employ.

Preventing Physician Burnout In Healthcare: Focus on Your Strengths

preventing physician burnout in healthcare
Photo by Andreas Fidler on Unsplash

It’s difficult preventing physician burnout when the demands keep increasing and it feels like the system is against you. For some, burnout becomes the norm, and it takes a big toll. In case you’re unsure, here are the three components of physician burnout:

  1. Emotional exhaustion and depletion
  2. Cynicism, depersonalization, and withdrawal from your work
  3. Inability to connect with your strengths and your accomplishments

These run together, creating a downward cycle. Looking at the last one, however, we see how a focus on one’s weaknesses can set the stage for burnout. As physicians, we are often our own harshest critics, saying things to ourselves that we wouldn’t say to others. Among the hundreds of physicians I’ve coached, I’ve seen many hyper-focused on their perceived inadequacies. Perhaps you can relate to this? Here are a few questions to help you see if you’re leaning in this direction:

Do you tend to see your strengths or your weaknesses?
Are you paying attention to what you’ve accomplished or what you haven’t?
Do you notice what’s going well or what isn’t?

If you answered yes, know that you probably come by these patterns honestly. They’re the result of our education, our workplace environments, and the broader culture we live in. Changing these habits takes some practice, but it’s a sure way to reverse the cycle of burnout.

Roadblocks to Seeing Our Strengths

Medical training tends to be deficit-based. In residency, our noses were often rubbed in any mistake we made. An Internal Medicine resident recently told me, “On my Onc rotation, the attending kept focusing on how few of the chemo regimens I was up on. On my Cards rotation, the fellow kept at my not being up on the latest STEMI trials. No one seems to notice when I do know something. It’s been so long since I’ve gotten any positive feedback, I’m not even sure if I have any strengths at all.” These types of hypercritical experiences of belittlement create stress, worsen physical and mental health, and can even lead to suicidal thoughts.

Most physicians have stories from their residency about being “pimped,” asked question after question by an attending, just so they’d finally get to the inevitable embarrassment of not knowing the answer. This pattern can leave us focused on our weaknesses as it relates to the practice of medicine.

Experiences like these are pervasive in our training and, for some, may be reminiscent of messages we received earlier in life. Whatever the origin, these self-defeating messages can fuel the downward spiral of burnout.

Physician Burnout and Negative Self-Talk

Let me share with you an example of just how deep this goes. When I give talks on resilience and preventing physician burnout, I ask:

What’s your typical ratio of self-promoting to self-defeating messages?

And do you know their typical response?

What is a self-promoting message?

Physicians are so used to the self-defeating voices that it’s difficult to identify with the concept of positive self-talk.

In addition to what we learn in our training, this also may result from perfectionism. Many physicians consider perfectionism an asset. And, while it may have served us in taking tests, perfectionism can hold us back today.

Physician Burnout and Perfectionism

Here’s one way of thinking about perfectionism:

  • Holding out for a barely attainable standard and then berate yourself for not achieving it.
  • Procrastinating to avoid facing self-criticism.
  • Believing that berating yourself will improve your performance.
  • Ruminating and experiencing anxiety about your performance.
  • Experiencing a lack of confidence.

Bottom line: Difficulty appreciating your strengths and successes.

A different frame to consider is: Have I done my very best? Can that be good enough?

Preventing Physician Burnout and a Strengths-Based Approach

If this resonates and you notice that the negatives dominate your thought processes, practice giving more attention to your positives. As discussed in a previous post, a strengths-based approach tends to be more motivating than whipping ourselves about our deficits. Here are some practical ways for you to shift focus to your strengths.

  • Notice when you get stuck focusing on your weaknesses.
  • Push yourself to shift attention to what’s going well.
  • Notice the “bright spots” in each day—times when something good happens; when you utilize your strengths.

When you find yourself back in the cycle of self-defeating thoughts, ask yourself:

  • What’s right about me?
  • Am I doing well?
  • What are the three things I’ve accomplished today?

Develop the habit of noticing what’s going well. Celebrate doing your best and practice letting “good enough” be enough. You may just find that this frees up your energy, replacing physician burnout with physician resilience which in turn helps you in preventing physician burnout.

Doctor Stress, Overwhelm, And Physician Burnout Treatment

doctor stress physician burnout treatment

Demystifying Physician Mindfulness: A 12-Part Mindfulness In Medicine Series

Does mindfulness in your medical practice seem achievable, or are you allowing “doctor stress”, overwhelm, and burnout run your life?

For many of my readers, the concept of mindfulness may seem out of reach. The term evokes imagery of tranquil monks and mountain tops, existing miles away, both literally and metaphorically. I created this series to bridge this distance, and to introduce mindfulness to practicing physicians as an accessible stress management tool for doctors, and a form of physician burnout treatment.

Each post in this series will examine the relationship between mindfulness and a specific area of a doctor’s day-to-day life. They each include a doctor’s story, and how the rigors of practice hamper their ability to fully enjoy that part of their life. After detailing their situation, I provide guidance for how the doctor can utilize mindfulness to gain fulfillment and mastery in that area.

With each post, I’ll give you an actionable step that will help you integrate the post topic into your daily life. I’ll also provide an exercise that you can practice in your free time that will help strengthen your resilience, calm, and fulfillment. My goal is to transform mindfulness from a daunting, unapproachable ideal into a broad toolkit that you have easy access to. Simply put, I want to help you be a happier, more productive version of yourself, at the workplace and at home.

Without further ado, the inaugural installment of Demystifying Mindfulness!


TODAY’S TOPIC: Doctor Stress, Overwhelm, And Physician Burnout Treatment

Our physician: Dr. P, is a cardiologist in a large Midwestern practice: 
“I don’t know what to do. I feel like I’m drowning in my work. Every day of my practice feels like a battle, and when I’m with patients all I can think about is getting to the end of my day. I used to be in love with my practice and I don’t know what happened. Now, my work feels meaningless, and I’m completely overwhelmed.  What can I do?”


 
Dear Dr. P, 
You’ve already won half the battle. You’ve noticed that you’re locked in an ineffective pattern at work, and you’re interested in strategies to improve your situation. This realization is no small thing! What I want you to start doing is focusing on your physical experience. You’ve just wrapped up with your last patient of the day, you’re late to make it home for dinner with your family, you still have a half dozen charts to complete – what does your body feel like? Is your heart rate elevated? Are your hands tense? Are you sweating? Get in tune with the physical sensations that accompany the feeling of overwhelm, and you’re well on your way to combating it,  and feeling more in control. 
 
Physical sensations often precede feelings of overwhelm; in some ways they’re an early warning system that can help you break the vicious cycle. Once you notice these physical precursors, take a brief pause. If you can take 5 seconds in between patients to take deep breaths and ground yourself, that’s a victory. See how many of these pauses you can give yourself in a workday. While this may seem trivial, over time, mindful pauses will begin to weave together into a calmer day, and a calmer and happier life. 

In addition to your feelings of “doctor stress”, overwhelm, and burnout, you wrote that you no longer feel connected to your work. Overwhelm and lack of passion and fulfillment often go hand in hand. Of course, it’s challenging to stay connected to work when it’s so demanding. Reducing feelings of overwhelm by mindfully pausing throughout the day will help you feel more authentically connected to your work, and may revive some of the enthusiasm you’ve experienced in the past. Reciprocally, mindfully nourishing your commitment to patients will shrink feelings of overwhelm.

At the end of every day, I encourage you to write down things that went well in your day. Focusing on what went well can reconnect you to your strengths and your sense of meaning. As doctors, we are trained to focus on what is going wrong. Give yourself structured time to focus on what is going right. 

Give this mindful strategy a shot to offset the daily stress in the medical field physicians like you face,  and to help reduce the risk of physician burnout as you move toward being more present and fulfilled in your practice 

To your resilience,
Dr. Gail Gazelle


Have an idea for a future Demystifying Mindfulness post? Want Dr. Gazelle to help you tackle your problem? Write in at drgazelle@mdcanhelp.com or contact us on the website.