Physician Health

The President’s Podium: A Final Message

Posted in Medicine, Physician Health on May 4th, 2016 by MMS Communications – Comments Off on The President’s Podium: A Final Message

By Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

Dr. Dimitri XIn my inaugural address a year ago, I spoke about something I consider to be one of the most important issues facing the medical profession today: physician (dis)satisfaction.

As the end of my presidency approaches, I believe it is important, not only to our colleagues in the profession, but to our patients as well, to reiterate some of what I said.

My remarks last May highlighted the fact that we physicians are privileged to have our patients come to us, sharing openly all of their own difficult circumstances, that they look to us to help them overcome these problems.

I urged my fellow physicians to remember that that privilege means we must put our patients’ interests before ours. I reminded colleagues that we should think for a moment about the impact we have on our patients’ lives.

Still, we hear much about physician burnout and the loss the joy in practice.

“Physician” still rates as one of the most respected professions in every public poll, yet many within the profession are less sure of that.

This increasing dissatisfaction within our profession provided the genesis for the annual education program at the 2016 MMS Annual Meeting – Sustaining Joy in the Practice of Medicine: Compassion, Innovation, and Transformation.

I have the privilege of moderating a program with national experts who share the love of practicing medicine and who are committed to helping physicians overcome these challenges and restore their passion for this profession.

Participants include Jeffrey J. Cain, M.D., Chief of Family Medicine at Children’s Hospital Colorado; M. Bridget Duffy, M.D., Chief Medical Officer of Vocera Communications; and Christine A. Sinsky, M.D., Vice President of Professional Satisfaction for the American Medical Association.

Among the topics to be addressed are lessons we can learn from patients, why caring for the caregiver is so important, how we can transform the practice of medicine, and how physicians can rediscover the joy in the practice of medicine.

My tenure as MMS president has been marked by many issues, most significantly the opioid epidemic, electronic health records, and the search for a new executive vice president of MMS.  Given the urgency of those subjects, I didn’t get as much opportunity as I would have liked to focus on the issue of physician satisfaction.

While I end my presidential year firmly believing that we have established our medical society as a leader in the Commonwealth’s fight against substance abuse, that we made an important contribution in easing the burdensome requirements of information technology, and that we have selected a new executive who will be a great partner of physicians for years to come, I wish to leave colleagues with the same message I imparted when I became president.

And that message is this: Physicians really are different, and what gives us the greatest satisfaction is providing good care to our patients. It’s what our patients expect, it’s what we like to be able to do, and it’s what we should remember on those days when the frustration mounts.

So when you are feeling dissatisfied about regulations, prior authorization, delays in payments, or searching for a course to fulfill your risk management CME’s, remember this: I helped some patients today.

The President’s Podium appears periodically on the MMS Blog, offering commentary on a range of issues in health and medicine.

 

Lessons from “The House of God”

Posted in Physician Health on December 3rd, 2014 by MMS – Comments Off on Lessons from “The House of God”

 

In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.


stethoscopeBy “Samuel Shem, MD”

I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.

These are times we all have each day, finding ourselves doing things—or not doing things we should have done—and we say to ourselves, “Hey wait a second, why did I just do that–or not?” There were so many of these, I started writing.

Looking back, what have I learned from The House of God?

My generation came of age in the ‘60s. We grew up with the idea that if we saw an injustice and took action together, we could change things: we helped put the civil rights laws on the books, and we stopped the Vietnam War.

In 1973 when we entered our internship, we were idealistic young doctors, wanting to learn, dedicated to treating our patients humanely. But soon we were asked to do things that we thought were inhumane.

We were caught in a profound conflict: between the received wisdom of the medical system, and the call of the human heart. And so, without thinking about it, we resisted. In fact, The House Of God can be read as a kind of medical manual of non-violent resistance.

I have four suggestions for how to stay human in medicine.

1: Stay Connected

Isolation is deadly; connection heals. And connection comes first. Think of a relationship you’re in: if you’re in a good connection, you can talk about anything; if you’re not, you can’t talk about anything!
The hospitals we entered were large medical hierarchies. In these “power-over” systems, we interns got isolated. Not only did we get isolated from each other and our friends and families, each of us got isolated from our authentic experience of the system itself. We started to think that we were crazy, for thinking it was crazy.

Isolation can mean death—as when Potts, one of the interns, commits suicide. In a power-over system, the only real threat to the dominant group—whether dominance is based on gender, race, ethnicity, class, religion, or sexual preference—is the quality of connection among the subordinate group. So in your training, please remember: Stick together. Connection comes first.

2: Speak Up

When we notice injustices and cruelties in the medical system—and believe me you will—speak up. Speaking up is necessary not only to call attention to the wrongs of the system, speaking up is essential for your survival as a human being.

If we see something and say nothing, it will gradually tear us apart. Because others before you have spoken up, your on-call hours are more humane. And believe me, that matters, a lot.

3: Learn Empathy

Once, when I mentioned this to second-year Harvard medical students, one raised his hand, “We learned empathy already.” What? “Yes, last year in interviewing. Empathy is when you repeat the last three words the patient says and nod your head.”

How do you learn empathy? By putting yourself in another person’s shoes, feelingly. By seeing, in that tiresome old lady, your mother, and in that cranky child, your son. By finding good teachers who live compassion—and following along behind, like a duckling a mother duck. Realize that any good connection is mutual; the other person is getting as much out of it as you are.

Warning: studies show that medical student empathy peaks at the end of year two—and goes downhill from there. It’s a real challenge, to stay empathic during the rigors of your residency.

4: Learn Your Trade, In the World

The patient is never only the patient—the patient is the spouse, the family, the friends, the community, the toxins, the crashing climate, where the water comes from and where the garbage goes. The patient is the world.

And here’s the good news: you graduates are totally awesome in one big way that my generation was not: you are citizens of the world. You have been everywhere, done everything. To you, foreigners are not foreign.

You are not isolated from, or suspicious of, different people and cultures, you are with them–even if only through your texts and twitters. You are the hope of the planet, and I—and your families and friends here today—are so proud of you it brings tears to our eyes!

So: Stay connected. Speak up. Learn empathy. Learn your trade, in the world.

Let me end with another moment from The House of God.

One of my patients was a middle-aged woman with metastatic breast cancer. The surgeons operated on her, found they could do nothing, and closed her up and sent her back to the ward.

After she woke up, a nurse came to me and said that no one had told her what the surgeons had found, and that I should. I couldn’t face it. I said that it was her private doctor’s job, not mine. I’m not sure who finally told her, but it wasn’t me. That was a “Hey wait a second” moment, an emblematic moment that I’ve never forgotten.

To this day, 40 years later, I’m still ashamed of my turning away, letting her down. And so in the novel I decided to write what I should have done. The Fat Man volunteers to take care of it:

“I watched the Fat Man [a character in House of God] enter her room and sit on the bed. The woman was forty. Thin and pale, she blended with the sheets. I pictured her spine x-rays, riddled with cancer, a honeycomb of bone. If she moved too suddenly, she might crack a vertebra, sever her spinal cord, paralyze herself. Her neck brace made her look more stoic than she was. In the midst of her face, her eyes seemed immense.

“From the corridor I watched her ask Fats her question, and then search him for his answer. When he spoke, her eyes pooled with tears. I saw the Fat Man’s hand reach out and, motherly, envelop hers. I couldn’t watch. Despairing, I went to bed. Later, after an admission, I looked into the room gain. Fats was still there, playing cards, chatting. As I passed, something surprising happened in the game, a shout bubbled up, and both the players burst out laughing.”

You never know when such a moment can happen, and change you as a person and a doctor—it’s still so fresh in my heart. You’re probably saying, “But who has the time to stay with her like that?”

True, and yet time’s a funny thing–it’s really not a matter of time: studies show that if a doctor’s intention is to listen deeply to a patient, it only takes about 18 seconds to have a moment experienced by the patient of “being with,” of good connection, of “feeling seen”—and then of being more open to revealing personal information.”

That present moment may be the most significant thing we do for someone who is suffering, that moment of mindfulness, what the Dalai Llama calls, “being a beautiful presence.” And hey—these are the moments we live for, yes? And you never know when they might suddenly appear! So be ready—as Hamlet put it, “the readiness is all!”

Or, as a patient of mine once said, “Doc, y’know, you never know, y’know.”

My new novel, The Spirit of the Place, is about primary care doctors in a small town—a young doctor joining his former mentor in practice. This was a dream of mine, to go back home to practice. It didn’t work out in life, so I did it in fiction.

At one point the young doctor is making a difficult personal decision, and hears the words: Don’t spread more suffering around. Whatever you do, don’t spread more suffering around.

This is the basic human story. We are all on the same journey. Every one of us will suffer–that’s the Buddha’s First Noble Truth. There’s no way around it. The crucial question is not suffering, it’s how we move through it.

If we isolate ourselves and try to gut it out, alone, “stand tall, draw a line in the sand”, we will suffer more, and spread more suffering around. But if we move through the crucible of suffering with others—with caring others, and that’s where we doctors come in, that’s our job!—we will not suffer as much, we will not spread more suffering around, and understanding will arise, and even kindness and awareness.

This is not a psychological healing, but a spiritual one—greater than your self. Each of you has been touched by it, the spirit, at least once, or you wouldn’t have made it here, now.

As a doctor, a writer, a husband, a father and a person, I believe in this power of good mutual connection to heal, I believe in this spirit, this redemption.

That’s the challenge, the thrill, the joy in The House of God: to become aware that the pain and suffering of others is the same as our own; to become aware that if we are ignorant of our neighbor’s sorrow, we bring sorrow to our own door; and with that awareness, to take anger and spin it to compassion; to give solace, to heal. For at our best, we don’t just doctor, we heal.


 

This article originally appeared on the blog What Works For Me.

Announcing “What Works For Me” – An Opportunity to Share, and Learn

Posted in Physician Health on April 18th, 2014 by MMS – Comments Off on Announcing “What Works For Me” – An Opportunity to Share, and Learn

Steven Adelman, MDBy Steve Adelman, MD

I believe that it is essential for health care professionals to balance the stresses and demands of medical practice with enlivening passions, absorbing pastimes, and effective self-care strategies.

Over the past year, I have spoken with more than a thousand Massachusetts physicians about the everyday challenges of practicing medicine in 2014.  The good news is that many busy doctors have developed passions, pastimes and coping strategies that sustain us and help us to maintain an even keel, even when the weather is stormy.

To that end, Dr. Eddie Phillips, a dynamic leader in the important emerging field of lifestyle medicine, and I have created a community blog, WhatWorks4Me.org to showcase and share personal and professional “best practices.”

What works for you? What do you do at home, at work, and in the community, to keep your personal batteries fully charged? What personal and professional practices keep you engaged and excited, when you are “on duty” and when you are “off duty?”

Our first two posts come from Dr. Jeremy Lazarus, immediate past president of the AMA, and Dr. Mary Ann Rose, a radiation oncologist and equestrian who hails from California.

If you’re interested in contributing to this community, please click here to submit a 300-600 word account of what works for you. Try to dig beneath the surface a bit and reveal the “why” behind your passion. Consider including a patient anecdote (disguised and de-identified) to make your story come alive. Do patients know what works for you? How have they reacted? We review and acknowledge every submission, and we will post those that promise to inspire other health care professionals.

We invite you to stop on by, and hope that you will submit a firsthand account of what works for you.

Steve Adelman, MD, is a psychiatrist and director of Physician Health Services, a corporation of the Massachusetts Medical Society.

In Memoriam: Michael Palmer, MD, Physician Health Pioneer

Posted in Physician Health on October 31st, 2013 by MMS – 3 Comments
Michael Palmer, MD

Michael Palmer, MD

Michael S. Palmer, MD, one of the nation’s leading authorities on physician health and a founding associate director of Physician Health Services, died yesterday. He was 71 years old.

In addition to his trailblazing work on physician health, Dr. Palmer was an accomplished author of 17 suspense novels, including several New York Times bestsellers. His work has been translated into 35 languages.

At the time of his death, Dr. Palmer was an associate director emeritus of Physician Health Services, and was still very actively involved in the organization.

He spoke openly about his own recovery from drug and alcohol abuse. In a 1996 New York Times article he said, “You’re taught from the day you start medical school that you’re a god, that you can have power over life and death. So when your life starts to crumble and the highest power you see is looking back in the mirror — and you know that power is flawed — it is very hard to get past that. …The doctor’s intelligence is often a barrier to recovery. But once he gets into recovery, it’s a huge asset because he sees the logic.”

Here is what colleagues and friends are saying today about Dr. Palmer:

“Dr. Palmer was remarkable about how openly and courageously he shared his struggles about losing control of his life early in his career due to problems with alcohol and drugs. What was more remarkable, however, was how he transformed his own challenges in dealing with these issues into an exquisite sensitivity and capacity to gain the trust and confidence of fellow physicians who suffered the same challenges that he overcame. He did this by providing compassionate direction and wisdom to help others to achieve recovery, change, and growth in their own life.”

— E. J. Khantzian, MD, President and Chair, Physician Health Services

“Michael was, and still is, the spiritual godfather of Physician Health Services. He possessed a unique combination of selflessness, keen intelligence, and compassion. His bottom line was to do what was in the best interest of physicians and patients, and he always stepped up to be helpful in the most trying of circumstances. His loss opens up a void that can never be filled; his legacy will help us to redouble our efforts to emulate the many examples he set.”

— Steven Adelman, MD, Director, Physician Health Services

“Michael was to me bigger than life. He was accomplished in so many areas; a famous best-selling author, a talented musician, a bridge player, a caring physician, a power of example, and so much more. Yet he truly personally cared about each and every one of us he encountered on his journey. I cannot fathom his not always being here.”

— Judith Eaton, MD, Associate Director Emerita, Physician Health Services

“Michael was one of a very small number of physicians who stepped up in the late 1980s to create  the original Committee on Physician Health, the predecessor to PHS.  He and Bernie Levy (and maybe one or two others) spent huge amounts of time educating Board members and staff about voluntary disclosure and treatment models that provide more public safety than 100% reliance on BORIM discipline.  You have to remember or imagine a world without PHS; it wasn’t pretty. He was one of the laboring oars that convinced the BORIM do a 180. What a loss.”

— Andrew Hyams, attorney, and General Counsel to the Massachusetts Board of Registration in Medicine, 1985-1990

Dr. Palmer served as a clinical instructor in medicine at Tufts University and was on the faculties of Harvard Medical School and the University of Cincinnati School of Medicine. He graduated from Wesleyan University in Middletown, Conn., and received his M.D. degree with honors from Case Western Reserve University. Following an internship and residency on the Harvard Medical Service of Boston City Hospital, he completed a senior residency at Massachusetts General Hospital.

Funeral for Michael S. Palmer
Sunday, Nov. 3, 2:00 p.m.
Stanetsky-Hymanson Memorial Chapel
10 Vinnin Street
Salem, MA 01970   |   (781) 581-2300

Reception to follow:
38 Outlook Road
Swampscott, MA

Barbra Streisand and the Practice of Medicine

Posted in Caring for the Caregivers, Physician Health on September 12th, 2013 by MMS – Comments Off on Barbra Streisand and the Practice of Medicine

By Steve Adelman, MD

What do these two pictures of Barbra Streisand tell us about the shifting role of physicians?

In the first picture we see Barbra in her full glory. Alone, on center stage, belting out one of my sister-in-law’s favorite torch songs. You just know that all eyes of the audience are on her, that she is in her element, that she may even be “in the zone.”

In the second picture, Barbra is a member of a chorus, a face in the crowd. To me she looks uncomfortable, almost lost. Other singers appear more engaged in the moment, more enthusiastic. Their eyes are trained off to the left, whereas Barbra looks straight ahead.  Barbara Streisand is no longer in her element.

Many of us went into medicine when the profession promised us autonomy, authority, and some measure of control of our destinies. Physicians were at the center of the health care stage. If we weren’t practicing like solo pilots, we were like ship captains. Our place in the health care hierarchy was at the top.

Medicine has become a team sport. The members of the team are too numerous to count. Some of them are nameless and faceless, yet the roles they play have a material impact on our sense of professional well-being, our livelihoods, and on our ability to maintain a sense of healthy balance in our lives.  The lives of some physicians are becoming increasingly unmanageable, as we endeavor to adapt and adjust to our new professional and societal roles.

All of this is stressful. And stress leads to professional and personal burnout – a sense of physical, emotional, and cognitive exhaustion.

We still have space in our 9th Annual Caring for the Caregivers Conference, “How Do We Reduce Physician Stress and Burnout?” This content-rich one day CME conference will be held on Thursday, Octo­ber 3, 2013, at MMS headquarters. If you choose to participate, you will acquire knowledge and skills to enhance your well-being at work, bulking you up to face the stresses and strains of everyday medical practice.

Register here for the conference, while space is still available.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org. Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

 

Where Have All the Smiles Gone?

Posted in Caring for the Caregivers, Physician Health, Steve Adelman on August 26th, 2013 by MMS – Comments Off on Where Have All the Smiles Gone?

By Steve Adelman, MD

What happened to turn the bright-eyed and bushy-tailed young house officer (right) into the late career physician (below) whose withering glance strikes fear in the hearts of patients, colleagues and office staff?

The answer, of course, is stress and burnout. The practice of medicine these days is inherently stressful.  The so-called health care system is more complex than ever, and the practice lives of most physicians are replete with all manner of acute and chronic stress.

We are victims of our own success. As life expectancy increases in the face of more and more administrative overload, reimbursements are decreasing. The art and craft of medical practice are gradually giving way to an industrial model of care that runs against the grain of many of our best and brightest. Our profession is in the midst of a painful transition, and legions of physicians feel as though they are wandering in the desert, with no view of the Promised Land in sight.

A Medscape survey earlier this year demonstrated burnout rates ranging from 30 percent to over 50 percent, depending on medical specialty. The hardest hit specialties include internal medicine, family medicine, and ObGyn, along with emergency medicine and critical care.

Medscape defined burnout as “loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.”  It also involves the trifecta of physical, emotional and cognitive exhaustion.  Little wonder that our late career physician isn’t smiling.

So what can we do to reduce physician stress and burnout?

Come learn about a variety of actionable countermeasures at our upcoming day-long Caring for the Caregivers CME program. Domain experts will share their wisdom on utilizing peer support, resiliency, mindfulness and compassionate care to combat the stresses of everyday medical practice.

Participants will have an opportunity to work in small groups to develop a roadmap for integrating these self-care methods into their daily practice lives. The program will conclude with a spirited feedback session that will involve discussing the matter at hand with a panel of senior health care leaders – an opportunity for dialogue to promote meaningful change on the front lines of medical practice.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org. Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

Each Physician Counts

Posted in Physician Health, Steve Adelman on June 6th, 2013 by MMS – 1 Comment

By Steve Adelman, MD

Last month I wrote about the MMWR’s report of an alarming increase in overall suicide rates when comparing 1999 with 2010. The demographic breakdown of the data did not include an analysis of employment or professional status.

It is well-known that physicians have an especially high suicide rate. Over the years, various studies suggest that physicians kill themselves at a rate that is about double that of the general population. Approximately one U.S. physician per day commits suicide. This represents an annual physician suicide rate that is the equivalent of 3 graduating medical school classes. If these high suicide rates are sustained, more than 2% of all medical school graduates will take their own lives.

The suicide rate of female physicians is particularly high. Women account for almost one half of all physician suicides, and they kill themselves almost four times as often as female non-physicians.

Time will tell whether or not the overall increase in completed suicides reported in 2010 continues to be sustained. It may be related to the economic downturn that led to high unemployment and the glut of home foreclosures.

We also do not know if the already high rate of physician suicides is increasing. The information on physicians cited above is based on data collected intermittently over the past 40 years. However, in 2013 the medical profession is rife with reports of physician stress and burnout. Few of us would be surprised to learn that suicide remains a significant occupational hazard in our profession.

There has been much speculation as to the causes of the heightened physician suicide rate. There are many reasons to believe that the current environment may be increasingly hazardous to the health of physicians. To wit:

  • We are victims of our own success. The explosion of medical knowledge and therapeutics has increased longevity, and as people live longer, their medical care becomes more complex and demanding. Concurrently, there is growing pressure on the health care dollar. In this environment, many doctors are called upon to do more with less.
  • Technology and regulatory requirements add new layers of complexity to the practice of medicine, and the pressures to be a productive physician have never been greater. There is less time available for the sustaining human connection that is at the heart of the doctor-patient encounter, and this frustrates every physician I know.
  • The demanding health care world we live in makes it more difficult than ever to balance the demands of work with the pleasures of family and community, and many of us find it increasingly difficult to take good care of ourselves.

It is incumbent upon us, as a profession, as members of health care teams and organizations, and as individuals, to meet these challenges effectively in order to improve the quality of physician life in our society. I am hopeful that we in the physician community will use our wits, our energy, and a spirit of self-help to establish successful strategies to counter the occupational stresses and pressures that may contribute to our unusually and unacceptably high suicide rate.

On October 3, 2013, the Massachusetts Medical Society and Physician Health Services are jointly sponsoring a one-day “Caring for the Caregivers” CME event that will focus on peer support, mindfulness, compassionate care and resiliency training as strategies that can be utilized to improve the work life of practicing physicians. Stay tuned.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org. Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

Listening First Aid

Posted in Boston Marathon, mental health, Physician Health, Steve Adelman, violence on April 23rd, 2013 by MMS – 1 Comment

By Steve Adelman, MD

In the past two days, I have had the privilege of participating in two large support sessions for volunteers who witnessed the horrors at the Boston Marathon finish line. The sessions were organized by the Boston Athletic Association, in conjunction with the Massachusetts Department of Public Health.

The purpose of these events was to give stressed and  traumatized volunteers an opportunity to come together, share their experiences, and to commence the process of regaining a sense of emotional well-being after having served a sudden and unexpected tour of duty in an urban war zone.

Sunday’s session took place at the Boston Sheraton on Boylston Street, not far from the finish line. Monday’s session took place at the offices of the Massachusetts Medical Society and Physician Health Services, in Waltham.

Many affected volunteers at each session expressed feelings that they wish they had done more. Virtually everybody at the scene was thrust into a chaotic and unpredictable situation, one that nobody anticipated. In the minutes after the blasts, most everyone at the scene of carnage experienced serious challenges to their sense of being competent and effective.

Although the results speak for themselves – many, many lives and limbs were saved by a superlative team effort – the members of the team are all feeling pretty bad. It’s as if they were saying, “I have no idea how our team won on Monday, because I certainly could have played better.”

Many of the survivors described awkward conversations in the community and the workplace:  “People call me a hero, but I don’t feel like a hero.” It’s very difficult to feel incompetent and to be told that you are a hero.

Several survivors have learned that people out there “just don’t know what to say.” After the manhunt ended on Friday, a common comment they heard was, “You must feel better now.” But they didn’t feel better – many of them felt worse.

Question: How do we talk to people who have recently endured extreme trauma?

Answer: Very little – better to listen than to talk.

Listen very carefully, and try to put yourself in their shoes. Ask open-ended questions and respect their answers and wishes. Follow the lead of the person you are listening to. Here are a few questions and comments to consider utilizing if you undertake a conversation with a traumatized person:

  • Do you feel like talking?
  • What would you like to talk about?
  • Tell me more.
  • What was that like?

Don’t assume that you know how the other person feels, and don’t assume that their experience of the trauma is what you imagine it to be. By asking gentle, empathic questions, you can help the trauma survivor to unburden himself or herself, but only if he or she wants to.

As an empathic listener, your job is to follow the other person’s lead, never to take the lead. If the survivor you are with prefers to remain silent, that’s okay. Just let them know that you’re ready to listen if they ever feel like talking.

Gregorio Billikopf Encina of the University of California Berkeley has referred to this form of “empathic listening” as “listening first aid.”

Now that the acute trauma of the Marathon explosions is beginning to subside, let’s approach our conversations with the survivors – in our communities and throughout the health care system – in a low-key, respectful, and empathic way. By applying “Listening First Aid,” we can promote healing by helping them to feel understood, by trying, as best we can, to see the fractured world through their eyes.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.

“This Too Shall Pass”

Posted in Boston Marathon, Physician Health, Steve Adelman, violence on April 19th, 2013 by MMS – Comments Off on “This Too Shall Pass”

By Steve Adelman, MD

The surreal situation unfolding today in Greater Boston will surely pass. In the meantime, a tsunami of images, directives, theories and fears is flooding the hearts and brains of our entire community. In this kind of atmosphere, those who are emotionally vulnerable are being whipped into a frenzy of stress, anxiety, and, in some cases, panic.

As physicians, we are uniquely qualified to help our community maintain a sense of proportion. We know how to stay calm in times of stress and strain; we know that the “tincture of time” is sure to heal in aberrant situations like this one.

The public looks up to us.  Let’s do our best to communicate a sense of calm and reassurance to all. Let’s use our knowledge, experience and professional perspective to help people maintain, or regain, their composure.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.

We are All Patients, We are All Healers

Posted in Boston Marathon, Physician Health, Steve Adelman, violence on April 16th, 2013 by MMS – Comments Off on We are All Patients, We are All Healers

By Steve Adelman, MD

Terrorism is a vile disease, and when this disease strikes civilized society as it has in Boston, we are all afflicted. A sudden explosion turns all of us, immediately, into patients.

In times of crisis like this, we are all in pain. We suffer together. Each and every one of us has been violated. Innocents have been slaughtered and wounded; lives have been permanently damaged; a day of joy and celebration has been transformed into a day of mourning.

The disease of terror is not a fatal one. We New Englanders are fighters and we are helpers, and within seconds of the Marathon explosions we went into “healing mode.” A photographer at the finish line used one hand to shoot pictures while, with the other hand, he tore down barricades to get to the wounded . Momentarily stunned medical personnel immediately transformed the first aid tent into a field hospital. Friends and family rallied to assist and reassure one another, taking advantage of technology to reconnect and begin bouncing back.

Some bounce back faster than others. Here are some readily available resources that may be of assistance:

Coping with Disaster
FEMA – Ready.gov

Managing traumatic stress: Tips for recovering from disaster and other traumatic events
American Psychological Association

Recovering Emotionally
American Red Cross

Disaster Distress Helpline (24/7 phone and text)
Substance Abuse Mental Health Services Administration

Kevin Kennedy, Ph.D., is a Chief of Behavioral Health at Harvard Vanguard Medical Associates and a highly-regarded expert in parenting. I asked Dr. Kennedy to provide some practical parenting tips to guide us in talking to our children about the disaster in Copley Square. Here’s his advice:

“Events like the tragedy at the Boston Marathon cause children to feel vulnerable and unsafe. This is unavoidable. It is important that parents be realistic about the fact that some people do bad things but that most people are nice.

“Children are reassured by order and structure, so it helps to maintain the usual schedule of routines and activities in the family. In an environment of 24-hour news, parents can help children by limiting their exposure to excessive television coverage. Repetition of troubling videos can convey a disproportionate degree of danger.

“For much the same reason, parents should limit the amount of conversation about the tragedy in the presence of their children. Be sure to ask if the children have any questions and be alert to their concerns. Don’t be surprised if they want to remain close to home and need more than the usual attention or reassurance.

Above all, parents can assure children of their love and affection and their intention to take good care of them.”

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.