On this week’s episode, Dr. Andrea Austin discusses what resilience looks like in the medical field and shares practices that can help physicians improve their well-being. Dr. Austin?

My name is Dr. Andrea Austin. I’m an emergency medicine physician. I’m also a simulation educator and director of a simulation center at Southwest Healthcare. I’m author of the book Revitalized: A Guidebook to Following Your Healing Heartline.

Resilience is a word that probably causes some physicians to recoil. It has been weaponized, to some extent, that the issues around burnout are related to physicians not being resilient enough. We know, in reality, physicians are so resilient to choose to go into medicine, be with patients, give them difficult news, and talk with families. Inherently, people that choose to do that work are resilient.

That said, there are some next-level resilient practices that are more common in the psychology and neuroscience worlds that we really need to bring to physicians earlier on in their medical education. They can incorporate some of these resilient practices to have a more fulfilling career.

One example of this next level of resilience is something that I like to call ‘grounded gratitude.’ We know gratitude is important to being fulfilled. Studies say gratitude can be as effective as an antidepressant for mild depression. But right now, medicine is hard. How do you tell somebody to have gratitude for the 30 patients that they need to see today and all the systems issues that they’re going to run into throughout their shift? So one of the practices I recommend is grounded gratitude.

You’re not thankful that you have a hectic day ahead of you, but you are thankful there are some great team members around you, or you’re thankful that you’re going to have dinner with your family at the end of the day. Those are what I like to call next-level resilient practices that don’t gaslight physicians and are truly practices that can improve our lives.

On one hand, it’s good that compassion fatigue is becoming a more recognized term in discussions around physician well-being. My friend and colleague, Sharee Johnson, who’s a psychologist, actually thinks compassion fatigue a little bit of a misnomer. When we think about compassion versus empathy, there is an important distinction that Sharee introduced me to that I wish I had known as a medical student.

We’re taught you need to have empathy. Certainly, empathy is important. That’s the ability to put yourself in someone else’s shoes. We do this all the time as physicians. You’re with a patient that maybe is homeless, and you’re thinking about how hard that would be, to not have a place to go that night.

The problem with empathy is it causes us to activate the pain portion of our brain. There’s actually functional MRI data on this. The empathy triggers the pain pathway in our brain. So when we look at burnout among physicians, well, it’s not surprising that you may suffer fatigue and burnout if you’re walking around being empathetic all day. What’s called compassion fatigue, Sharee suggests we should be calling it empathy fatigue.

The way to solve empathy fatigue is through compassion, which sounds weird, but I’m going to explain how that works. Compassion is empathy plus an action. And this can be as simple as saying, “I can’t solve this patient’s homelessness tonight, but I’m listening to their story, I am offering a free sandwich that we have and some clean socks, and I’m refilling all of their medications that I can.” And that’s a compassionate act.

What we know from the functional MRI data is that actually activates the reward part of your brain. So imagine you’re going through a day in which you’re feeling like a dishrag that’s been rung out too many times from empathy, and then you change the way you’re thinking about it. It’s a mindset shift to “I’m doing compassionate acts all day,” and then suddenly your day becomes something that is activating the dopamine part of your brain, the reward. What I do matters and is important.

That’s a key mindset shift that we need to be teaching people early in their careers. But if you’re like me and you didn’t find out until mid-career, it is a mindset shift that you can put into action now.

There is a paradigm shift; the old way of putting the patient first and forsaking ourselves is increasingly being recognized as one that doesn’t work. We have to put our own oxygen masks on before we can take care of our patients. By doing so, we actually take better care of patients.

Certainly, patients deserve the care that they’re asking for, and they don’t need to be worried about our well-being. We don’t want the patient to have to take care of us. We’re there to take care of them. So pause and say, “What do I need right now?” if you’re having a difficult emotion, like “I’m actually still sad about the last patient that I saw and the news that I had to break.”

The good news is neuroscience shows us that a difficult emotion usually lasts for 90 seconds to a few minutes at most. Pause, attend to yourself, and take some deep breaths, maybe go outside, get some fresh air, or do a tend-and-befriend action, like talk to a colleague and say, “That was a rough interaction that I just had.” Then you can show up to that next patient as your best self.

What do you need right now? Maybe you have to do a call shift and getting a full night of sleep isn’t going to happen, but you can squeeze in a nap. I recall being on my pediatric ICU rotation and hitting the wall, which physicians are familiar with, and the charge nurse recognizing that. I said, “I need 15 minutes in the call room to try to get a nap. Please only wake me up if it’s truly an emergency.” Those naps are shown to be very restorative and can bridge us until we can have a longer amount of time to rest. So it can be little practices like that. It doesn’t have to be huge. Little things can add up and contribute to our well-being.

Self-care has proliferated the zeitgeist. There’s so much consumerism around the concept of self-care. I like to say that I am a self-care champion, that I’ve done every self-care thing you can think of. I have my monthly massage, I take vacations.

But what I realized after years is self-care doesn’t help me in the middle of a challenging moment—when I’m on shift, and the hallway is so full of patients that have arrived by ambulance that I have to walk sideways and shimmy down because we’re so overcrowded. The massage I had the day before doesn’t help me in that moment.

I had to figure out strategies for when I am acutely under stress. What do I do in those moments? For me, in those challenging moments, what it’s about is channeling my values. Yes, I am working in a really crowded emergency department and stressed right now, but why do I do that work? Well, it’s because service is one of my core values, and I believe in being there, 24/7/365, and being part of the safety net for people in our country. That can provide the extra boost that I need in those tough moments.