In physiatry, one of the most rewarding aspects of the specialty is celebrating our patients’ achievements. Cheering them on as they reach their goals can serve as an uplifting experience in what is oftentimes an extensive journey. However, rehabilitation often must address the psychosocial challenges that can hinder recovery, many of which preexist or result from their injuries. As emerging physiatrists, we strive to tackle these issues while maintaining our emotional health and other resident responsibilities– a balancing act that can lead to fatigue.
Managing expectations, delivering difficult news or assisting those with intractable pain can be particularly challenging for a resident. Recently, I cared for a patient struggling with inpatient rehabilitation due to progressing cancer metastasis. Despite their inability to meet the demands of intensive therapy, a family member remained hopeful they could return to baseline for further treatment. I felt vulnerable at this moment. How could I convey the medical responsibility of moving toward a goal of care while tactfully acknowledging their grief? Although I ultimately guided the conversation toward follow-up visits with palliative care and oncology, I felt conflicted and emotionally drained.
Throughout residency training, I've acknowledged that empathetic listening and navigating complex discussions are vital skills that require ongoing practice. While residents often understand the basics of conflict resolution, such as validating concerns and maintaining composure, these skills must be continually refined.
- Establish an appropriate environment. A calm, unbiased environment enhances communication by minimizing distractions and stress. Nonverbal signals play a crucial role; consider how your body language can alleviate the patient's discomfort.
- Utilize "I" statements and engage in reflective listening. By recognizing and validating the patient's emotions, you cultivate a sense of mutual understanding.
- Define boundaries and clarify expectations. As a healthcare provider, it's crucial to communicate realistic outcomes for the visit, address the patient's immediate concerns and collaboratively create a plan. Recognizing when to seek help from a senior resident or attending physician can also reassure both the provider and the patient.
Continuous management of stressful situations alongside various resident responsibilities can gradually lead to burnout. This emotional fatigue not only affects our capacity to care for others but also compromises our self-care.
- Identify signs of fatigue within yourself. Symptoms like detachment, chronic fatigue, headaches and sleep issues may signal burnout. Acknowledging your mental health can help you seek support from colleagues or mentors, enabling you to provide better care.
- Prioritize self-care. Evaluating your diet, exercise routine and sleep patterns can significantly alleviate burnout. Honesty and accountability can motivate you to allocate small amounts of time throughout the day for relaxation and rejuvenation.
- Engage in mindfulness practices. Journaling can facilitate emotional processing and help derive meaning from patient interactions. It is crucial to acknowledge that not every patient will be discharged satisfied or have every problem solved. Establishing boundaries between professional and personal life, along with seeking constructive feedback from trusted mentors, fosters open communication.
Mastering difficult conversations is an art refined through experience and resilience. As we dedicate ourselves to our patients’ well-being, we must also care for ourselves to continue making a difference. This balance is both the challenge and privilege of being a physiatrist, as healing encompasses not just physical rehabilitation but also restoring independence, confidence and optimism.