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The Podium

Caring for the caregivers

The Marathon bombings two weeks ago cast a bright spotlight not only on the courageous first responders, and volunteers at the scene, but also on the extraordinary people who work in health care in the Boston area. From the Mass General trauma surgeon who completed the race and then went on to care for the gravely wounded, to the ER staff at Boston Medical Center who openly wept after their life-saving care was complete, to the Beth Israel Deaconess Medical Center staffers who found themselves caring for not just one but two of the alleged bombers, professionalism and compassion have never been more visible or critical to the collective healing of our community.

This focus on what it means to be a caregiver is long overdue, for while the number and scope of the injuries as well as the medical response were unprecedented in this case, health care professionals care for seriously ill and injured patients and their families every day. Consider the physician telling a couple that their child has been diagnosed with a life-threatening illness, or the nurse delivering chemotherapy to a young mother with advanced stage breast cancer, or the EMT providing care to a gang member who has been shot. Just as challenging can be patients who despite caregivers’ best efforts, are unable to make the lifestyle changes necessary to save their lives and their health — even in the face of debilitating illness.

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We assume that people who enter the health care profession are prepared to deal with just about anything. But the reality is that these caregivers feel the same emotions we all do, but are trained to put their feelings aside while providing medical care to patients and families. This is a necessary part of the culture of medicine, but eventually, unless these feelings can be expressed and dealt with, caregivers can become disillusioned and burned out. And burnout is the enemy of compassion — resulting in less empathy for patients and families, more medical errors, and longer patient recovery times.

Burnout is not just reserved for those involved in caring for the traumatically injured, but is occurring more frequently among all caregivers. The latest statistics are alarming: more than a third of nurses and more than a quarter of physicians are believed to be suffering from burnout, and the numbers are increasing.

In addition to the day-to-day challenges of interacting with patients, families and co-workers, often under difficult circumstances, other factors contributing to burnout include: lack of adequate time to care for patients and families, loss of a sense of community with colleagues, the distancing of technology, the pressures of healthcare funding and financing, and administrative demands. And this is happening at a time when more people are entering our healthcare system, and there are fewer primary care clinicians to care for them.

So what can be done to reverse this epidemic of burnout among our nation’s healthcare professionals?

First and foremost, individual caregivers need more support to help them recognize and process their own feelings of anguish and distress, including regularly scheduled opportunities to discuss with co-workers the challenges and joys of caring for patients and families. These conversations renew compassion, restore a sense of individual and collective purpose, foster community, and help caregivers feel less isolated and alone.

Second, those working to implement system reforms in healthcare organizations across the country must make patient and family interactions a priority, not something to be trimmed in the name of greater efficiency. We must support and reward the time healthcare professionals need to provide the compassionate care we all want for ourselves and our family members – and which we know improves health outcomes and reduces costs.

Finally, we must create a health care system that values the health and well-being of its most important members — caregivers themselves. For without their continued commitment and resilience, our health care institutions would not have been able to respond as admirably as they did.

Julie Rosen is executive director of the Schwartz Center for Compassionate Healthcare. Dr. Beth Lown, the organization’s medical director, is also a practicing internist at Mount Auburn Hospital in Cambridge and associate professor of medicine at Harvard Medical School.
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