Dr. Greg Hammer on Healthcare Burnout in the Age of Covid-19

April 20, 2020

Dr. Greg Hammer

Dr. Greg Hammer, Pediatric Intensive Care Physician, Anesthesiologist and professor at Stanford, authored a new book to help mitigate the repercussions of burnout in the healthcare profession. The book, GAIN Without Pain: The Happiness Handbook for Healthcare Professionals, will be released this May 15th. In the age of COVID-19, Salonpas sat down with Dr. Hammer to learn how our hard-working healthcare professionals can stay emotionally healthy during these trying times:

Your book could not have predicted the outbreak of COVID-19, so it is especially pertinent today.   How can healthcare professionals, who are the front lines for COVID-19, deal with the unique trials and tribulations they are experiencing now?

We can all become better equipped to deal with even the most difficult of circumstances. As a physician, I believe that all doctors have a duty to become more resilient in order to provide the best quality care to our patents. When we lack the ability to adapt to stress and adversity we experience “burnout.” Burnout is associated with an increase in medical and surgical errors, hospital acquired infections, and an overall
 diminution in the quality of patient care.

We doctors are used to being in control and feel helpless and frustrated when we are not able to “drive the bus.” The current coronavirus pandemic is an example of a rapidly progressing health care crisis that we cannot control. This creates uncertainty and stress – in other words, it predisposes us to feeling and manifesting burnout. 

How can we become more resilient in this trying time? All of us are well served by focusing our thoughts on gratitude, acceptance, intention, and non-judgment, the principles that constitute the acronym “GAIN.” This is at the heart of my book on resilience, “GAIN Without Pain: The Happiness Handbook for Health Care Professionals.” Let’s bring our attention to the following four truths:

  1. GRATITUDE. No matter how this coronavirus pandemic plays out, we certainly have much for which to be grateful – the privilege of serving our beloved patients being one. We should also be grateful for our health, relative wealth, and the love we share with our family and friends.
  2. ACCEPTANCE. We must all embrace acceptance – the ability to discern what we can and cannot change, and open our hearts fully to the latter. This is expressed in the “Serenity Prayer” and is a fundamental message of many religions and philosophies.
  3. INTENTION. We are capable of re-wiring our brains to think more positively. This requires a purposeful effort, given the “negativity bias” that seems to be an intrinsic part of how the human mind operates. For example, simply by thinking of 3 good things that happened during the day as we prepare for sleep will make us happier.
  4. NON-JUDGMENT. All of us can train ourselves to be less judgmental. We are wired to constantly compare ourselves to others – he is not as smart as I am, she is in better shape than I am, this is good, that is bad. The continuous firing of neurons in our brains whereby these comparisons and judgments are generated is exhausting. We CAN and MUST let go of these thinking patterns in order to be happier and more effective in our work and personal lives.

Why do you think that half of all physicians in the US report experiencing professional burnout? Why are so many nursing graduates leaving the profession within two years of joining it in some parts of the country?  Why is the suicide rate so high for nurses?

There are several key drivers to burnout in medicine. One is that medical practitioners are faced with more and more metrics by which our “efficacy” as practitioners is judged. Administrators are quick to tell us when our patient satisfaction scores decline, and yet the root causes of this are often beyond our control. In our clinics, for example, we are asked to see more and more patients per hour in order to generate more revenue. For our patients, this causes more time spent in the waiting room and less time with their doctor or nurse. There is mystery as to why our patients are unhappy. We providers are also frustrated over these conflicting directives presented to us.

Another source of burnout is the electronic medical record (EMR). Although there are positive aspects of the EMR, we doctors find ourselves taking more and more time to do our charting, spending an extra hour or more every day either staying late at the clinic or bringing work home. Nurses in hospitals feel the same pressures from their management – the need to care for more patients with fewer resources and spend more time charting on the EMR.

The “quality” measures by which we are increasingly measured can be suffocating and give us a sense of loss of control over our practice. There is a deficit in the culture of wellness at work. The efficiency of our practice is hampered by inadequate clinic space, staffing, and time for healthy breaks. It seems that the administrators don’t “get it.” More than one physician commits suicide every day on average.

Burnout in medicine is indeed a disease we MUST cure.

Tell us about your antidote to burnout – GAIN.

As I indicated above, GAIN is an acronym for the fundamental principles of gratitude, acceptance, intention, and nonjudgmental. These elements are essential to our resilience and happiness. One can be happy and blind or otherwise physically challenged, but one cannot be happy and ungrateful. One cannot be resilient without accepting adversity that he or she cannot change. We need purposefulness or intention in our lives as well. One key application is learning with intention to re-wire our brains to think in a more positive manner. This CAN be accomplished, even after the age of 30! Finally, being judgmental breeds isolation and unhappiness. We too often judge ourselves most harshly, bringing us shame and sadness. We need to learn to be our own best friend – we can talk to ourselves as we would a dear friend and thereby learn to go easy on ourselves. This is challenging but not impossible. The GAIN practice can help us accomplish all of these directives if we practice every day. We learn best by taking small bites regularly (daily).

Have you seen GAIN help medical professionals avoid burnout?  Please relay an experience or two.

GAIN has helped many of my trainees and colleagues. One of my residents had difficulty breaking bad news to her patients and their families. She was extremely nervous even entering a child’s room in the pediatric ICU when things were not going well. We discussed the utility of having her focus on her breathing and thereby slowing it down before she entered a patient’s room. Then she should remind herself that she has much for which to be grateful, including caring for her challenging little patient. It is a privilege to have the training and expertise to do so while working in a top-notch children’s hospital. She also learned to be more accepting of that which she could not change, including her patient’s chronic illness. These practices helped her immensely.

I had a pediatric anesthesia fellow who was particularly self-critical. If he had one negative experience amidst a large number of triumphs working with challenging patients over the course of a day, he would beat himself up and have trouble sleeping at night. Again, we worked on acceptance and also being nonjudgmental – of himself. Over time his attitude and happiness at work improved greatly.

Describe a typical day in your life, from when you wake up to when you retire?

Upon awakening in the morning, I open the blinds and gaze at the garden outside my bedroom. I head to the bathroom for the usual morning hygiene routine. I then get comfortable in my meditation area, relax, activate the singing bowl, and settle into a GAIN meditation. I let gratitude wash over me, appreciating the love for my family, friends, and colleagues. I allow acceptance of life’s painful experiences into my open heart; the first thoughts that come to mind are of my beautiful son, who passed away 3 years ago. I did not cause nor could I assume responsibility for this terrible event. I transition to the intention to be present, to fully experience this very moment. I commit to bringing presence into my life whenever possible this day. Finally, I embrace non-judgment of others and, with more difficulty, myself. I let all of these feelings surround and pass through me. Going back to the effortless rhythm of my breath, I slowly open my eyes. I am ready to go out into the world.

Whether I am in the intensive care unit, operating room, my office, at home, or on a hike or bike ride, I engage in brief GAIN practices throughout the day. I may begin to judge a pedestrian who is in my way on the bike path; I catch myself doing so and smile at him as I ride by. An unpleasant experience becomes a pleasant one! I begin to feel upset about the seemingly excessive time spent charting in the EMR, then realize I cannot change it – I let go of the frustration, watching it dissipate. There are so many examples of how we can be more present and mindful. Again, baby steps.

As I climb into bed at the end of the day, I reflect on at least three good things that I experienced during the day. This simple practice has been shown to improve sleep and, remarkably, happiness itself. No matter how badly we feel the day may have gone, there are always three things we can count on the positive side. Let’s gradually re-wire our brains to embrace more positive thoughts and chip away at our negativity bias.

On the COVID-19 front, what advice do you have for people in the United States?  Do you have any predictions on when it will be controlled?

I would suggest focusing on all of the principles of GAIN. Despite the extreme difficulties this pandemic presents, we still have many gifts in our lives for which to be grateful. This is a golden opportunity to bring our attention to accepting the many aspects of this experience that we cannot control, while not forgetting to do what we can to limit the spread of the virus by washing our hands and keeping our distance from others. Let’s remind ourselves how to remain purposeful in being present and mindful that this will pass. Perhaps we will have learned to be more connected to and caring of each other in the process.