DGIM Generally Speaking

Bit of Balint

By: Karen Carlson

Just as it is very difficult to operate with a blunt knife, to obtain sharp images with a faulty apparatus, to hear clearly through an unserviceable stethoscope, so the doctor will not be able to listen properly if he is in poor shape.
- Dr. Michael Balint. The Doctor, His Patient, and the Illness, 1954.

In this era of proliferating medical technology, it is easy to lose sight of the fact that the clinician is still the fundamental instrument of healing. In primary care, it is the clinician who must make sense of the array of disorganized concerns and complaints our patients bring to us. Although we may sometimes feel like little more than sophisticated data entry devices, we know that to understand and address our patients’ problems we must be able to hear, to see¸ and to feel what is bothering them. It is up to us to understand what is happening in order to make the right diagnosis. Listening, to the patient and to ourselves in the encounter with the patient, is fundamental to understanding.

Yet as Balint pointed out over 60 years ago, doctors cannot listen properly if they are in poor shape. This year, the problem of burnout has come to center stage at MGH and Partners. There are many factors contributing to burnout: some systemic, some organizational, some individual. While it is essential that our leaders energetically address the systemic and organizational factors, it is up to us as individual clinicians to do what we can to keep ourselves in good shape, for our patients’ sakes as well as our own. Being in good shape means more than simply not being tired, distracted, or depleted by the demands of patient care. It means actively staying connected to a sense of curiosity, a desire to connect with patients on a human level, an ability to sustain empathy while not taking on the burden of suffering, to maintain a sense of joy and meaning in our work.

What are some of the tools available to us to keep ourselves “in tune”? One that our colleagues in family practice have used for years is a form of group peer supervision known as a Balint group. Such groups provide an opportunity to discuss cases that are on our minds with colleagues in a supportive, nonjudgmental setting. They provide a space to reflect, to explore new angles, to see things differently – to sharpen our senses as clinicians and keep ourselves well-tuned as instruments of healing.

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Interested in finding out about a group? There is an ongoing on-campus group and one forming for clinicians at the community health centers. Please contact Karen Carlson for more information. 

Read more articles from the Fall 2017 edition of Generally Speaking