DGIM Generally Speaking

Carrying One Another’s Burdens: Connection with Colleagues as a Path Back to Joy in Practice

By: Susan Hata, DGIM Balint Scholar

Dr. Hata (front row, third from left) joined by colleagues at the Reflection and Resiliency course in Orvieto, Italy.

As primary care physicians, we are no strangers to wounds. New or old, physical or emotional, visible or invisible, healing or nonhealing, our years of experience examining and listening to patients have taught us to recognize wounds in their many forms. We know that only when the wound is uncovered, seen, and understood can the healing begin. And so we encourage our patients not to hide their wounds from us.

We are far less tender with our own wounds. We’re all acutely aware of the occupational hazards of our profession in terms of burnout and mental health struggles. But our training has not equipped us to protect ourselves from these risks. Carl Jung described physicians as “wounded healers,” a term that resonates with the struggles I see in myself and my colleagues. As someone who mentors residents interested in primary care careers, I think a lot about how to support those who choose this path, and how to prepare them to thrive.

This spring I had the opportunity to attend the “Reflection and Resiliency” HMS CME course, co-directed by Karen Carlson of the DGIM, and held in Orvieto, Italy. As I traveled the miles by plane and train, I thought about the intensity of our days in clinic and wondered what this course could offer that would ease the struggles we face.

What I found was a refreshing, structured time and space to explore the joys and sorrows of our work as physicians. Wise and experienced faculty-led morning discussions focused not on the problem of burnout, but on empathy and ways of finding meaning in our work. Time was set aside to consider the questions crowded out of our minds in a busy clinic session at home: “What do I love about my work? What would it look like for my work environment to be healing for me and for my patients? How can I be present with patients and colleagues?” The rich conversations continued over hiking trails, cobblestoned streets, and glasses of wine throughout the week.

But the real magic of the course occurred in the afternoons when we gathered for Balint groups. This physician training group model has been used worldwide since it was developed by Dr. Michael Balint in the 1950s. In these groups, physicians meet regularly to share challenging cases with one another, with a specific focus on the doctor-patient relationship and the feelings it evokes. Like many things in medicine, the best way to learn the Balint model is by doing, and we shared cases with each other every afternoon in our own class Balint group.

Over the course of the week, we took turns sharing our difficult patient cases and each time the group respectfully and generously debriefed the emotions and questions involved. Metaphorically, we unwrapped the bandages over the wounds of our hard cases, and submitted to our colleagues tenderly and respectfully examining the contours of disconnection, fear, guilt, regret. Again, and again, I watched the healing process unfold in the relief, validation, understanding, and care that were returned by the group.

As I’ve returned back to my practice, I am implementing many lessons learned from the discussions of the course, but I remain most moved by the realization that the way back to healing in our work does not lie in hiding our struggles, but in opening ourselves to give and receive support to each other. We may not have had training in our residencies to prepare us for the occupational hazards we would face, but there are skills we can still learn to tend ourselves and each other, and we can practice these skills together.

Interested in learning more? Dr. Karen Carlson is currently co-leading a Balint group for clinicians within the DGIM (see below), and under the leadership of Mary McNaughton-Collins and Josh Metlay, the Division is investing in training more leaders of additional Balint groups. Over the course of the year to come I will undergo the training needed to start a group, and next spring the Division will sponsor another faculty member to attend the Reflection and Resiliency course. 

♦ ♦ ♦ ♦ ♦

DGIM Balint Groups

Balint groups are a powerful training method that helps develop the clinician’s ability to use empathy skillfully. Since September 2016, Dr. Karen Carlson and Dr. Kathleen Ulman have led a successful Balint group for DGIM physicians. The group is open to take in new members over the summer and into the early fall. 

The on-campus DGIM group meets twice a month for one hour to focus on a specific case brought by a member. The group explores the case from the standpoint of the patient, the doctor, and the relationship, in a structured and safe setting. Physicians who participate regularly in a Balint group report that they

• feel supported and understood
• develop new ways of understanding difficult patients
• have more empathy for their own and colleagues’ feelings
• tolerate uncertainty better
• become more patient-centered;
• feel better connected to their original desire to practice medicine

If you are interested in learning more about the on-campus DGIM Balint group or about starting a Balint group at an off-campus practice, please contact Dr. Karen Carlson (Carlson.Karen@mgh.harvard.edu).

Read more articles from the Summer 2017 edition of Generally Speaking