By Richard Pinckney MD, MPH
University of Vermont College of Medicine
“HELP!” “HELP!!” You look around to find the person calling in distress and see a swimmer struggling to stay afloat. As the lifeguard on duty, it’s time for you to spring into action. What will you do?
When confronted with analogous scenarios many physicians do one of two things: some say the equivalent of, “Wait right there, I’ll be back with help!;” while others simply dive into the treacherous waters without a thought. Lifeguards would caution us that the swimmer may not be above water by the time help arrives, and diving in risks getting pulled under by the victim.
Though doctors are not often called upon to rescue someone that is drowning, they are often faced with patients who feel like they are drowning in their own emotions and pain. Rather than hungering for air, these patients are often equally desperate for controlled substances like benzodiazepines and opiates that they believe will bring them some reprieve from their suffering. Patients are told, “Wait right here, I will get some help,” as physicians frequently feel unprepared to manage these situations and resort to making referrals which are often times ineffective. Likewise simply diving into the murky waters with the patient and providing controlled substances can be a treacherous way to proceed. How can physicians be prepared to address this challenge? Lifeguard training offers us three important lessons that may help us: Stay alert, learn to swim, and use life preservers.
Just as lifeguards must train themselves to be constantly vigilant in scanning the horizon, so too must we work to keep attentive to the potential of suffering in our patients. It is too easy to be distracted with our medical to-do list of activities. When our brain is completely focused on making a diagnosis, checking the allergy list, and making sure immunizations are up-to-date, we may overlook the subtle currents of emotion that may signal the potential for decompensation. Cultivating mindfulness can serve as a way to ensure you are in tune with the patient’s emotional wellbeing.
Learn to swim
It seems obvious that a lifeguard should be a good swimmer, yet when it comes to emotional coping skills, many physicians are doing the doggie paddle. Like most Americans, they were never taught about evidence-based skills such as Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR). Ironically medical schools and residencies use more of a sink or swim approach to teaching emotional coping rather than offering swim classes. Trainees are immersed in an extremely stressful environment with no real training as to how to handle the emotional complexities of the experience. There are very few medical training programs in the United States that offer structured training in stress management. As a result, many students and physicians resort to using less effective coping strategies that don’t allow them to reach their full potential as human beings and physicians.
Learning to become more effective at navigating our own emotional waters also allows us to become more buoyant in the presence of another person’s suffering. As a result, we can be more conscious in our approach to caring for their needs, teach them how to swim as well, and develop a plan that is in a patient’s long-term best interests.
Use a life preserver
If a lifeguard can save a life without getting wet, that is always the preferable approach. Life preservers, poles, and other tools allow lifeguards to safely reach out to others while staying well grounded.
Communication skills are the tool we can use reach out to our patients who are suffering. There are a wealth of such tools in the world of psychology that have demonstrated their value in research and clinical experience. Reflective listening and motivational interviewing are several examples of ways we can throw a lifeline to those in need. Through these tools we can express our empathy and compassion effectively, support patients, and engage them in a healthy path to recovery. As a result, patients will rely less on controlled substances to make themselves feel better, and use strategies that will lead them to happier and more productive lives.
Take the plunge
Just as lifeguards can train themselves to be more effective at saving drowning swimmers, physicians can learn critical skills for helping patients with emotional suffering. Though many medical schools do not offer such training, the tremendous success of MBSR, CBT, and motivational interviewing has created a plethora of workshops and self-study materials for physicians to supplement their traditional biomedical training. The specialists that teach these programs are incredibly excited to have medical students and physicians attend, and in fact, some of these programs are designed specifically for medical professionals. So jump in and try some of these skills!