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Today I started my training for my eighth marathon, the Chicago Marathon in October 2015. I started running as a way of relieving stress during my first job as an oncology social worker at Beth Israel Hospital in Boston in 1984. Running along the Charles River was extremely therapeutic! I had no idea how emotionally challenging the work would be, and yet I absolutely loved it. My training as a clinical social worker taught me the most invaluable defense against burnout: self-awareness (aka dual- awareness or counter transference). This is the one learned skill that I have used every single day in my practice working with end of life and cancer patients. I don’t think about it anymore because it’s second nature to me, but I teach other providers about it every day. Self-awareness, learning about how our reactions impact our patients’ families and ourselves is, in my opinion, the most important thing you can learn to do as a clinician that will both improve your practice and protect you against compassion fatigue and burnout.
Like resilience and self-care, training for a marathon requires just a couple of things: focus on a goal, time commitment and willingness to self-examine. OK, a good pair of shoes is also required! Using that as a metaphor is how I like to think about resilience in palliative care. You could go out and run 26.2 miles, but without training you’re going to hurt yourself and may never run again. With practice, and small successes you can reach your goal and that finish line; and may have even learned something about yourself in the process.
As most marathon runners will tell you, it’s about the training. When do you need water; when should you take a walk break; what is the best gear; how do you deal with hitting a wall, what are the roughest miles for you; what should eat the night before? The only answers to these questions come from training and trial and error. I think it’s the same for assessing what you need to stay resilient throughout your career – what works for you; what should you do when you start to get “crispy”, what are the signs you take a walk break; how do you reward yourself? Of course, you can run a marathon just by increasing your mileage each week and not thinking much more about it. But in my experience, your marathon will go better and will have lots more meaning if you take stock and self-examine along the route. We all know about burnout and compassion fatigue. Thankfully there have been many wonderful studies and articles about how burnout affects providers in palliative care. I’m glad so much attention is being paid to our sanity and longevity. It’s time to adopt some strategies for a lifetime so that we can continue this work, and survive, for the long haul. I encourage all of us to think about our commitment to resilience and self-care as a marathon, not a sprint. Developing habits and insights that can carry us through to a finish line, not just the first water stop.
Take time to think about this work we do and how it impacts you and how you impact your patients and families and co-workers. This skill and knowledge will surely take you to the finish line and hopefully you won’t be last!
Vickie Leff, LCSW, ACHP-SW is a Clinical Social Worker for Palliative Care at Duke Hospital in Durham, NC. She has run (slowly) 7 marathons so far and still hasn't come in last. She and her husband live in Cary (Containment Area for Yankees) but, will soon move to Durham because their kids went off to college. You can contact her at victoria.leff - at - dm.duke.edu
Photo Credit: Vancouver Sun Run Alain Limogenes via cc
Image Credit: Christian Sinclair for Pallimed avail via cc