The Lunch Hour

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SPECIAL REPORT: CLINICIAN WELLNESS

It is an honor to chair the Psychiatric Times Special Report on Clinician Wellness. In a recent news bulletin, a staggering 63% of physicians were reported to have experienced at least 1 symptom of burnout during the COVID-19 pandemic.¹

As can be readily observed, our rapidly changing medical climate demands that we, as clinicians, find positive and effective ways to maintain a sense of balance. This Special Report gathers a range of wellness perspectives from our contributors. I hope my introduction provides a glimpse into the understated yet basic importance of taking a lunch break as a way of recharging during the workday.

One of the perks of my job is ready access to First Street, a lively thoroughfare of 16 to 17 blocks transecting the lower part of Hoboken, New Jersey. With its mature trees shielding the sunlight that hits the eateries, shops, and business establishments, this street offers a portal to replenishment during the busy workweek.

My team member, Patricia Garcia, LCSW, a behavioral health specialist, inspired me to explore First Street early on in my position as a psychiatrist. “You must simply check out the candle store!” she exclaimed. How refreshing, I thought. Pat and I were taking a short break from reviewing our cases. Eventually, I discovered the candle shop to be located near but not directly on First Street, and sure enough, it lived up to Ms Garcia’s glowing endorsement.

“If you start taking on everyone’s problems, you begin to lose yourself. In our field of behavioral health, it is important to realize when to stop…. I take my lunch walks in Hoboken, and the candle place? Well, the fragrance is enticing! We tend to overvalue the sense of vision, but the other 4 senses, like the sense of smell, are vital to our well-being,” Ms Garcia reflects.

According to John Rimmer, DO, system chief medical officer of CarePoint Health, we as a society cannot ignore the glaring public health realities of medical provider burnout and hospital staffing shortages. Although the stress among physicians has captured the attention of academia, this is not the case for frontline or first-response professionals.

“There is a lack of research and documentation on the psychological state of emergency [department] nurses, paramedics, ambulance drivers, firefighters, and police who will eventually see every kind of unimaginable human trauma in the course of the workweek,” Dr Rimmer said. “This population needs our help. They themselves are traumatized.”

Out of deep concern and respect, Dr Rimmer and associates launched the innovative MindLine Program, which offers anonymous professional support to health care workers who may be hesitant to go to therapy due to fear of stigma and/or licensing insecurity.

I decide to avert the feeling of being bogged down and to indulge my inner neighborhood appreciation with a walk along First Street one sunny, temperate day. Initially stopping to admire the plant store display, I find mounds of exotic vegetation piled high to the top of the window frame; perhaps I shall circle back after work to purchase a Monstera as a gift for a friend.

It is delicate, watering plants—an art form much like conducting therapy. In the plant’s case, watering prevents the roots from becoming either parched or drenched without the worry about transference and countertransference.

Next, as this is Hoboken, there are the frequent reminders of Frank Sinatra. I wonder whether Ol’ Blue Eyes was primarily known as an American icon or recognized worldwide—undoubtedly the latter. You never know your true legacy as it invariably unfolds over time. Take Louisa May Alcott, for example. Did she have any way of knowing that her modest tale of 4 cash-strapped New England sisters in Little Women would become a popular, and beloved classic and quickly sell out its 2000 original copies upon release?² It’s inspiring to consider!

While enjoying a sandwich in a quiet outdoor spot, I notice a young woman across the street walking her Cavalier King Charles spaniel. The woman is trying to be patient while the dog casually sniffs around at the sidewalk’s debris. Tension is mounting, however, as she furtively glances around, then reprimands the dog in a sharp tone: “We are wasting time, and I have to get back to work. Finish your business already!”

Pause. What? All of a sudden, the young woman across the street is crying, with the petite spaniel cradled in her arms like a very young child. Tears are streaming down the woman’s face, softly landing on the spaniel’s ears. In between her muffled sobs, I surreptitiously overhear something like an apology. “I’m sorry, pumpkin pie. I was mean to you. Let’s go back to the apartment and finish our walk there.”

At this point, my heart is overflowing with compassion. Is she upset that she fell short of being the perfect pet owner or that she hurt the puppy’s feelings? Maybe someone was recently unkind to her, and she is displacing her feelings onto the spaniel. The cloudless, beautiful day makes the scene all the more poignant. Although the doctor in me wants to jump in and help, I remind myself that I am not her psychiatrist, that she is entitled to her privacy, and, honestly, I could use the rest of my break time.

So, what about the automatic response to help others? In that regard, Dr Rimmer comments that a certain amount of self-discipline is required for clinicians to pull back in adapting a meaningful wellness routine: to acknowledge one’s personal limits, to perhaps note a mounting level of fatigue, and to accept the need for time off, and to maybe even skip the available extra work shift to pause and reset. “We are so conditioned to be in the busy, caring role,” Dr Rimmer observed. “Plus, we hold ourselves to a high standard.”

Nancy Block, MD, a retired psychiatrist, expresses a similar opinion. “Burnout is not a new phenomenon; it was observed in the early 20th century among overwhelmed social service workers,” she said. “In our climate, you have to set up your boundaries and take ownership of them. They may change depending on the situation, but you need to feel in control so you can feel confident in your own judgment.”

In wrapping up my break, I finish a side of fresh fruit and then head back to the office, deciding along the way that a coffee is called for, given the fully booked afternoon ahead. This will be my third caffeinated beverage today—but if you need it, why not?

Entering the building, I greet the front desk staff and float along the hallway with a steamed cinnamon swirl latte minus the whipped cream in my left hand. In the next 5 minutes, the immediate goal will be to transition back into full doctor mode, all while contemplating that First Street, on balance, is a reminder that the world most certainly goes on.

Dr Sofair is a psychiatrist affiliated with CarePoint Health.

Acknowledgments: Dr Sofair would like to thank the following colleagues for their time and generosity: Dr John Rimmer of CarePoint Health; Ms Patricia Garcia of Hoboken University Medical Center; and Dr Nancy Block, a psychiatrist currently in retirement. Dr Sofair also extends a special thanks to SOHO Flower & Garden and MOJO Coffee Company for their support in preparing this column. Dr Sofair extends a thank-you to Psychiatric Times for this writing and editing opportunity.

References

1. Robust claims boost practice revenues and alleviate stress. Glenwood Systems. July 24, 2023. Accessed August 15, 2023. https://www.glenwoodsystems.com/post/robust-claims-boosts-practice-revenues-and-alleviates-stress

2. Little Women. Wikipedia. Accessed September 15, 2023. https://en.wikipedia.org/wiki/Little_Women#Publication_history