Jordan Babando // Imagine a friend of yours comes to you for relationship advice. The issue that is presented to you involves your friend’s significant other telling them they are not allowed to express emotions. Your friend is made to feel like any noticeable emotion would make their partner and anyone else around them feel uncomfortable. Furthermore, your friend’s partner wishes them to keep their emotions to themselves and save it for when they’re alone. Even when faced with a dying loved one or the overbearing stressors stemmed from their relationship, they are expected to render any screams of pain silent. What would you tell this friend?
What happens when the relationship is between the worker and their employer? How is it that controlling someone’s behaviour and emotions, while additionally ignoring their feelings, can be seen as emotional abuse in one context and not another? Job descriptions or working duties for nurses and physicians do not tend to outline the emotional management or abuse that come with their associated working roles and social interactions.
It has been documented for some time now that a healthcare worker’s inability to deal with stress from work creates consequences for their personal lives and within the doctor-patient relationship (Berry, 2007; Shapiro, Schwartz & Bonner, 1998). Importantly, emotional awareness, skills and communication are associated with a higher quality relationship (Wachs & Cordova, 2007). Relationships that poorly navigate through emotional experiences will cause damaging outcomes, such as increases in negativity. Many physicians, for example, are shutting down emotionally, causing them to withdraw from their patients and further removing them empathetically in their patient’s greatest time of need (Berry 2007). Such attempts by physicians to emotionally protect themselves unfortunately leads to further needless and avoidable emotional isolation and suffering by their patients. A breakdown in emotional understanding further creates a breakdown in all communication between healthcare workers and their patients (O’Toole 2012). It is important to understand that although healthcare workers do care about patients, they are faced to deal with an overwhelming amount of negative emotional experiences that leaves them with little to no room for the inclusion of their patients’ emotions.
It is vital to understand some of the negative emotional experiences and stressors that healthcare workers must face, and I will only be able to provide a brief overview here. In the U.S., healthcare workers experience high levels of workplace violence (Phillips 2016), and it is no different in Canada (Statistics Canada 2015). A Canadian study revealed that 46 percent of the nurses surveyed had experienced some form of workplace violence in their last five shifts, with emotional abuse being the most prevalent (Duncan et al. 2001). It was alarming that 70 percent of those who experienced workplace violence did not report it. Healthcare workers’ chronic unhealthy experiences with emotional stress are leading them to burnout and compassion fatigue. When physicians experience emotional burnout, they do not tend to seek professional help or take mental health leave (Misselbrook 2001). Instead, a concerning rate of physicians are found to turn to substance dependency to cope with emotional exhaustion, and they also have higher than average rates of suicide compared to all other professions (Misselbrook 2001). Additionally, a recent national survey by the Canadian Medical Association (CMA) has found that even the most resilient physicians are suffering from depression, suicidal thoughts, emotional exhaustion and burnout (Vogel 2018). Clearly there is something wrong with the current hospital environment and immediate improvements need to be made.
The emotional well-being of healthcare workers is improved through providing empathetic and safe environments for healthcare workers to express and share their feelings and personal experiences. Additionally, being able to discuss their emotional experiences can improve their psychological and physical health (Shapiro et al. 1998). The CMA suggests that changes are needed to shift the focus from the resiliency of healthcare workers to system-level initiatives that include improving the working environment (Vogel 2018). Healthcare workers should never be solely responsible for their emotional well-being, in the same sense that any other workplace would never expect their workers to be solely responsible for their own health and safety–it indeed must be a shared responsibility. There also needs to be a change in the healthcare culture toward encouragement and recognition of the fact that healthcare workers are emotional human beings and are not immune to the emotional challenges and experiences of human life. Experiences of loss, sadness, and anger should not be seen as weakness, and healthcare workers should be provided the tools and opportunities to communicate and express these experiences in a safe and healthy way rather than suppressing them.
Workplaces in Canada have a legal obligation to protect their employees from harm (Ministry of Labour 1990 ) and as far as I can tell, hospital management are failing healthcare workers. I am unfamiliar with health and safety laws elsewhere, although I recognize that there are serious problems with healthcare work in North America that are not being acknowledged. From my experience and research I will offer some concluding thoughts here. Willfully ignoring, undervaluing or supressing emotional problems in healthcare work does not make the issues go away. Current ways of hospital management thinking and the workplace culture that views emotions as a weakness tend to individualize the problem by placing blame on the healthcare workers themselves. This supports the deterioration of the doctor-patient relationship and further makes patients feel alone in their suffering. For management, allow your healthcare workers to be human emotional beings. For healthcare workers, allow yourself to acknowledge and express a healthy level of emotion with your patients and fellow staff. For patients, please recognize that many healthcare workers are suffering in their own way, so perhaps try giving them a hug and saying thank you. In my previous posts in this series I have opened with a quote, and as I conclude I find it only fitting to finish wish one:
“One ought to hold on to one’s heart; for if one lets it go, one soon loses control of the head too.”
― Friedrich Nietzsche
Image: Association of American Physicans and Surgeons (2018). Sad-Doctor. Retrieved March 1st, 2019 from: https://aapsonline.org/systematic-abuse-and-misuse-of-psychiatry-in-physicians-heath-programs-%EF%BB%BF/sad-doctor/
Berry, P. (2007). The absence of sadness: Darker reflections on the doctor-patient relationship. Journal of Medical Ethics, 33: 266-268
Duncan, S., Hyndman, K., Estabrooks, C., Hesketh, C., Humphrey, C., Wong, J., Acorn, S. and Giovannetti, P. (2001). Nurses’ experience of violence in Alberta and British Columbia hositals. Canadian Journal of Nursing Research, 32(4): 57-78
Ministry of Labour (1990. Occupational Health and Safety Act, RSO 1990. Toronto, ON: Queen’s Printer for Ontario
Misselbrook, D. (2001). Thinking about patients. Newbury, UK: Petroc Press.
O’Toole, G. (2012). Communication: Core interpersonal skills for health professions. Toronto, ON: Elsevier
Phillips, J. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374: 1661-1669
Shapiro, S., Schwartz, G. and Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioural Medicine, 21(6): 581-599
Statistics Canada (2015). Factors related to on-the-job abuse of nurses by patients. Retrieved February 26th, 2018 from: https://www150.statcan.gc.ca/n1/pub/82-003-x/2009002/article/10835/findings-resultats-eng.htm
Vogel L. (2018). Even resilient doctors report high levels of burnout, finds CMA survey. CMAJ: Canadian Medical Association, 190(43), E1293.
Wachs, K. and Cordova, J. (2007). Mindful relating: Exploring mindfulness and emotion repertoires in intimate relationships. Journal of Marital and Family Therapy 33(4): 464-481