The Most Important Medicine:
Responding to TrAUMA & Creating Resilience in Primary Care

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Hey friends,

I was recently interviewed by Kevin Pho, MD for his podcast. You’ve likely heard of him through his hugely popular website

I thought I’d drop the article below so you can tell me what you think. And I’ve linked up to the podcast via youtube as well.

Enjoy! And Happy Thanksgiving to those who celebrate – I’m thankful for all of you!

With that said, we’re confusing the term resilience with grit. 

Reading many articles on burnout, physicians are understandably frustrated with being asked to be more resilient in the face of the pandemic, staffing shortages and oppressive systems, to name a few. Often, when wellness is eluded to, physicians are encouraged to take better care of themselves or show “resilience” when truly what’s going on is that we’re asking them to adapt to unhealthy systems and show intense perseverance without signs of emotional exhaustion. Sigh…

It may be helpful to differentiate resilience from other terms such as grit, motivation or determination. Resilience refers to withstanding, overcoming or adapting to adversities and challenges despite hardship; and maintaining good physical and mental health. Here’s where we might confuse that term with grit, meaning, stick-to-it-iveness or perseverance. And if that’s the case, physicians are righteously upset about being encouraged to simply stick with things a bit longer, be more persistent or determined. But there are a few caveats that are often overlooked with resilience. 

First, resilience is multi-faceted and determined by experience, culture, temperament, and social and systemic support. We are not meant to be resilient ALL of the time in EVERY situation. Some of us might find that we’re resilient for periods of time when we have support and in situations where we feel safe. That’s normal. Second, resilience is built IN RELATIONSHIPS. The best antidote for trauma & stress is in relationship with a safe, stable, nurturing people with whom we can regulate our nervous system. Finally, resilience is built in communities and systems of support. When we look at research on resilience, it’s those that feel seen and heard in supportive communities that feel resilient. 

Arguably, it’s NOT that physicians need to be more resilient it’s that we’ve failed to provide them with 1. The goodwill to be human and embrace their “whole selves” – people who are resilient often, but not always 2. Access to safe and consistent relationships to heal; and, 3. Systems that support their well-being.

Physicians have persevered despite hardships. They have shown grit. Now, let’s give them supportive spaces, relationships, communities, and systems so that they may have the ingredients to feel resilient more often.

Take care – and tell me what you think!

With compassion,

Dr. Amy

Birthday Reflections, Part Two

Hey Friends,

I’m so incredibly touched by your emails & messages. In last week’s newsletter, I shared my soul work with you around my mission and asked you to share yours. Here’s a sprinkle of what I heard:

  • Joy that comes from your animals, especially a dog’s loyalty
  • Being outdoors and breathing
  • Your children
  • Finding purpose in your occupation
  • Satisfying, life-giving friendships

Geez, I love hearing and sharing all of this! 

Here’s your next bit of work. When you think about the quiet whisper, or loud resonance of your soul’s mission statement, what gets in the way? What are the barriers to you leaning into this effort fully? Wholeheartedly? 

Here were some of my reflections:

  • Time
  • Money
  • Rigidity – I often feel like I have to do things a certain way, in a certain order, or put other things aside
  • Doing other things out of obligation
  • Feeling like I should take care of others before myself

How about you? 

I encourage you to write down both – your important soul work AND the barriers. Put them in writing. See what bubbles up. 

Again, I’d love to hear from you. 

Less aloneness in the world. That’s my soul’s mission – so tell me how this is going. 

With compassion,

Dr. Amy

Friends,

Happy November! Wow, it’s gone from sunny and gorgeous in the valley of the Pacific Northwest to rainy and windy. I hope this message finds you less soggy. 

Last week, I turned 47. I enjoyed beautiful celebrations and felt so incredibly loved. As I creep towards 50, I find myself reflective of my work as a psychologist, mom, educator, wife, daughter, sister, consultant, friend, all-the-roles! I have an incredible therapist, Sarah, (ask me more about this if you’d like to) who identified a phrase for me as I seek out purpose in my work and in life. She called it, “Your Soul’s Mission Statement” as I described to her what fuels me. 

I’ve always been drawn towards resilience-building. When I was in my undergraduate career, we studied stress as seniors in my honors psychology class. Onto graduate school, I wanted to know what helped families thrive in the face of hardship, having a child with a chronic medical condition. As a young resident in psychology, it was curious to me how some families were able to overcome extreme obstacles while others continued to suffer or worsen. My work with organizations focuses on the “now what” part of trauma-informed care and organizational wellness. I build resilience interventions for physicians to utilize during patient encounters. 

But that all started well-before college. If I had a theme song, it would be titled “Things will all be ok” and if you asked me about my favorite movies, they feature underdogs who beat the odds and survive, despite hardships. I could literally watch Rocky, The Hoosiers, or Rudy all day. So, when friends, clients or patients are experiencing hardship, I operate under the assumption that a. they’re not fragile, b. they have the capacity to heal, and, c. I can help. I’m ok holding space for people to struggle until they realize their own strength and capacity. 

What Sarah pointed out to me – yes, psychologists have therapists too – was that my soul’s mission statement: You’ll be ok. You’re not fragile. You have resilience AND the capacity to heal. And I can help – is simply something that is “just so” for me. Factors I take for granted. And it comes from a threshold of experiencing a great deal of trauma, myself. 

Today, as I strive in all of my roles to be fully present and genuine with who I am, I reflect on my soul’s mission statement and what that looks like, in real time.

I don’t want people to feel alone. 

Mistakes are normal and what make us human. 

You can LOVE someone immensely, but not LIKE them. 

Holding space for someone is a gift.

Listening is the MOST important skill we can hone and offer another human.

Grey areas are where we grow.

Sometimes, saying goodbye to a relationship is the healthiest action.

You didn’t sign up for your family. 

No one deserves your loyalty.

Being vulnerable helps others feel okay.

The ability to be your whole self with another human offers a treasure to you and them.

Well, those are my reflections so far, as I venture into my 48th circle around the sun. 

Tell me, what is your soul’s mission statement? I would love to hear from you. 

With compassion,

Dr. Amy

Friends,

Happy November! Holy smokes, I cannot believe it’s November already. 

First, if you’re a physician or healthcare provider, I’ve got a belated Halloween Treat for you! Join us this Thursday in The Provider Lounge where we’re talking about quality time in relationships. From special time with toddlers to wine clubs with friends to date nights with your partner, we’ll talk about how quality time affects health for you and your patients. Your first meeting is a treat for you! 

Second, I want to talk about PLAY. Amidst the despair of healthcare professionals, the degree of burnout is at an all-time high. Research indicates up to 60% of physicians are reporting burnout and nurses are resigning at a record rate. If you’ve heard me talk about burnout and overwhelm that leads to burnout, then you know there are only TWO cures for overwhelm: NOTHINGNESS & PLAY. 

Let’s talk about play! When was the last time you played and what did it look like? If you have a toddler or young child at home, you’ll notice they play all of the time. Everything is better if it’s a game! In fact, psychologists acknowledge that play IS the work of children – it helps them learn and process important information. Or, if you have an animal at home, you’ll notice they play every day, multiple times! But somewhere, we begin to exchange play for other “more important” pastimes and we have to build in time to play by joining sports, recreational activities, or clubs. And often, as adults, we make little time for play. And yet play is necessary. 

Play allows us to process feelings as adults too. The endorphins created through laughter are like a dopamine shower for stress & cortisol. When you’re in loving play with a partner or child, your body releases oxytocin, a hormone involved in strong attachments. Whether it’s watching movies with your family, laughing with friends or playing with your pets, play is critical for your health. It helps to mitigate the effects of overwhelm. Learn more here

Often, people tell me they don’t know how to play. If you’ve grown up in an emotionally deprived setting where play was absent, the concept might feel foreign to you. So, I’ve put a list and some links below. Use this until you find your own delightful ways to process all that’s going on in the world. 

Playful Ideas – I tried to throw in some passive play as well as ideas you may not think of as playful:

  • Watch movies that make you laugh
  • Bake with someone you love
  • Sing loudly with the windows down in your car
  • Jump on your bed, jump on a trampoline, jump rope
  • Dance – anywhere, to any music you love
  • Make love
  • Plan a special date for your best friend or partner
  • Surprise your kids with a tea party or picnic
  • Chase your dog
  • Dress up in a costume
  • Paint, draw, knit
  • Listen to a baby giggle
  • Eat with your hands
  • Swim nude
  • Read a funny book
  • People watch at the mall
  • Call someone who loves you
  • Ask siri to tell you a knock, knock joke
  • Play a board game, card game, or any game 

Resources:

  1. https://www.helpguide.org/articles/mental-health/benefits-of-play-for-adults.htm
  2. https://www.playyourwaysane.com/blog/play-for-adults
  3. https://youtu.be/6UeJcPtrzvs

How are you going to play this week? Reply and let me know!

With compassion,

Dr. Amy

Friends,

In case you missed it, you can still watch the recording of last week’s workshop. Already watched? Please forward this to a colleague who needs to hear the messages in there! It was truly soul-shifting – I saw folks in tears due to validation and support. And so many great questions and comments endorsing how much we need community right now. 

A 2017 study summarized 40 reviews on the public health consequences of lonlieness. Loneliness impacts our overall health, well-being, and longevity. And in medicine, it’s more prevalent than ever. Often, because of the culture of performance, professionals in healthcare have a deepened sense of not belonging and isolation. So, here’s what I want you to do: 

Commit to connection today!   

All humans are wired for connection. We cannot survive without it.  

  1. Reach out by text or email or phone to check-in with someone and let them know they matter and you are there for them. It might just save a life. 
  2. Stop for a moment and say hi to yourself. Give yourself a pat on the back for simply making it through all you’ve gone through. Notice what comes up. 
  3. Find an affinity group through your organization or online – being with folks that have similar experiences feels less isolating. 
  4. Join a community like The Provider Lounge – as of last week, we’re welcoming new members into our learning collaborative. It’s an incredible group that gathers monthly, via zoom, to create a trauma-informed community and learn tools to build resilience for patients. 

Ya’ll – stress, overwhelm and burnout are real and I’m here for you. And so is an entire community of like-minded physicians waiting for YOU, in this community where we’re combatting burnout through connection with colleagues, showing up for each other every month. I like to say, “Come for the content, stay for the community!”  

I was speaking with a physician today who said to me, “We’re SO GREAT at asking for resources and taking care of our patients. But we’re LOUSY at it for ourselves.”  

This sounds like every physician I know right now, so I’m thinking it may resonate with you.  

Want to hear more?  

The Provider Lounge: A Learning Collaborative to Build Resilience provides an opportunity to: 

  • Bridge the gap for unmet mental health needs of your patients
  • Gain CME 
  • Monthly coaching with peers 
  • Learn more about tools of trauma-informed medicine 
  • Answer the question “NOW WHAT?” in response to how to respond to trauma and adversity 
  • PLUS!  
    • Specialized meetings for Behavioral Health Consultants 
    • Monthly workshops for YOUR patients AND 
    • An online portal chalk-full of resources, tangible interventions, videos and scripts. 

Yes, it’s important to be a physician who’s trauma-responsive. But I already know how compassionate you are – you’re in it and you’re doing it! What this community provides is a safe space to ask tough questions, gain resources, and learn new tools to incorporate into your practice NOW. All while gaining CME and, if we’re honest, a touch of therapy.   

The NUMBER ONE thing I hear from physicians in this community: I feel less burned out.  

The increased confidence, community and competence around recognizing trauma (in yourself and in your patients) and responding with efficacious approaches leads to less overwhelm – and therefore, less burnout. Resilience is built for you, in community, over time, in our monthly meetings, with your colleagues. A confidential space where it’s ok to “not know,” be curious, and lean into support.  

Join us! Questions about The Provider Lounge or want to learn more about bringing it to your organization? Let’s chat

With compassion,

Dr. Amy

Friends,

About 4 times per year I offer a free workshop to our community. This fall’s workshop is happening tomorrow, Wednesday, October 19th, 2022 at 6 pm PST. The workshop, We’re Really NOT OK: 5 Steps to Address OverwhelmToday, is specifically for physicians, NP’s, PA’s, nurses, and BHC’s. Here’s what we’re going to address:

  • Differentiating between stress and overwhelm — it’s a game changer!
  • Understanding the compounding stressors that have contributed to burnout 
  • Breaking down factors of medical complexity in patients 
  • WHAT TO DO with ourselves 

Friends, this is what a physician said to me last month:

It’s just really hard right now. Patients are angry. People are tired of waiting. I’m tired. We’re all still wearing masks all day and struggling with staffing and rescheduling people all the time. And now, our patients are sicker b/c of delayed care and they’re so complicated. It’s like there’s this massive pile up of all of the unmet mental health needs for everyone. SIGH. I just don’t know what to do. This all feels like so much. 

She was definitely feeling overwhelmed. Is everything feeling heavier right now?  

Pre-pandemic physicians and healthcare providers were ALREADY overwhelmed to the point of burnout. Add in medical misinformation, vaccine hesitancy, vicarious trauma from loss, and the moral injury of this constant feeling…COULD I BE DOING MORE? 

It’s too much.   

Please join us for an evening discussion about complexity in the medical world right now. In our one-hour workshop, we’ll explore factors that have led to this feeling of overwhelm, why patients are so darn complex right now, and what to do about this before we’re all burned out. 

And we’re going to dive deep into what I really think is going on right now: A TRAUMA RESPONSE. 

But wait, before you run away…take a deep breath. You’re not alone. Other physicians and healthcare professionals are already saying, “Yeah, if I’m honest, that’s me right now.” So, please don’t miss this opportunity to be in community with other professionals. 

If I’m good at anything it’s tools – that’s where the magic happens. A lot of people can tell you WHAT is going on…I’m going to share with you WHAT TO DO with all of this uncertainty.  

Won’t you join me? Oh, and a small gaggle of your peers! 

See you soon! 

And I know what you’re thinking…I don’t have time for this – None of us have extra time right now. We have to make it by focusing on being in community and saying “YES” to help and support right now. This is for you. See you soon.

With compassion,

Dr. Amy

This past week, I had the honor of interviewing Dr. Bruce Perry for my podcast, The Most Important Medicine. Holy smokes! If you’re anxious to hear everything he said, you can catch it on Wednesday, October 19th when it drops! But in the meantime, I want to share with you a literal prescription he laid out for physicians. 

When I was talking to him about my work with physicians and other healthcare providers, I mentioned that, in addition to providing free resources and workshops, I host a monthly meeting for physicians, NP’s, PA’s and BHC’s called, The Provider Lounge: A Community to Build Resilience. He was super impressed! As we were discussing how important trauma-informed medicine is, ways to reach physicians, and the importance of continued support, he laid out the following flow for the BEST WAY for physicians to learn. And ya’ll – I was like – we’re doing this in The Provider Lounge! And, folks get CME, PLUS a whole online portal of resources. Here’s what he said:

  1. Context is Important: Physicians and other healthcare providers learn best in the context of their work. This means, that, while conferences and continuing education workshops are fun to attend and certainly meaningful, education that is provided within the workday is critically important. That way, you can go back to patients and colleagues and utilize the skills you learn right away! It reminded me of a conversation I had with a pediatric hospitalist while presenting at grand rounds. She said, “Geez, had I known this earlier today, my entire morning would be different. I’m going to change things this afternoon!” Yahoo!
  2. On-site Learning: Dr. Perry mentioned that time must be carved out for providers to learn within their work day and work week. When they’re asked to come in early, stay late, or take days off, it can add to the burden they already feel to be focused on their career vs. their WHOLE self. I mentioned that our meetings take place over the lunch hour and, sometimes, before work when physicians might already have time carved out for rounding, meetings, and EHR work. Brilliant!
  3. Reflective Supervision: This is something you’re going to hear a lot about in the next year or so. Reflective Supervision is both active listening and thoughtful questioning that occurs on a regular basis. Dr. Perry mentioned that the opportunity for physicians and other providers to have time, with an expert, to get feedback, grow, and gain skills in a safe environment is critical for the evolution of medical practices. It reminded me of one of our Provider Lounge members telling me, “I literally save questions for this group. I know I’ll get my questions answered and find new ways to solve problems in my practice.” Fantastic!
  4. Community Matters: The last aspect that Dr. Perry mentioned was the importance of community. He insisted that, because of the high degree of burnout in medicine, folks need to know they’re not alone. He pointed out that the medical field encourages unfortunate extremes of stoicism (always be OK!) and a disconnect from our feelings and from each other. That leads to burnout, overwhelm, and isolation. Community is the antidote. I cannot tell you how often I hear from folks that being part of a group like this is like a balm for their soul. 

Anyway, I share this now because the news was TOO GOOD to hold onto. If you’re on the fence about whether or not being a member in The Provider Lounge is right for you – this is literally the prescription that spells it all out! 

And, if you want to get a taste of what it feels like you can:

  1. Join us in a week on October 19th, 6PM PST, for a free workshop on addressing overwhelm: We’re Really NOT OK: 5 Steps to Address Overwhelm Today, or
  2. Sign up for a Provider Lounge meeting here! Check it out, see what it’s about and tell us what you think. 

There’s space for you where you’ll grow, learn and be in community.

Friends,

The AMA, in partnership with the Mayo Clinic and several other esteemed research institutes, published an article this week about the alarming rate of physician burnout. Here are the facts:
The researchers also found out that the rate of work/life integration dropped 16%. Also, physician suicide is on the rise with the best estimate between 3-400 physicians/year taking their lives. 

Perhaps this is not news to you. You’re feeling it in your bones. If that’s the case, you’re not alone.

I won’t waste your time, so let’s just cut to the chase. 

Please join me in two weeks when we tackle practical ways to handle overwhelm. I hope systemic change is coming. I hope physicians and healthcare providers will rise up and say, NO MORE. I know you’re resilient and that asking you to engage in more self-care isn’t what you need. Until then, we MUST be in communities of support and take advantage of the help and practical tools to decrease overwhelm that leads to burnout. 

I promise it’s not about performative self-care – we’ll talk about:

How overwhelm leads to burnout and how it’s different than everyday stress
5 practical tools to address overwhelm
Why patients are so darn complex right now
Ways to find joy inside and outside of work
Where to begin

I’ll see you soon. In the meantime, take a listen to my podcast! Thanks for letting me support you – 

With compassion for all you do,

Dr. Amy
Friends,

So many of you are feeling overwhelmed right now. As I listen to physician stories on my new podcast, I hear so much fatigue and despair. I wish I could give you a huge hug and sit with you for just a bit over some coffee or wine. For now, hopefully this provides some solace and validation. 

Look at the model below. I think what’s happening is a reckoning. It’s like there’s just enough breathing space to look up and realize what you’ve been through. If you’re not like one of my friends, with 10 (!) physicians out this past week with COVID, you’re likely trying to work through the phase of reconstruction. The phases of disaster (shown below) are ways we can anticipate responses to overwhelming events. Where are you?
I’m going to guess that most of you are in phases of reconstruction – working through grief, experiencing some setbacks and trying to create a new beginning. But that’s easier said than done. In actuality, what I’m hearing from folks as they begin to process this grief is, “I’m really NOT OK.” You’ve been pushed pass what should be expected from healthcare providers. As you work through grief, my worry is that many of you are experiencing acute trauma. You can’t begin to create new meanings and return to “normal” if you’re in a space of trauma.

Here are some signs of acute trauma:

Psychological symptoms

• Anxiety
• Low moodIrritability
• Emotional ups and downs 
• Poor sleep
• Poor concentration
• Wanting to be alone.
• Recurrent dreams or flashbacks, which can be intrusive and unpleasant.
• Avoidance of anything that will trigger memories. This may mean avoiding people, conversations, or other situations, as they cause distress and anxiety.
• Reckless or aggressive behavior that may be self-destructive.
• Feeling emotionally numb and detached from others.

Physical symptoms

• Heart palpitations
• Nausea
• Chest pain
• Headaches
• Abdominal pains
• Breathing difficulties

Here are some helpful resources for physicians:

Burnout Toolkit
Wellness Affinity Groups
“Getting Rid of Stupid Stuff” Initiative
Physicians Anonymous 
Oregon ECHO Network

In the meantime, I also want you to join me at a FREE workshop I’m hosting next month called, “We’re really NOT OK: 5 Steps to Addressing Overwhelm Today!” on October 19 at 6 PM PST. You don’t want to miss out on this opportunity to be IN community with your peers and talk about actionable tools you can utilize now to address overwhelm. It’s not a replacement for therapy or coaching, but it’s a great place to start. 

With compassion for all you do,

Dr. Amy

Friends,

Take a look at this photo! It’s over 90 degrees outside – hot and dusty with no breeze. He’s charging out of the box on his horse, string in his mouth, rope outstretched as he throws to catch his calf. It’s SO MUCH to put together. He practices for hours. Besides the sheer grit and determination on this young cowboy’s face (my son!), look behind him. All of those kids, trainers, and peers? They’re ALL ROOTING FOR HIM. Every single one of them hopes he catches that calf. They look on with anticipation, hope, and a sense of urgency – “COME ON JACK!” Even the announcer in the crow’s nest wants to celebrate him. And the cool thing? Even if he misses, they celebrate him. They’re celebrating the effort. The sheer determination and dedication to a sport where you often miss – no accolades, no awards. 

Does this sound familiar? 

In the absence of accolades, we all need someone rooting for us, win or lose. 

There’s been so much loss over the last few years – loss of colleagues to burnout, loss of patients, loss of hope and dedication to jobs once coveted, loss of authority, loss of determination. 

Who’s rooting for you through loss? Who’s helping you hold onto your purpose?

We all need a little more community right now. The gang behind us cheering for our success – and not success with a blue ribbon, or money, or star power – success for trying, for our efforts, for our sheer perseverance. 

I want you to think about this – who are your people in your corner, rooting for you? Have you told them? And who’s corner are you in? Do they know? Tell someone today that you believe in them. You never know what a difference it could make. 

Please join me in a few weeks to honor you. You’ll learn 5 Steps to address overwhelm today – 5 practical tools so that we have less loss and more support in this space. 

I’ll be in your corner, rooting for you!

With compassion,

Dr. Amy

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