Nathalie Martinek, PhD is a recovering developmental and cancer biologist who transitioned out of the controlled environment of the laboratory into the messy world of human behavior and relationships. She continues to apply her critical and objective lens honed as a scientist to understanding drivers of human behavior in the various relationships that exist in healthcare contexts to discover what prevents and promotes wellbeing and professional satisfaction.
Dr. Martinek is a speaker, listener, coach and consultant who facilitates training programs and workshops worldwide for diverse health professional audiences to enhance their capacity for human connection, abuse prevention and healing through cultivation of psychologically safe and stable therapeutic partnerships. She recently published her first book, The Little Book of Assertiveness, to provide scripts for shifting power dynamics in professional relationships to embody the qualities of a respectful and compassionate healthcare culture that enables everyone to thrive.
We discuss how to be assertive in a hierarchical environment like medicine without offending your superiors – and it starts with being curious. We then pivot into discussing compassion fatigue, first by defining it and then by exploring ways to interact with patients in a way that doesn’t end with us unnecessarily burdening ourselves with no benefit to the patients. We then end with some self-care practices that allow us to process those burdens.
Find her at drnathaliemartinek.com
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Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.Dr. Natalie Martin Nick is a recovering developmental and cancer biologist who transitioned out of the controlled environment to the lab and into the messy world of human behavior and relationships. She continues to apply her critical and objective lens honed as a scientist to understanding drivers of human behavior in the various relationships that exists in health care contexts to discover what prevents and promotes well being and professional satisfaction. Dr. Martin Nick is a speaker, listener, coach and consultant who facilitates training programs and workshops worldwide for diverse health professional audiences to enhance their capacity for human connection, abuse prevention, and healing through cultivation of psychologically safe and stable therapeutic partnerships. She recently published her first book, The Little Book of assertiveness to provide scripts for shifting power dynamics and professional relationships to embody the qualities of respectful and compassionate healthcare culture that enables everyone to thrive. We discuss how to be assertive in the hierarchical industry. That is medicine without offending your superiors. And it starts with being curious. We then pivot into discussing compassion fatigue, first by defining it. And then by exploring ways to interact with patients in a way that doesn’t end with us unnecessarily burdening ourselves with no benefit to the patients. We then end with some self care practices that allow us to process those burdens.Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.And now, here’s Dr. Bradley Block.Dr. Natalie martynuk. Thanks so much for being on the podcast.Thanks for having me, Bradley.So let’s start with your origin story. What what’s your PhD and And what was your thesis?My thesis so this is a really awesome title. It’s spark is required for basal lamina stability by mediating type for collagen deposition during embryonic development of just soft lemme Lana gastric.Oh, Monica master mind my favorite my old friend. Yeah, that sounds that sounds really interesting and really that tends to be the theme of this podcast is everything that can be learned about the basal lamina of a I’m not even sure if that’s what you said of the dressage. That’s right. So what what does that make your PhD in? You are a developmental biologist,development biologist, so I was really interested in understanding the unsexiest the least sexiest part of a body, which is the connective tissue, the extracellular matrix, all the environment outside of a cell. So while everyone’s studying inside, what’s going on inside the cell, I was looking at what’s going on outside of the cell that is eating influencing how cells behave, how they move, how they invade. And that led into my postdoc in cancer research. And the reason I was interested in that is because it’s a less controlled environment, you know, whereas you’re working in a cell, you can kind of manipulate the proteins being made, or you know, the enzymes, and you can see its effect of what’s going on inside the cell. Whereas what I’m interested in what I was interested in is looking at what the cell is producing how it influences its behavior, as well as the development of the organism. Yeah, so that’s basically where I started and I was looking at the cells, the macrophages of the of the fruit fly, which are involved in surveillance and removing pathogens and other things that invade that you don’t want in your body.So is that what you’re working on right now?I guess yes and no, biologically No. So where that led to was trying to understand how to relate this the cells that normally move around the body play a role in the music system monitoring surveillance protection against, you know, my microbes and pathogens into still using your software to study tumorigenesis. And so is looking at what how do cells move from an original location and invade into tissues and start to migrate and take over the body basically co OPT the defense system of a body of an organism for its own means of survival. And so while that was occurring, during my postdoc years, I started to become very interested in the conditions within a workplace environment that would enable certain behaviors to start to manifest as bullying or to, you know, spread around an environment and create a sort of toxic culture. So what I’m studying biologically was mirrored mirroring or mirrored in my external workplace environment, and that became more of an interest to me.Oh, I was hoping that that was the direction you’re We’re gonna take this in, because I was hoping this wasn’t gonna be an entire podcast about Drosophila. And knowing you and what you’re doing now, I was like, man, I hope. I hope she ties this in. Oops, didn’t go back to the lab, and she’s gonna be talking to us about pipetting. Again,no. Okay, looking at the conditions that exist that promote or prevent certain behaviors from existing and amplifying what what made you make that transition suddenly different things? burnout is one of them. You know, and the way my experience of the way I experienced burnout is that when you’re working in an environment or in a, in a in any place where you believe that it’s the right direction for you based on your training and education, what’s expected but yet it doesn’t speak to your heart. It doesn’t address some of your major interests. And what else you could be doing, the longer you stay in that situation, the less I guess the more energy is required in order to make maintain that, that makes sense. So you’re not actually living a fulfilling, at least not your work life. And it’s and it seems to spread into all your other parts of your life.Well, sometimes it seems like it’s, you’re like a hamster on a wheel, and you’re kind of that idea of publish or perish, that you’re almost doing it for someone else, not for yourself, not for your own interests, not for not for the research, but more like you have to produce something, just in order to keep your job and keep your grant. Even if it’s just kind of like paying lip service, not not what you’re, you know, not not that you’re trying to answer a question.Yeah. And when I start exactly so when I started to think about well, why what’s not right, what’s not going well here for me why, you know, on the surface, this should be what I’ve always wanted, interrogating the mysteries of life using fruit fly and biology. And then I was looking at the culture around me and seeing, you know, the effect of being an environment like that. on me, I was turning into someone I didn’t like in order to survive. And that that type of pressure and environment, looking at the way we address illness and try to get a better idea about the mechanisms behind disease. And we’re using a lot of data or theories or beliefs that are quite biased and, you know, got to the point where I’d be listening to someone’s talk or reading a paper and I’d be able to spot the unconscious bias very early on, and would poke too many holes within their story that I couldn’t listen to anymore. And after a while, I’m like, if this is my, if this is my experience, why am I still here? The other thing is we’re looking at human disease, you know, cancer, which doesn’t happen in a fruit fly naturally, or quite rarely, but doesn’t have the same impact. And we’re trying to understand the mechanisms of this disease in the fruit fly, but we’re using almost assumptions that by understanding the mechanisms in a fruit fly, we can apply it into the human experience, which we can’t because only humans are the only organisms on the planet who can make meaning about their life experience who, you know, we’re not looking at the impact of trauma, intergenerational trauma, community healing, we’re not eight emotions, we’re not able to study that in the controlled environment of a lab or in a tissue culture. So I started to become disillusioned with what we’re trying to achieve and whether or not what I’m doing in the lab applies to that patient that was in the floor underneath me, you know, in the in the floor down with their chemotherapy treatment, is this what they want? Is this the kind of research that they’re wanting us to do? Is this really what’s helping them? And the answer kept coming back to me No. So after a while, it was just I recognize that this is not ethical or within my integrity to continue in this way. And I had to make that tough decision to hang up my lab coat for good, at least in that setting.So it sounds like you were so distanced from the intervention itself, like, you know, the research that you were doing was so far down the road from the eventual intervention which was then you know, distance very far from the patient itself. Then it was hard to, to continue doing that work. And it was almost like you were in the academic rat race.Totally. No. And, and it felt a bit exploitative because we’re, we’re getting public funds, we’re using public funds. We’re justifying our, you know, the rationale for our research by saying this can potentially have some sort of direction towards a cure. But we don’t know when we’re kind of building up hope. And I, you know, I recognize the importance of that, but it’s like, it didn’t feel authentic, that we’re actually caring about the patients that were in the same hospitals or Research Institute. We weren’t actually talking them to find out what’s meaningful for you, what is it that you need us to be studying in order to support your experience? So it just felt so removed?So then you pivoted and one you wrote a book on assertiveness, which I would imagine a lot was taken from your experience in academia and in that lab setting and then you also To speak on compassion fatigue. So, first, with regards to the shortness tell us just tell us a bit about the book and your workshops.So assertiveness, you know is this topic that I didn’t anticipate would be this common thread running through my life since I was a kid. I noticed over the years, especially as a Canadian having moved to Australia, you know, there’s so many similarities between these two countries. So there’s quite some massive differences. And I noticed the one difference is that people were not as upfront with the feelings or their truth being honest. So you wouldn’t know where you stand with everyone. Everyone’s working hard to make sure everyone you know, looks good. Feels good. In which country? Australia In Australia, okay. Yes, sorry. And no one would really raise issues. It’s only that you know, you only discover that there’s an issue when it just becomes conflict, like boom, out of nowhere, and then it would make me think about why why that is. Why are people so afraid to speak honestly about their thoughts and feelings or ideas. What are we so afraid of, and it wasn’t quite my experience in Canada, people would be upfront with where things stood. And you’d be able to, I don’t know, work together. And maybe it was the environments that I were that I was in. But I found among really educated people, and this is not just in Australia, this is widespread. And this comes from doing lots of coaching and training work with physicians and other health professionals among health professionals. The common theme is that people are too afraid to challenge ideas, especially the ideas that come from someone who’s perceived as an authority figure, or someone who’s more knowledgeable than that than they are about a topic or an area of expertise. And so they’re more likely to be compliant and listen, or be combative in order to push their, their viewpoint across instead of challenging. And then when I started to, you know, go deeper into it, the skill involved in challenging an idea and learning more about it or getting to shift perspective is assertiveness, it became clear that we need some more information about what assertiveness could look like that is not combative, aggressive, trying to control a situation to get the outcome that you want. It’s looking at what are our values? What do we really want? And what is best for the US, not just me to see you, but weYeah, medicines very hierarchical, right? Like, you’ve got your medical students, your residents, your fellows, your attendings, you have the nurses and the nursing assistants, you have, you know, this is a complex system but with a very clear hierarchy. So, it can be challenging to assert yourself without being disrespectful or, you know, without fear of the repercussions of at least being viewed as disrespectful. So what recommendations do you have for within within that hierarchy for asserting ourselves, right? If we See, if we have a quiet if you’re a resident, we have a question for attending. If we think that a patient’s we should be paying more attention to lab value, or we think that the surgery may not be the best thing for this patient. You know, what, what recommendations do you have for asserting ourselves without being disrespectful?Hmm, it’s a good question because I think there’s this assumption that assertiveness comes with disrespect that we can’t be assertive and respectful at the same time. Whereas my version as I described in the book is extremely respectful. It’s acknowledging the role that we each play among in a team that we each have an important role, and they’re all required in order to fulfill a purpose or to achieve You know, this desired outcome for all of us, including the patient, so as best as we can, so assertiveness, the way I use, it is about applying inquiry or curiosity. So we all have different assumptions. We all have different beliefs, we all are, view our roles differently and each other’s roles differently. So how do we know what we’re thinking? Unless we ask the question, tell me more. Tell me more about what you understand about the situation, or you help me understand what you mean by that. So I’m on the same page as you. So we have to recognize everyone’s role is important. Therefore, we should be respectful that we don’t each know everything. There’s something that I can learn from someone else. And I want to learn from you in this moment. So please help me understand. So I see that just the asking, asking questions instead of expecting to know all the answers, because that’s part of the culture as well that you just should know. And that’s a sign of weakness. If you ask questions, assertiveness kind of breaks through that and goes, I don’t have all the information. I don’t know everything. I’d like to know what you know, please teach me please show me I want to, you know, you have some wisdom that could benefit me and us I’d like to know it.So it sounds like you would maybe rephrase the question as if you’re acknowledging that you may be wrong. So like, if you’re questioning the way a surgeries, the plan for the way the surgery is going to be done, it should be you think it should be done. B. And the plan is to do it a, you would more ask it assuming that A is the correct way to do it, but you think it’s B. Right? So like, yeah, the assumption is that the person who is asserting themselves doesn’t, is actually incorrect. But they want to know why. You know, why? Why answer a is actually correct. So that’s one way that you’re being deferential within the hierarchy. But at the same time, maybe, you know, that’s the way that you’re questioning the authority.Yes, you’re not coming across as I know better than you and you must be wrong. And I’m also not coming across as I’m wrong. I’m not making any assumptions. I’m just saying I’m, I’m wondering about your plans, please describe them to me because I want to make sure I understood them because I may have missed something. And that way I can ask questions as to, you know, explaining why you’re doing it that way, not because I think you’re doing the wrong thing, or I don’t trust your judgment. I’d like to know. I’m curious because it’s part of my learning. It’s coming from this place of humility, curiosity. I want to learn more. I want to learn more from you.So that if this patient were to walk through my door, I don’t know if I would have made the same decision. How did you arrive at that decision?Yes. Okay. So share your thinking process behind it. Because I’m, I want to, I’m curious about how you approach a problem or you approach a situation and it’s, I’m curious to know if it’s the same as an as a how I would do it. It’s like, it’s like that just the idea about learning. I’m here to learn.Are there any and those individuals, right, that’s what their primary role is, right? They’re apprentices so they’re, they’re likely to learn Yes. Are there particular phrases that you found useful? Or the opposite and any phrases that that are particularly toxic that we should avoid,or anything to do with feelings where you’re trying to describe someone’s feelings. So when you say, you know, when someone’s expressing something and they’re coming across as little agitated, I see you’re really agitated. Or don’t do that, because you’re just gonna tap into their agitation and amplify it. It’s also kind of suggesting you understand their experience better than they are, when you’re pointing out their feelings. You know, the other way of doing that is I can see that there’s something that’s there’s an outcome here or there’s something that happened, that wasn’t what you expected. Can you tell me what’s going on? You know, what’s happening right now. So that’s what I call a safer way less emotive, potentially less condescending sounding, even if that’s not your intention. Another thing is, I’m sorry, you feel that way. You know, if you said something or did something that was the right thing in that situation with that other person. You’re not taking responsibility when you say I’m sorry, you feel that way. I’m sorry. That what I said was hurtful or I’m sorry, that what I said, didn’t land? Well, that wasn’t my intention. Let me try this again. You know, that’s taking responsibility for the impact you have on someone else rather than I’m sorry, you feel that way. Which is pretty much saying, Yeah, it’s like, your problems, you know, your feelings, your problems. I had nothing to do with it. Like, that’s not.That’s sorry, Your reaction wasn’t what I expected. Yeah, yeah. Okay. Yeah. But with regards to the the assertiveness, are there particular phrases that that would be useful?I guess it depends on the context, because in the book, it’s talking about different situations and barriers to assertiveness, what kind of power dynamics are occurring, that makes it hard to speak up. Because, you know, like what you mentioned, there’s a hierarchy. But there’s also other inequalities that are present within any, any environment. We don’t all have the same starting line in life. So we can’t just go I’m going to stand up for myself because you could be making your situation a lot worse. If you don’t Understand the unwritten rules of the place. So it’s always about understanding what are the values that we each share here and communicating that I see that you want this best outcome. So what do we each need to do in order to achieve that? very proactive?Alright, let’s pivot now to your other area of interest, the compassion fatigue, right, something that a lot of us in medicine are experiencing. We had a speaker on the podcast a little while ago, Dr. Tory SEPA, she’s a psychiatrist, and something that she’s written about is the fact that we give so much to our patients that when we get home at the end of the day, we really have nothing left for our family. So first, let’s define what is compassion fatigue?Hmm, yeah, I’m interested in what you said. It’s like we give so much to our patients that there’s nothing left for us. That’s exactly it. We are giving too much and we’re not able to monitor the level of which we give and whether When it when it’s enough, you know when is our level of giving sufficient to get the job done or within the realm of our role and responsibility with that patient, which will differ slightly with every other patient, the definition of compassion fatigue. So there’s, there’s a few definitions out there, because it was coined in 1995. By figley. And from my own study of doctors and other health professionals over the year, I’ve come to a different definition, which is less about compassion and more about empathic overload. So compassion fatigue is not because we are being too compassionate, it’s because we’re not being compassionate. That’s the problem. So there’s empathic overload that resulting from an imbalanced emotional investment in helping another who we perceive to be in a more vulnerable or disempowered position coupled with an absence of self care practices. So we are dealing with this sort of power imbalance or this perception that this person is so needy that I need to get Give them more than I can then I have the reserves for and I’m not doing enough practices within myself to recharge my supply of energy. So that’s how I see compassion fatigue.Alright, let’s unpack that. Let’s go to the to the first part. So the fact that we’re we’re feel like we’re giving so much to the patient that we have nothing left. It sounds like you’re saying the assumption of that means that they require so much of us, and often it is the case that they do not. Mm hmm.Yes. So do you have an example of when you’ve given too much to a patient? What that looks like?Well, I would think, let’s say I just I have to give some bad news, right? So the bad news could be, we’ve been monitoring somewhere to cancer and their cancer came back or if I have someone that, you know, we’re gonna have to do a biopsy on you because there’s a possibility that you’re right. That’s the big concern. That’s the elephant in the room is his cancer, right? So let’s just use that as the example. So right. So I see up to that 30 patients in a day. And so what might happen is I have someone in whom I have to give that type of bad news. And now I’ve got someone across the hall with a completely unrelated problem. And now I need to somehow reset, forget the patient whose room I just left because now their hand right there, I give them the news, they have a plan, they have a strategy, but I’ve explained everything to them, but, but that can be really emotionally fatiguing. So now I’ve got to be able to go and completely refreshed to this next patient who has a completely different problem from you know, starting from zero. So, you know, doing that over and over and over and over, is just, it’s really taxing. So, you know, that that that’s really the, the scenario that I that I think our listeners need to be able to work with.Okay, so let’s let’s do this in a stepwise fashion because as you’re as you’re sharing the situation with the other contexts, you know, my mind is going off of like, oh, you’re doing it this way. And then you’re doing that way. And of course, it’s going to be texting, let’s go back here with the patient, you have the results of a test, and it’s not positive, you’re sharing the news with them. And they have, you know, an emotional reaction to it, I imagine some sort of reaction. And at the same time, you also want to make sure that they they’re informed about their follow up actions, their options, etc. And so you’re working hard, you’re working really hard to try to help this person. equip this person with what you think they need in order to feel a bit more in control. After having received this news.They’re overwhelmed. They’re shocked. They don’t know what questions to ask. Yeah, they’re asking more logistical questions than anything else. like where do I go next? What’s the phone number? Is there parking there? Because they’re just so shell shocked about their diagnosis.That’s right. So you’re already working. You’re already doing too much work there because what you have what is required, which Just the compassion thing. So it’s not saying any other ways not compassionate, but it’s like the right action that’s needed in that moment is giving them space to process that a little bit. And so what can happen is because we’re feeling really uncomfortable with their, the first of all that the information you have to give, how it’s going to be received by them, and then their emotional response to it. We tend to go into this, give information, I need to do something to appease my discomfort at saying something that upset someone else, but you’re just the messenger, you’re not the cause of their upset. There’s a situation that is happening for them, you’re reporting to them, what the tests have shown. And what is needed is to allow space for them to just receive that information and process it in that time and space you have with them in the way they need to. That might mean that they ask you questions, but when you start giving information, they have no room and capacity to do anything with it. It’s just more energy that you’re You know, putting out in order to somehow fulfill this kind of role or obligation you feel to make them feel better. But you’re working hard to do that you’re trying to force them from the state that they’re in, which is deeply uncomfortable for you into a different state that might feel more comfortable for you, even though it’s not wonderful overall. Does that make sense?Yes. But, you know, if they’re, if they’re asking these questions, I don’t see. You know what I mean? Like, like, realistically, a lot of times they can’t they’re so overwhelmed with this new diagnosis with this new complete change in their world, right. It’s hard for them to process any information, totally. But they’re still asking you the questions. So I don’t see a situation in which I would redirect them and tell them listen, this is not the time for you to be asking those, you know, I, I’m not sure how to pivot from there.Yeah. So it’s almost like you know, this is big news. And this may not be what you expected or might be what you expected. But we don’t know how we’re going to you know how how we’re going to feel about it in the moment? Do you need some time to process this? Do you need time and space? You know, I’m here to answer any questions you have. But I want to make sure you’re in a headspace where you can actually do something with this information. So you’re giving them permission to take space. The problem is you have, you know, I can only imagine that there’s short appointment times, or maybe there’s a longer appointment time if there’s test results to disclose, and that everyone is trying to the patient is trying to get as much as they can from you in that time. But like what you said, they’re not in any position to be able to process any event. So sometimes it’s a good thing to go, Hey, this is big, you might need some space. And I can answer questions after before you know, so that you can be in a different headspace where you can look at all your options and look at the next move you need to make and I’m here to support you with that. Would that be okay? Or do you have questions you want to ask now? So you’re giving them choices, and it’s less laborious for You know, and then you won’t walk away feeling like you had to do all this stuff in a certain ritual within a short period of time, and then have to move on to the next patient, you gave space you allowed, you allow the space for them to decide what they need next, which is I’m not saying that that’s not what’s done. It’s just a different way of doing it.Yeah, that is more than I want to know, just acknowledging out loud, that this is gonna, this is a very overwhelming thing. And they might have difficulty processing it all at once. And so if you know, if they need just a little bit of time before we regroup and decide what happens next, then when they can do that, you know, at least in my practice, I could very easily just go, I could go see the next patient and give them at least a few minutes to kind of, you know, maybe they want to call a family member if they came close, or something like that.Yeah, that’s right. So there’s ways you can manage the time. Definitely. So you see those options now. And it gives you room to breathe. It’s the you probably holding your breath for a whole day. Sure. If you’re going back to bed, Patience gives you the space to breathe with them.So you, you know, we talked about compassion, fatigue and empathic. I apologize. It wasempathic overload. empathic overload.So what’s the difference between compassion and empathy? Or, I guess empathy is?Yeah, compassionate empathy.So again, there’s so many different ways that I see people describing it. Empathy to me, is emotionally neutral. It’s the ability to basically attune to what someone else is feeling. It’s not about being in someone else’s shoes. We can never ever, ever be in someone else’s shoes. We have our own experiences, our own ways of perceiving the world. We can’t actually enter into someone’s shoes, but we can imagine what it might be like for them to to experience the bad news or, you know, experience living with cancer experienced an illness. We can imagine it and we can also be, we can also appreciate how they’re using their resourcefulness to live with With it, to deal with it to manage it. That’s empathy. It’s not about feeling what other people feel. But because we are emotional beings as well as you know cognitive beings, we can actually feel in our bodies, what people are feeling. I know for me personally, the more time I’ve spent working with people I can feel in my body where they have pain. So I already know where their pain is, before they even disclose it to me that we could start to believe that’s our pain. If we didn’t know better, we didn’t know differently. So empathy is what connects us. We need that in order to build a rapport and trust in a therapeutic relationship with a patient or client. But what can happen is we can feel people’s feelings so extensively, and we can just dive into the their story of their suffering, that we fail to see all the other positive things that are also occurring in their life at the same time, we can fail to appreciate their strength in their capacity to overcome challenges that we all have and we can just see We’re the we’re the one that ruin their day because we gave them bad news, we put that on ourselves. And so we become overloaded by all those feelings, those negative feelings and we become, it can feel quite heavy. And if you’re doing this daily with so many different patients day in, day out, and not going through any sort of internal process or debriefing process or any sort of self care process where we can make sense of it and unload it from ourselves, we become quite exhausted very quickly. So let’s talk about the debriefing process. Oh, what I didn’t act that I didn’t mention was compassion. What is the difference? So compassion is recognizing that we all suffer and we all have joy. Just because you’re in the doctor patient doesn’t mean we’re so different in that way. We all have these feelings. We all have, you know, our experiences, so I can, I can appreciate that you’re in suffering right now. But you know, there are other areas of your life that are also joyful or pleasurable, that it’s not only about the suffering, and my job is not to make you suffer less than this moment or feel differently. I’m here to recognize that we all suffer, we all feel joy, and I can see them both with equanimity. And my role is to do what? To do the right action in this moment. So how, what do I need to do with this person who’s just received news that upsets them? That is compassion. Compassion is not making them trying to make them feel something different. Like what I mentioned before it’s holding it’s it’s holding space for them to experience whatever they need to experience right now. That to me is compassion. So that’s the difference between empathy and compassion. Compassion is like what I call love with action, check. It’s empathy plus action, his compassion, and empathy is just being tuned into their experience, whatever they’re what they’re feeling and thinking. And it requires some listening skills, some inquiry skills, so asking certain questions to get a better understanding of what’s going on for them and just being curious about that rather than feeling what they’re feeling and trying to make them feel something else.So it sounds like the theme here is really giving the patient space either really giving them space or verbally acknowledging the fact that they may need to take some space and that’s gonna unburden us at least just a little bit. Definitely. What about the that debriefing that you were talking about? Can you elaborate on that?Yeah. So I don’t mean the debriefing that occurs, if that can occur after an adverse event. I’m talking about just the everyday the stuff that weighs on us the things that we encounter on a day to day basis, you’re as a physician, you’re seeing suffering, pain, joys, everything on a day to day basis, who are you talking to about this because it can be burdening especially if something that you’re experiencing doesn’t make sense to you or you haven’t, you know, resolve it within yourself. We have all these unresolved stuff that we carry every day, unless we give a voice to it and, you know, debrief it, disclose it, offload it, it just stays inside us and it becomes again, quite heavy. So it’s having a trusted person in your life. Whether it’s a therapist, a counselor, appear, a colleague, a manager supervisor, doesn’t matter as long as you feel safe with them, and you trust them. And they’re not trying to give you advice, and try to make you solve the problem. It’s about holding space for you, to giving you space to disclose the things that are weighing on you. And through that process, you might develop your own aha moments. So it’s just again, give allowing yourself to have the space the same way you’ve just given for your patient.Is there a role for journaling in there, you know, there, there might be some issues with legality and HIPAA, at least in the United States, just being able to talk to people about what’s happening with your patients, although it’s easy to make these fairly anonymous. You know, if you’re speaking to a spouse, or a colleague about a patient, it’s really important that you leave out any identifying information because the legal issue Yeah, so here’s the thing. So your lawyer before you Yeah, before you Again,well, it’s not about your patient. In the end, we can say it’s about our patient, but really is it’s about us where there’s something that we experienced with the patient that’s bothering us. So it’s you don’t even have to talk about the patient. It’s about what’s bothering you what’s unresolved in you, that working with a certain patient has brought up, but it’s not about the patient at all. It’s about your experience of that. So it’s working with someone, again, trusted, confidential space where there’s no risk that they will expose that information. And you can, again, de identify everyone involved in the situation, but really is about an opportunity to talk about yourself and learn about yourself. And journaling is definitely part of it. But it requires a structure like, you know, we could do a stream of consciousness where you’re just writing whatever’s on your mind and just offloading it. There definitely can be therapeutic. You can use a self reflection practice that is helping you get clarity about a problem or, you know, again, something that’s weighing on you. By the way, what I find the most powerful is when you’re doing it in the presence of someone else. Someone else is witnessing you. They’re not trying to solve your problem because they can’t, it’s not them. They don’t have more expertise in your problem than you do. It’s your problem. It’s them just being open and holding space and allowing whatever that’s lying underneath to reveal itself. So, so is thelistener, an empathic listener, or a compassionate listener?I think the both of you need both. You can’t have compassion without empathy. It’s like I say, empathy is the doorway to compassion because you don’t know compassion is the action. You don’t know what to do unless you are able to attune to what’s needed by that person. What’s needed or what’s needed in that situation. And what’s needed is not dictated by you. It’s dictated by the moment you know, like I said, some Breaking Bad news. You think you have to kind of appease them and make them feel better before you know you send them on their way. That’s not necessarily compassionate because you didn’t give them space to actually grieve and maybe they’re not really great at grieving or, you know, expressing emotion You allow that you enable that to happen, which is a really good thing. So compassion is the enabling the allowing the permission, the non compassion is the pushing the for things that are trying to control.Are there any other self care practices that you recommend? AndI’m all about talking as you can tell some of the talking anddebriefing with again, a trusted person who knows how you how they can support you, you’ve told them or you’ve trained them on how to support you. Big one is reflective practice. So, you know, one form of that or shorts rounds where you know, that’s a way of getting together with other physicians or your team and talking about things that occur in the workplace and, you know, holding space for these conversations to happen, which are often held secret and buried in shame because somehow we’re supposed to believe we know everything, and that we could do everything perfectly and that that’s not possible. So the short surrounds is One format reflective practice is a more structured format that also allows you to figure out what next step to take or how to do something differently. Because you would have reviewed the impact of your actions with a patient with a colleague, whatever the situation is, and then learn from it, and learn and think about how you could take a different step forward next time. And it’s really, again, non judgmental, very open, and about Problem Management. So those are two very powerful ways that can prevent compassion, fatigue, and they all involve talking about everyone’s favorite subject themselves themselves, right? But what we also learn from everyone in the group, what you learn about from someone in the group also applies to you. So one person shares their issue and it becomes a group kind of learning opportunity, because we all experience these things.Is there anything that we didn’t talk about today that you’d like to mention to our physician audience, either about assertive Or compassion fatigue?Yeah, cuz. Yeah, I think overall it’s learning I guess overall, it’s learning how to be okay with the myriad of emotions that we get exposed to and the emotions that we feel. And the more we allow ourselves to be uncomfortable, the easier it becomes to be with someone when they’re going through their toughest day, and not trying to make them have any other experience and the one they have, and it’s less and less energetically taxing on us. And it’s actually more supportive for the for the patient. So everyone benefits from that kind of interaction.I think I heard Tim Ferriss once say, a successful life is judged by the number of uncomfortable conversations you have. I think there’s something to that,that and that’s assertiveness, exactly. It’s it’s naming the elephant. So in my book, I talk about ways I provide scripts on naming the elephant and it breaks the tension in the room and again, it brings some relief to everyone in there.So we’re getting People find the book and where can people find you online?Well, I’m on Twitter a lot. And it’s where I found you. That’s very family. So I’m at NATS for number four docks. And the book can be found on Amazon. And it’s called a little book of assertiveness. And don’t let the name fool you,Dr. Natalie martynuk. Thanks so much for being on the show today.Thank you so much, Dr. Brad for having me.That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for a previous guest, or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.Transcribed by https://otter.ai