{"id":4787,"date":"2016-05-11T00:00:00","date_gmt":"2016-05-11T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/05\/11\/good-grief-rounds-help-docs-heal-themselves\/"},"modified":"2023-03-06T10:03:49","modified_gmt":"2023-03-06T17:03:49","slug":"good-grief-rounds-help-docs-heal-themselves","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/good-grief-rounds-help-docs-heal-themselves\/","title":{"rendered":"Good Grief Rounds help docs heal themselves"},"content":{"rendered":"
<\/div>

Medical residents \u2013 the young MDs in the years-long, boots-on-the-ground phase of their medical training \u2013 do amazing things in academic medical centers like University of Colorado Hospital. Under the supervision of faculty attending physicians, they patch up the injured and help get them back on their feet. They help nurture the sick back to health. They bring babies into the world.<\/p>\n

Hospitals like UCH abound with stories of birth, rebirth and rejuvenation. But there\u2019s another reality to hospitals, one that get less attention. Some of the sick and injured \u2013 including the babies \u2013 don\u2019t make it. Or despite the best efforts of providers and first-class medical care, their wounds, illnesses and disorders render them shadows of their former selves.<\/p>\n

Their stories can be heartbreaking. Families of patients can lack coping skills, leading to despondence, even aggression. Medical residents working 80-hour weeks quite commonly find themselves thrust directly into scenes of life-threatening emergency, extreme emotion, and profound sadness. They then exit the room and, for reasons ranging from medical-business mores to the practical realities of busy units, walk into that of another patient, maintaining the physician\u2019s stoic fa\u00e7ade, making every attempt to put the unforgettable out of their minds.<\/p>\n

\"medical
A few members of University of Colorado Hospital\u2019s volunteer Good Grief Rounds team. Left to right, former CU Palliative Care fellow and Veterans Administration physician Morgan Elmore; Palliative Care physician Katie Morrison; Palliative Care chaplain Rev. William Jensen; social worker Erin Rosenberg; and nurse practitioner Nicole Rondinelli.<\/figcaption><\/figure>\n

So it should come as no surprise that residents and physicians can bear heavy emotional burdens, or that they burn out, or that they commit suicide<\/a> at higher-than-average rates. Katherine Morrison, MD<\/a>, is doing something about it.<\/p>\n

Morrison is a palliative care specialist and assistant professor of Internal Medicine at the University of Colorado School of Medicine. For three years she volunteered her time to help residents help each other through the emotional trials of their chosen careers. These “Good Grief Rounds” have earned positive feedback from residents and others who have participated, and Morrison is hoping to develop a formal, half-day training program to spread the approach through UCH and beyond.<\/p>\n

No outlet<\/strong><\/h3>\n

Dealing with grief is the focus. Physicians and other health care providers are people, and they\u2019re fundamentally empathetic, too \u2013 if you\u2019re not interested in the well-being of others, you don\u2019t go into medicine. Morrison, who was a primary care doctor for 13 years before focusing on palliative care six years ago, recognized that she and her Internal Medicine colleagues had had few avenues to deal with grief (in palliative care, in contrast, she and other physicians debrief routinely with a chaplain or licensed clinical social worker). Physicians in primary care\u00a0didn\u2019t tend to discuss the emotional aspects of cases with each other or with others in their lives.<\/p>\n

\u201cYou get to a point where you can\u2019t really bring this stuff home,\u201d Morrison said. \u201cFor one, it\u2019s confidential, and two, it would just depress the heck out of your partner.\u201d<\/p>\n

Morgan Elmore, DO, MA, who completed her palliative care fellowship at CU in June 2015 and is now a palliative care physician at Veterans Affairs Medical Center in Denver, added that despite working in team environments, health care providers who go through emotional experiences are often isolated.<\/p>\n

\u201cThat\u2019s how we\u2019re trained,\u201d she said. \u201cYou see terrible stuff, internalize it, gut it out, and move onto the next person.\u201d<\/p>\n

Burnout<\/strong><\/h3>\n

Good Grief Rounds happen once a quarter over lunch during weekday noon conferences usually set aside for medical education. Internal Medicine residents are encouraged to attend, said third-year resident Tyson Oberdorfer, MD.<\/p>\n

\u201cI find them incredibly useful,\u201d he said.<\/p>\n

The Good Grief Rounds have themes. In April, it was anger \u2013 anger directed at doctors; doctors\u2019 anger at patients, families and other providers.<\/p>\n

\u201cI had a lot of anger that came from these difficult patients in critical-care settings,\u201d Oberdorfer said. \u201cTalking through that in the small-group setting, I actually felt a lot lighter afterwards. Just getting it off my chest. Just having a few colleagues hearing me and validating what I was saying \u2013 it was therapeutic.\u201d<\/p>\n

Being in an elective month in which he wasn\u2019t on the floors also helped him gain perspective, he said. He\u2019s headed to Harvard for a geriatrics fellowship next year and is reenergized and looking forward to it. \u201cBut there\u2019s such a need for structured support for residents going through these rotations, and also nurses who spend their entire careers in ICUs.\u201d<\/p>\n

Making the rounds<\/strong><\/h3>\n

Morrison designed the Good Grief Rounds to include four components. There\u2019s the setting of ground rules and about a minute of mindfulness breathing exercise \u201cto help switch gears from being on the floors to talking about this,\u201d she said. Then there\u2019s a \u201chumanities\u201d portion. For the anger session, they read the lyrics of Peter, Paul and Mary\u2019s \u201cThere\u2019s Anger in the Land.\u201d A previous session featured the poem \u201cAirlift<\/a>,\u201d by Scott Wilson, MDiv, a chaplain at Benton Hospice Services in Corvallis, Ore.<\/p>\n

A \u201cstoryteller\u201d then shares an experience \u2013 what happened, how it affected him or her, and what they learned from it. Residents, faculty, and advanced practice nursing students have done this.<\/p>\n

\u201cWe\u2019ve had people share some profound stories, people reading their story and crying throughout the whole thing,\u201d Morrison said.<\/p>\n

They then break up into small groups of two to four people, where they share their own stories. Morrison and four medical colleagues \u2013 a rotating group, she says, depending on who\u2019s available \u2013 facilitate.<\/p>\n

\u201cIt\u2019s experiential. You learn to tell your stories. You learn to debrief,\u201d Morrison said.<\/p>\n

A wider net<\/strong><\/h3>\n

While there\u2019s little published research about provider grief, Morrison and Elmore say, there is some good science around post-traumatic stress disorder and depression. Debriefing on tough experiences changes how our brains encode and process them. How we encode and process them, in turn, affects how they ultimately affect us, as books like \u201cBuddha\u2019s Brain\u201d describe.<\/p>\n

\u201cVery rarely do people take the time to debrief about the bad stuff they see,\u201d said Kinnear Theobald, MD, a fourth-year and chief resident in Internal Medicine. She\u2019s attended several Good Grief Rounds and encourages colleagues to do the same. \u201cAs physicians, you have the emotional response that everybody else in that position would have. So this is a time when you can open up.\u201d<\/p>\n

Interest in the rounds has extended beyond Internal Medicine, Theobald says. Residents in Emergency Medicine, Maternal Fetal Medicine and other specialties who rotate into Internal Medicine and participate in the Good Grief Rounds have asked her, \u201cWhy don\u2019t we do this?\u201d she said.<\/p>\n

The hospital\u2019s Occupational Therapy team is doing it, says Erin Erickson, OTD. With Morrison\u2019s help, they launched their own version of Good Grief Rounds in December. Erickson now presides.<\/p>\n

Erickson herself was the storyteller in the first session. There had been a patient with whom she had had much in common. Since sharing at the rounds, she said, she\u2019s finally able to talk about her without crying.<\/p>\n

\u201cIt\u2019s really opened up an avenue for people to discuss difficult cases,\u201d Erickson said. \u201cIt should be expanded throughout the whole hospital. I think it\u2019s critical for the work we do and the patients we see.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Medical residents \u2013 the young MDs in the years-long, boots-on-the-ground phase of their medical training \u2013 do amazing things in academic medical centers like University of Colorado Hospital. Under the supervision of faculty attending physicians, they patch up the injured and help get them back on their feet. They help nurture the sick back to […]<\/p>\n","protected":false},"author":23,"featured_media":2620,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[7],"tags":[113,4796,154,126],"class_list":["post-4787","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories","tag-behavioral-health","tag-grief-bereavement-support-groups","tag-palliative-care","tag-suicide-prevention"],"acf":[],"yoast_head":"\nGood Grief Rounds help docs heal themselves - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Medical residents and physicians bear heavy emotional burdens, burn out, and commit suicide at higher-than-average rates but Good Grief Rounds is helping.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/good-grief-rounds-help-docs-heal-themselves\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Good Grief Rounds help docs heal themselves\" \/>\n<meta property=\"og:description\" content=\"Medical residents and physicians bear heavy emotional burdens, burn out, and commit suicide at higher-than-average rates but Good Grief Rounds is helping.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/good-grief-rounds-help-docs-heal-themselves\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-05-11T06:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-03-06T17:03:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144845\/EXT_051116-GoodGriefRoundsTeam.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Todd Neff, for UCHealth\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Todd Neff, for UCHealth\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/good-grief-rounds-help-docs-heal-themselves\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/good-grief-rounds-help-docs-heal-themselves\\\/\"},\"author\":{\"name\":\"Todd Neff, for UCHealth\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/da7733ff5562e48e55c027d111ee5911\"},\"headline\":\"Good Grief Rounds help docs heal themselves\",\"datePublished\":\"2016-05-11T06:00:00+00:00\",\"dateModified\":\"2023-03-06T17:03:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/good-grief-rounds-help-docs-heal-themselves\\\/\"},\"wordCount\":1235,\"publisher\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/good-grief-rounds-help-docs-heal-themselves\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/uchealth-wp-uploads.s3.amazonaws.com\\\/wp-content\\\/uploads\\\/sites\\\/6\\\/1970\\\/01\\\/28144845\\\/EXT_051116-GoodGriefRoundsTeam.webp\",\"keywords\":[\"Behavioral health\",\"Grief & bereavement support groups\",\"Palliative care\",\"Suicide prevention\"],\"articleSection\":[\"Stories\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/good-grief-rounds-help-docs-heal-themselves\\\/\",\"url\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/good-grief-rounds-help-docs-heal-themselves\\\/\",\"name\":\"Good Grief Rounds help docs heal themselves - 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Left to right, former CU Palliative Care fellow and Veterans Administration physician Morgan Elmore; Palliative Care physician Katie Morrison; Palliative Care chaplain Rev. 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