WASHINGTON -- Former Surgeon General Vivek Murthy, MD, spoke about the epidemic of loneliness in the U.S. and how clinicians aren't immune, in a talk at the workshop here on Wednesday.
"The irony of loneliness is we all feel it at the same time -- together" -- Rupi Kaur, "The Sun and Her Flowers"
The quote above, introduced by the Action Collaborative's director, Charlee Alexander, had particular relevance for Murthy, he said.
As a child, he felt a strong sense of loneliness in school. "I think back on it now, and I realize the loneliest place in school is the cafeteria ... You're wondering, 'Who do I sit with? What if I'm alone? What does that say about me?'"
As he grew older, he saw loneliness among his colleagues in residency.
"I go to Monday report and I feel like my differentials aren't as long as everyone else. I can't cite the same number of papers and depth of papers that other people cite on rounds," one female resident told him.
"The only thing I can do, the only thing, is I can sit down with patients and make them feel better," she told him.
The audience laughed.
Marissa King, PhD, a sociologist and professor of organizational behavior at the Yale School of Management, also spoke at the workshop. She shared her own personal experiences with loneliness as an academic researcher turned professor.
"I was given advice, which I think physicians are often given, which is to take on a role, and then act like someone else," she said.
But King said the more pretending she did, the more isolated she felt. By the third year of her professorship, she said she needed beta-blockers to function, and ultimately had a breakdown.
"I was trying to be someone I wasn't," she said.
While one in five adults in the general population is lonely, that ratio narrows in medicine: "One in three physicians will report having experienced a feeling of loneliness just even in the past week," she said.
Some of the causes for loneliness stem from increased mobility in jobs, a lack of family support, and increased dependence on technology, but on a basic level, people just aren't communicating and connecting.
The average American spends less than 40 minutes each day in any form of social interaction -- a number that has declined by about 15% in the last decade -- she noted.
In a that used wearable sensors to track physician interactions in real-time. King and other researchers found that the physicians who were having the largest number of interactions were the most dissatisfied with their jobs, and were at the highest risk of turnover and burnout, King said.
Just as in her own life -- King was interacting with dozens of people a day -- these physicians were also constantly engaged with others, but there was "no depth or quality" to those social interactions, she said.
A Time to Share
On the other hand, clinician teams that showed high-quality interactions were more resilient and more able to innovate.
"It really is critical, I think, to improve the quality of those interactions, to allow people to be themselves, to feel heard, to be recognized in their day-to-day work, in order to improve both healthcare delivery and well-being for individual physicians and patients, but also to help guard against burnout," King continued.
Asked what tools and approaches could help increase social cohesion, Murthy suggested taking 5 minutes a week at meetings to have one person on a team share photos from a part of their lives that isn't related to work.
He did this with his own team when he was surgeon general, he said.
"In those 5 minutes, we developed such a deeper and better understanding of the people that work with us. We developed a greater affection for them as we came to understand who they were, not just what they could do."
Fostering opportunities to get to know others in an authentic way is one way to defend against loneliness, he said.
Active Listening
King echoed that self-disclosure, both among colleagues and with patients, is an effective tool for building social cohesion.
Listening is another.
While it's difficult to teach compassion, effective listening can be taught, she said. In one exercise, clinicians turn to each other and ask a single question: "What does it feel like to be you today?"
Then, King said, the listener gives the other person 2 minutes to respond, without interrupting or nodding or interjecting "your own story."
She said frequently she sees people start to cry when they do this exercise, "because they've not had the experience of being listened to for so long."
In addition to listening, Murthy advocated for embracing a culture of medicine that values compassion.
"We walk around, so many of us, with masks on -- masks that display what we think we should be ... an incredible intellectual or a highly published author -- we're more than what we can do," he said.
A Cultural Shift
It's time to reevaluate who is deserving of praise, commendations, and promotions in medicine, Murthy continued.
The clinician who cares deeply for colleagues and friends and is there to help when help is needed, doesn't get recognized in the same way that he or she would by being first author on an important paper or head of a committee.
"To the extent that that is a core part of who we are as people, we're telling people that they don't matter as much ... The most important traits and qualities that we need as clinicians are ones that we had long before we came to medical school: Our ability to listen, our willingness to be compassionate towards others, our willingness to bring love into our practice of medicine."
One way to shift that dynamic is to create opportunities for people to get to know each other. Another is to begin re-imagining medicine as a field where having vulnerabilities and imperfections is okay.
"Leadership really has to model that kind of behavior," Murthy said. Leaders need to let others know that they aren't perfect either.