Avoiding burnout: A physician shares self-compassion strategies for provider wellness

By Dr. Rishikesh S. Chavan, pediatric oncologist and medical director of the blood and bone marrow transplant program at the Hyundai Cancer Institute at CHOC Children’s

Navigating the COVID-19 pandemic and a rapidly evolving medical landscape has put added pressure and stress on the healthcare workers braving the front lines. This is why it’s more important than ever to recognize signs of burnout in yourself and your colleagues, and essential that we as physicians practice self-compassion.

As physicians juggle their position as a healthcare provider, possibly the head of their household, and many other roles, it can be almost unnatural for physicians to think of themselves and their own needs.

But as the saying goes, you cannot pour from an empty cup. Physicians can’t do their best to care for patients and their own children at home unless they’re supporting their own comfort. I liken it to the safety instructions on an airplane – put your oxygen mask on before assisting others.

Self-compassion tactics

To avoid self-sabotage or self-destructive tendencies, one needs to feel a deep sense of love and acceptance of themselves. That’s why practicing self-compassion is so important. Here are some ways to get started:    

  • Make your own checklist Similar to a checklist one uses at the end of a shift to transition cases, make a personal one to end or begin your day. Everyone’s checklist will look different. We each classify different habits or rituals as essential. Do you need your morning coffee to function best? If you have exercised are you then your best self? For your checklist, consider elements such as:
    1. Acknowledge something that was difficult during your shift. After the feelings come up, let them go.
    2. Name three things that went well.
    3. Did you notice anyone else have a particularly hard shift? Check on them.
    4. Check in with yourself. Are you OK?
    5. Rest and recharge.
  • Relax – Identify your strategy for relaxation to help you take your mind away from the daily grind. Be aware of self-compassion versus self-indulgence. For example, watching an episode of your favorite TV show is one thing but binge watching an entire season is another. For several people, activities like bike riding, working in the garden, reading a book, practicing a musical instrument, or taking a yoga class may help establish a state of flow and provide an opportunity to go deeper.
  • Meditate – By definition, meditation means to focus on something. As you gently have a subtle focus on your heart, you can be a silent observer of your thoughts without reacting to them. An assumption that you are not your thoughts allows you to ignore intrusive thoughts and achieve a sense of peace. Sitting quietly with a guided meditation via apps such as Heartfulness, Headspace or Calm may help you get started. Studies have shown that peace and tranquility rank among the most common feelings people report after meditating, in whatever modality suits them.
  • Check in with your colleagues –Not only should we check in with ourselves, but we should check on our colleagues as well. If you see signs of burnout in a colleague, gently bring them into a conversation, or bring them a cup of coffee, and ask, “Is everything OK? Is there something that you want to talk about? Can I help you with anything?”

Interventions for physician burnout

A 2017 JAMA study found that the strongest evidence for effectiveness in combating physician burnout was organization-directed interventions, but the study noted such programs were rare. Most interventions for physician burnout put the onus back on the physician, with a focus on incentivizing physicians to participate. More effective intervention models are engrained across an entire hospital or healthcare system.

In January 2018, CHOC convened a Physician Wellness Subcommittee, composed of a group of physicians dedicated to help CHOC continue to be proactive and supportive of physicians. Its mission is “To promote physician wellness to benefit ourselves and others.”

Additionally, at CHOC, the spiritual care team offers regular “Tea for the Soul” sessions where chaplains are available to clinicians and provide a compassionate, non-anxious, non-judgmental presence to help them cope with added stressors.

CHOC leadership has taken other steps to provide additional support for its physicians and staff, recognizing the additional stressors placed upon CHOC staff during COVID-19. CHOC’s on-site daycare was set up within 72 hours, giving clinicians peace of mind that their children are safe and happy while they work. Recognizing that shopping for groceries and sundries might be challenging for staff, CHOC has set up in-house shopping resources, as well as a grab-and-go meal program and farmers market.

Fertility future with testicular cryopreservation

Fertility preservation is now a reality for male pediatric and adolescent/young adult (AYA) patients with cancer or blood disorders.

The Hyundai Cancer Institute at CHOC Children’s is a center of excellence and the only program on the West Coast offering testicular preservation for prepubertal patients unable to bank sperm. Testicular tissue is biopsied and preserved in liquid nitrogen.

“Recent research indicates these biopsies contain stem cells, leading to the possibility of generating sperm in the future,” said Dr. Carol Lin, a pediatric oncologist at the CHOC Hyundai Cancer Institute.

Evidence-based research

CHOC participated in an eight-year study alongside U.S. and Israeli institutions to establish a standardized protocol and centralized process to freeze and collect biopsies.

A CHOC Children's pediatric urologist speaks with an adolescent male patient in an exam room

“In total, 189 patients provided samples. A quarter of each sample was used for research and the rest stored for future use. These patients ranged from ages 5 months to 34, with an average age of about 8,” said Lin.

The study discovered that a centralized process and testicular biopsies from multiple sites was a viable option and could accelerate recruitment. Click here to learn more about the study.

Sharing expertise

CHOC is a member of the Oncofertility Consortium, a group of scientists and providers who are committed to fertility preservation in cancer patients. The consortium studies the science of cryopreservation methods, storage of tissue, in vitro follicle growth and communication between patients and doctors, as well as ethical and legal concerns.

Our care and commitment to children has been recognized

CHOC Children’s Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Best Children's Hospitals, U.S. News & World Report, Cancer, 2020-21

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.

Testicular Cryopreservation bringing hope to CHOC cancer patients

Young male patients undergoing treatment for some cancers or blood disorders at CHOC Children’s have another hope for fertility preservation.

The Hyundai Cancer Institute at CHOC Children’s is the only program on the West Coast offering testicular cryopreservation as an option for young male patients unable to bank sperm but who would like to take steps to preserve future fertility.

Under the program, testicular tissue is biopsied and stored in liquid nitrogen at temperatures close to absolute zero for future use. Recent research indicates these biopsies contain stem cells, leading to the possibility of generating sperm in the future, says Dr. Carol Lin, an oncologist at the Cancer Institute, and Lisa Klimpel, an oncology nurse practitioner.

CHOC was among a group of U.S. and Israeli institutions to participate in an eight-year study wherein a network of centers used standardized protocol and centralized processing and freezing to collect and store biopsies.

In total, 189 patients provided samples. A quarter of each sample was used for research and the rest stored for future use. These patients ranged from ages 5 months to 34, with an average age of about 8.

Recently published in the journal Human Reproduction, the study, of which Klimpel is a co-author, found that centralized processing and freezing of testicular tissue from multiple sites is feasible and could accelerate recruitment.

A generation ago, cancer survivors had few options to have biological children. Today, many solutions exist, however many oncologists, despite these advancements, still don’t discuss fertility preservation with their patients, particularly young patients. 

At CHOC, however, discussions about fertility preservation with cancer patients early into diagnosis and treatment are a matter of course, as the program works to ensure a meaningful survivorship, says Dr. Lin and Klimpel.

Learn more about referring to the Hyundai Cancer Institute.

Premier CHOC leukemia and immunotherapy conference draws international experts

A premier CHOC Children’s symposium centered around the complex issues facing pediatric leukemia patients drew more than 150 international leaders in the field of children’s leukemia treatment and research. This two-day conference had 33 speakers from various renowned institutions.

Building on the scientific foundation and exchange of information established in the gathering’s five-year history, attendees of the 2018 Society of Young Adult Oncology (SAYAO)/CHOC Children’s Leukemia Symposium shared the latest scientific and clinical advances in acute leukemia, specifically immunotherapy.

CHOC Children’s physician Dr. Van T. Huynh, chaired the symposium and presented her research on asparaginase therapy and silent inactivation.

Titled “From Pediatric to Adult Acute Lymphoblastic Leukemia – The Age of Cellular Therapy,” the Nov. 5 and 6 symposia focused largely on CAR-T cell therapy and new agents for the treatment of acute leukemia. Specific topics included:

  • an update on CAR-T cell products and trials;
  • the future of CD 19, CD22 and NK CAR cell trials;
  • the economics of CAR-T cell therapy;
  • update on leukemia therapy for pediatrics and adolescent and young adults; and
  • supportive care and oncofertility for the leukemia patient.

The symposium drew more than 150 international pediatric leukemia leaders and 33 speakers from various renowned institutions.

The symposium was chaired by CHOC physician Dr. Van T. Huynh, who also presented her research on asparaginase therapy and silent inactivation. CHOC physician Dr. Carol Lin discussed toxicity and management of asparaginase therapy.

Learn more about referring a patient to the Hyundai Cancer Institute at CHOC Children’s.

Conference Tackles Acute Lymphoblastic Leukemia

SAYAO-LogoIn a contrast to its inaugural year, the 2014 Society of Young Adult Oncology (SAYAO) Conference focused entirely on a specific type of cancer: acute lymphoblastic leukemia.

Instead of again focusing on general psychosocial aspects of cancer treatments in the adolescent and young adult (AYA) population, this year’s approach allowed attendees to explore survivorship disparities between adult patients and the AYA population, Dr. Leonard Sender, SAYAO founder and medical director of the Hyundai Cancer Institute at CHOC Children’s, told “The Huffington Post.”

Held Oct. 6 through 8 at UC Irvine, “Breaking Barriers in Acute Lymphoblastic Leukemia” drew about 250 attendees, including 60 speakers and delegates. For more coverage of the conference, as well as a video, read “The Huffington Post” article.

The 2013 conference covered general psychosocial aspects of cancer treatment in adolescents and young adults. Read an in-depth summary of the 2013 conference, including links to its coverage on “The Huffington Post.”

Learn more about SAYAO.