Impact of Literature on Physician Burnout: An Interview with Dr. Morrison

Kayla: Today, we are with Dr. Wynne Morrison, former Faculty Affairs Associate Chief for Critical Care at the Children's Hospital of Philadelphia. Would you like to introduce yourself briefly?

Dr. Morrison: Sure! My name's Wynne Morrison, and I'm a physician practicing critical care and palliative care at the Children's Hospital of Philadelphia. Until recently, I was Head of the Palliative Care Team, but I have just transitioned out of that leadership role. Also, the Associate Chief role has gone on to someone else.

Kayla: Are there any projects that you're currently working on?

Dr. Morrison: Projects. Let's see. Yes, we have a lot of things going on. So, in addition to being a clinician, we have an annual medical humanities conference that we just started, and we had our second annual event this September. We also have an annual event for staff at the hospital who can bring any work they do in the humanities, whether that's writing, music, photography, painting, or anything of the sort, and share it with other staff once a year. In addition, there's a literary magazine that the Children's Hospital has started. And I'm going to start a master's program in poetry soon! So, I'm using some sabbatical time, which is the impetus for handing off my leadership positions. As you will discover at some point in your life, at some point, you have to make a choice between how many things you want to keep doing or are able to keep doing, and in this case, I decided I wanted to really focus on poetry for a while.

Elia: That's so cool!

Kayla: That's really, really interesting. Good luck with your new program!

Dr. Morrison: Thank you!

Elia: Okay, to get started with the question, I know that burnout is very commonplace in today's society, but physicians may experience, like, a particularly unique kind of burnout from their profession that can lead to various struggles, such as with mental health. So, what factors do you believe contribute to its prevalence in today's society? And would you be comfortable sharing how burnout has specifically impacted you or your colleagues?

Dr. Morrison: Yeah, it's a great question, and I'm glad the topic is getting more attention these days. One thing that I think could happen is that systematic factors can certainly affect burnout. So, with what we do in medicine, we see a lot of emotional situations and struggles. That's an expected part of what we do; in a way, you adapt to managing that and figuring out how to manage it. What can make that harder to manage is when you know the hours are long, there's no flexibility, and you have no control over your schedule. Those are the types of things where how the system is set up can really make a huge difference. Like if you're working in a setting where you get some input and some control into when you work and how you work, or you know how that is structured and what works in your life at that time, that can make a gigantic difference and help you be able to handle all the emotional situations with a little bit more equanimity, I would say. And I think, when I have seen people struggle, it's much less often due to managing and seeing things that are really hard, which, again, can be a challenge, but it's also a privilege to be there with patients and families when they're going through really hard things. And it's more due to that feeling of lack of control, so the finances play into that. If a medical system is stressed financially and they're asking everybody to do more and more, with perhaps less reward, that also can get people more worked up about stuff. I do think, as physicians, we are blessed to be able to get well paid for doing work that is very important, but that doesn't mean that you don't still potentially build up resentments if it seems like that's not recognized.

Kayla: That's really insightful, and I see how a lot of that plays into, like, your role as a physician as well. So it's definitely a very, very complex issue and I don't think there could be a single response to that. But do you see literature as being a part of that solution, in a way? How can literature help with physician burnout, and how can it generally enhance your experience?

Dr. Morrison: Yeah, I hope it can, and it may not be the answer for everyone. One important thing to realize is that how you deal with burnout has to be individualized to what works for you. But that's when we started the arts and humanities yearly session for all staff. We called it building resilience through the humanities, and the goal was to let people share how they used whatever it was, within creativity or humanities, to help them keep doing the work. And again, it's different for everyone. So we've had people who write about their work. We had people who wrote about things outside their work. As I mentioned, the musicians, we had someone who juggled, and when he had a long week, he'd go out on the weekend and go stand near the river and do juggling, and that's what brought him joy. So there's such a variety of things, and it may not be the same thing for everyone. Sometimes, the humanities and creative work can be really hard, too. It's not just always like, let me go have beautiful little rainbows and clouds. It's like, oh, this is horrible. I just did all this work on this, and it stinks, and I'm never going to be any good. And then you start beating yourself up about that. And realize that it gives you a different lens on things. It can make you look at life differently, but that doesn't mean that it's [easy]. If it's going to be fulfilling, it is probably also hard work.

Elia: Makes sense. Yeah, everyone has their way of dealing with stress, and I think how literature comes into play with medicine or other fields often causes people to think of science or medicine as separate from literature. But I love how they're intertwined for many people. So here comes the next question. Can you recall any specific books or essays or literary works or poetry that resonated with you or your colleagues during your time as a physician?

Dr. Morrison: That's a very broad question. So if you look at recommendations of other people's writing, I think Atul Gawande does a beautiful job of, like, breaking down the medical experience and making it accessible to people to understand. I think a lot of the first person narratives have been really meaningful to me. You know, as a pediatrician, I remember one in particular, a book written by a journalist when she was pregnant and her baby had been diagnosed with a severe heart defect before birth. The book's name is Waiting with Gabriel, and Amy Kuebelbeck is the author. That was one that brought me to tears. And I'm always amazed at literature or storytelling; even when I deal with equally distressing situations every day at work without crying, you know when someone has put it into a story in a way that you're completely in that space with that person, that's when the emotion can really hit you. And I think a lot of the art and literature that gets to me has that component of it, that there's a connection. There's a story; there's something that pulls you in.

Kayla: That's really beautiful, and it seems like such a cathartic experience that you can utilize for your everyday practice. But that's really, really wonderful. So, with such busy schedules, how do you find the time to read these sorts of narratives with your practice? Like, what does it look like working at that intersection?

Dr. Morrison: It is kind of crazy! My husband also mixes medicine and the humanities; he's an artist as well as a surgeon, and he and I encourage each other because I think we both have a dual interest, and that encouragement really helps. At one point, when we were really, really busy raising two kids and two medical careers, we decided we were going to have a five-minute-a-day rule. And it's because we knew we each wanted to water something other than just medicine and raising the family. And we could never find big chunks of time. So it's like, okay, we'll each get just five minutes a day. That's going to be the goal, and it didn't mean that that always happened, and it didn't mean that we always stuck with just five minutes. But there was something about having this, like, super short "I can do five minutes [of this]." It would at least get you started, and some days, you squeeze in more than that once you were going. And other days, it would just keep us from putting things off for decades because you never have as much time as you wanted, if that makes sense. So chipping away at a little bit of time and just making it a habit, that's what matters.

I remember hearing a quote by the writer Annie Lamott, who said that, "if you want to be a writer, what you need to do is put your butt in a chair for 45 minutes a day and don't let yourself do anything except write during that time. I don't care what you do, but don't pick up the phone, don't play games, don't start scrolling the web every day." And it's probably really, really good advice.

Kayla: Absolutely.

Elia: Wow, that's amazing. Even though I'm an undergrad, sometimes, if it's midterm week, I find it really busy just to sit down and do things I love. So it's really amazing how, even if it's just for five minutes a day, you can spend time on literature and reading outside of medicine. So the next question is, how would healthcare systems integrate literature into physician well-being programs? I know you discussed it earlier, but I want to learn more. And then I also want to learn about, like, what implementation barriers may exist in such programs and then, what kind of impact do you think such a program would have?

Dr. Morrison: Wow, that's a lot. One barrier, I think, is that in medicine, time is money. In most healthcare systems, the way that they pay your salary and the way the hospital also stays afloat is if you're seeing as many patients as you possibly can during any of that time. And so, a big barrier then is having time for anything else, and for the humanities, if you were going to be a bench researcher with your non-clinical time, you probably would be getting grants and money to fund that time. There are certainly some people who get funding and money out there for the humanities, but it is not nearly as standard that you can get grants or any external endowments or funds in that area. So that makes it harder, then, for anyone you know out there working to build in that time. So as I mentioned, this year I am using some sabbatical time and I'm really lucky that the University of Pennsylvania felt that my pursuing poetry was worthy of a sabbatical. And of course I have to make a good argument to them of why that is, but that's how I got the time. But I had to save up for the sabbatical by working decades and doing other things as well, if that makes sense. I don't think I have answered all components of the question yet, so I think for anything that you do for well-being, the Holy Grail is trying to prove its value. Because if you could prove the value of something, then every health system would say, well, of course. If I take better care of the staff and their well-being, they'll be less tolerant and will help us financially in the long run. That would be a great investment. Some healthcare systems are able to see that, but then many appropriately may want some proof, like showing us the data. How is this going to help? And so, how do you work towards these sorts of efforts, sort of from the ground up with, again, people being able to individualize what helps them and what works for them? So that you can allow both flexibility and time, I guess. I don't know if they are as popular an employer as they used to be, but if you look at Google from when they were giving everybody 20% time to work on whatever you wanted to work on, having that sort of model in place, that probably really helped them recruit people too, right?

Kayla: Oh yeah, that's a practice that I think a lot of systems, not just in medicine, but every field, could use. So we talked about literature's or poetry's role in, like, your life. But do you think that impact also extends to your patients as well, like how? Does your poetry translate into the way you treat your patients?

Dr. Morrison: Well, first of all, I don't necessarily write for the patients or the families. If I have an audience in mind and I'm writing something that's related to healthcare at all, I probably have the other health care providers in mind as an audience because I think that's the shared experience for me and where I expect that what I'm writing will resonate. But I still think being a writer affects how I interact with the patients and the families, and I think what I want to avoid is you don't want to just be going through your daily work thinking like I might write about this, I might write about you. You know, you don't want to be objectifying people in that way. But I do think that taking a writer's eye and how one notices the world as a writer, it can help me slow down and maybe be more patient. In those interactions with patients and families and to treat everyone as an individual whose story I care about because I care about stories, and I train myself to care about stories, I hope, is a beneficial way of doing it. But you wouldn't want to start turning your patients into subjects in your mind. That would be a problematic way of doing it.

Elia: Yeah, absolutely. It's really interesting! Like I think this topic is something that hasn't been brought up as often, and then what you're telling me is really interesting because I first got interested in, like, medical humanities through poetry class held by the physicians. So last year I was in a class called Emergency Poetry, where I had a valuable experience of going into the trauma center. Then, we will sit in a circle and share poems, like read poems each day, and then the instructors and some of the students are actual physicians. So I really got to hear a lot about, like, how literature plays into a physician's daily life, not directly relating to the patients but themselves and the other physicians.

Dr. Morrison: That reminds me of one other program we have at the hospital that is modeled on the narrative medicine program at Columbia, the Rita Charon's program, and it's one evening a month. Anyone that wants to join can get together. We read something together and then discuss that. We have a few minutes to write and then discuss with anyone that wants to bring up something that they've written. So it may be similar to what your experience was.

Elia: Yeah, it sounds really similar.

Dr. Morrison: Once people come to that a couple of times, they tend to want to keep coming, and the amazing thing is you never know what's going to come out. Like, you'll get a prompt about walking into a room. It was the most recent one I used. And then, the things that people start bringing up based on that, you never would expect.

Kayla: Yeah, that sounds like a really collaborative environment, and I would love to experience that environment one day as well. So other than poetry, what other parts of medical humanities do you believe are foundational to your practice, and how has writing helped you process your life experiences in general, both professionally and personally?

Dr. Morrison: Certainly, not all my writing is about medicine. So I write plenty about my family or my husband and kids or my father who died a couple of years ago, I write about that. And of course, I have my medical experiences in the background of that. So I think all of that, that's my way of taking time to reflect and process some of the things that come up in work, but different people have different ways. As I was saying earlier, you know everything is going to be individualized. And if you know for someone else that it was writing or painting or photography or music or whatever, whatever brought them a little bit of joy or allowed some of that creative outlet. I think it probably helps just to exercise a different part of your brain from time to time. I'm going on a tangent, I'm sure from your question, but I remember one of the yearly arts and humanities events that we did. At the end of it, someone from the audience came up and said like, ah, you just she'd been a musician before medicine and coming to that event inspired her to go back and pick up her instrument. She got it out of the box and started practicing again, and then within a couple of years, she was performing with a group from time to time. She still didn't have a huge amount of time to do it, but they do a couple of performances a year and let her bring that part back into her life, which I think, I hope, was a huge benefit and a hugely positive thing for her.

Kayla: Oh, wow! Like, being able to integrate that sort of creative outlet into being a physician, that gives a lot of hope and joy honestly, because I also kind of use, like, creative outlets like music, dancing, et cetera. I'm not able to connect it with medicine just yet, but I hope to be able to do that in the future. And, like you said, to be able to have that experience while also being a physician at the same time.

Dr. Morrison: Well, in this group she joined, most of the performances they did were like large medical conferences. So you know, the audiences were all healthcare providers as well.

Elia: Wow, that's amazing! So cool.

Kayla: Absolutely. Are there any additional comments, experiences or advice you would like to share with us?

Dr. Morrison: I think that especially when you have so many possibilities ahead of you at this point in your lives try to treasure that. And live in the moment and think about what really brings you joy and watering that, building skills in an area, so that then it can be a part of your life forever in the future. Also, at the same time, don't look back on things with regret. Don't be like, I should have done that years ago, you know? It's a new day and there's tomorrow. One other interesting point for me has been how one thing about being in medicine is that you know the hours can be long enough and your attention tends to be completely absorbed in the work that you do, and that's okay. I love the work I do, so that is okay for the most part. But then that makes it hard to do other things, like if I wanted to do a class or if I ever wanted to do a workshop before I got this sabbatical time that's coming up. So in some ways, with the wealth of online availability now, all of that can be overwhelming, but it's amazing and it's a huge advantage for someone whose schedule does not always align with being able to do something in the middle of a day. Although I'm lucky I got to do this interview today. So that's been an absolutely wonderful thing and almost a gift from the pandemic that it is now just so, so available that we can use tools like Teams and Zoom and connect across space and across time. If a talk was given that I missed, I may still be able to see it, which is wonderful.

Kayla: That's very wise, I really appreciate that. With how you brought up the accessibility, how that was transformed from the pandemic, that also really helped us a lot as well because we weren't able to get out, but we still got to have the experience of still being able to learn through Zoom and everything. And having everything online, especially during situations such as when my printer wasn't working, to still be able to do that sort of work, I feel like that was really impactful too.

Dr. Morrison: Absolutely.

Elia: Thank you for taking your time to interview with us, we greatly appreciate your insights and experience.

Dr. Morrison: It was great to talk with you both today!