1. Building Relationships with Physicians and Mid-Level Providers: Practical Wisdom NACC National Meeting Columbus, Ohio March 13, 2006 Chaplain Mary E. Johnson, MA Assistant Professor of Oncology Mayo Clinic College of Medicine

2. Objectives To identify physician and mid-level provider (MLP) support w/in the scope of the chaplain’s role (theory) To identify intersections between the cultures of medicine and ministry (rationale) To identify collaborative strategies that support and encourage the chaplain- physician relationship (approach)

3. Approach Why is this important? Cultural Comparison What is taught? Support strategies Education strategies

4. WHY IS THIS IMPORTANT? Some Questions to Consider Is physician support part of your mission? What opportunities exist for physician support in your ministry setting? What has worked? What hasn’t worked?

5. It is easy to philosophize; the philosopher is said to be the one who bears with equanimity the suffering of others. W. J. Mayo, Minnesota Medicine. 1936.

6. I had thought that life was broken and that I, armed with the powerful tools of modern science, would fix it. R.N. Remen, Kitchen Table Wisdom. 1996.

7. The well-being of physicians is important to the well-being of their patients. Shanafelt, et al., Annals of Internal Medicine. 2002

8. While much has been written about physician depression, burnout, substance abuse and broken relationships, very little is known about physician well-being and its ability to enhance care. Shanafelt, et al., Oncology. 2005

9. Loss is one of the most common aspects of the practice of medicine. The way in which we deal with loss impacts the way we deal with the rest of our lives. R. N. Remen, 1996

10. WHAT IS TAUGHT? U.S. & Canadian Medical Schools

12. THE CULTURE OF MEDICINE Cure Fix Solve Resolve

13. WHAT IS TAUGHT? Pharmacology - Pharmacology - Pain Management Palliology - Palliology - Symptom Management Psychiatry - Coping D/O (pathologization) Psychiatry - Coping D/O (pathologization) (CurrMit Database, AAMC, 2005)

14. CASE EXAMPLE Christmas Eve ICU Pulmonology Fellow Third withdrawal in 48 hours “I didn’t go into medicine to do this.”

15. SUPPORT/EDUCATION STRATEGIES Casual contact opportunities Mutual education opportunities Invite yourself to the table Participate in institutional leadership Read the literature

16. The dying need the friendship of the heart--its qualities, care, acceptance, vulnerability, but they also need the skills of the mind--the most sophisticated treatment that medicine has to offer. On its own, neither is enough. Dame Cicely Suanders

17. BIBLIOGRAPHY Mayo, William J., “Education Guides the Young to Good Citizenship, Minnesota Medicine. Vol. 19, July, 1936. Remen, Rachel Naomi, Kitchen Table Wisdom: Stories that Heal. Riverhead Books, New York, 1996. Shanafelt T, Bradley K, Wipf J, Back A, “Burnout and Self- Reported Patient Care in an Internal Medicine Residency Program, Annals of Internal Medicine. Vol. 136, 2002.

18. BIBLIOGRAPHY Shanafelt T, Novotny P, Johnson M, Xinghua Z, Steensma D, Lacy M, Rubin J, Sloan J, “The Well-Being and Personal Wellness Promotion Strategies of Medical Oncologists in the North Central Cancer Treatment Group, Oncology. Vol 68, 2005. Curriculum Management Information Tool (CurrMit) Database, American Association of Medical Colleges. Mitchell K, Anderson H, All Our Losses, All Our Griefs: Resources for Pastoral Care. Westminster Press, Philadelphia, PA, 1983.

19. ADDITIONAL RESOURCES jama.org (J. of the American Medical Association – A Piece of My Mind) jco.org (J. of Clinical Oncology – When the Tumor is not the Target) annals.org (Annals of Internal Medicine – On Being a Doctor)