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Relational Impact Medicine: a different kind of insurance for doctors

By Ava Diamond, MSW LCSW & Jacqueline Cohen, MADT – Senior CoverMD Contributing Editors


In this article, Ava Diamond, LCSW and Jacqueline Cohen, MADT explain Relational Impact Medicine and how it can help physicians deal with the stress and burnout often associated with their profession and thus help doctors provide more effective medical care to their patients.

Relational Impact Medicine (RIM) is the practice that doctors need to protect themselves

Even with top clinical expertise, medical errors happen because of communication breakdowns and burnout-related fatigue. The impact on the patient is clear ... the impact on the physician is often ignored. The effects are both emotional and physical distress.

Medical malpractice insurance is a policy that doctors need to protect their livelihood. Relational Impact Medicine (RIM) is the practice that doctors need to protect themselves.

RIM reintegrates care with cure by providing skills for health care professionals to:

  • Alleviate and prevent symptoms of burnout(stress-related illnesses, depression, substance abuse, relationship problems, fatigue).
  • Improve interdisciplinary communication between nurses, doctors, physicians assistants, social workers, etc.
  • Rejuvenate empathic care of patients.

Medical treatment has become increasingly molecular and fast-paced

Today's medical treatment has become overwhelmingly molecular and fast-paced. The human-to human connection that often makes the difference in medical success, and always makes an impact in the hospital experience, has suffered.

Julius Landwirth, MD, JD, retired Director of Yale University Interdisciplinary Center for Bioethics, states "The problem is the growing disconnect between the human being behind the stethoscope and the human being under the patient gown, as both try valiantly but often with great frustration to negotiate the system barriers that contribute to sub-optimal quality, dissatisfaction on both sides, and even mistrust. The overpowering allure of impersonal technology, the sometimes misplaced emphasis on evidence-based practice guidelines and the holy grail of cost-effectiveness have clouded some of the basic intuitions that motivate health care professionals Today’s headlines about health care reform are, in many respects, outward expressions of this problem.

Any serious attempt to introduce into the training agenda for health care professionals techniques designed to restore and strengthen underlying value of genuine interpersonal understanding and respect cannot help but accrue to the benefit of patients and providers."

Relational Impact Medicine works to re-establish the empathic abilities of burned-out caregivers by providing a venue of supportive and effective training. Applications of this model will allow for more balanced and comprehensive medical care while successfully bridging the historic "divides" between doctors and nurses.

Relational Impact Medicine: a recipe for resiliency

resilience: a concept that proposes a recurrent human need to weather periods of stress and change successfully throughout life. The ability to weather each period of disruption and reintegration leaves the person better able to deal with the next change.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.ncy

It is normal for health care providers who work routinely with medical issues and trauma to experience some form of fatigue. Most people have an intuitive idea of what burnout is. From the research perspective, burnout is associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively. These negative feelings usually have a gradual onset. They can reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or a non-supportive work environment. When a doctor constantly sacrifices his own health and wellbeing for the sake of the patient, margins of error and inefficiency are increased, patient satisfaction decreases and unavoidable burnout is the ultimate consequence. (Psychology

Compassion fatigue, also called secondary trauma, is about your work-related, exposure to extremely stressful events. If you are exposed to others’ traumas as a result of your work, such as so often found in medical practice, this is secondary exposure.

Compassion satisfaction is about the pleasure you derive from being able to do your work well. For example, you may find pleasure through your work in helping others. You may feel positively about your colleagues or your ability to contribute to the work setting or even the greater good of society.

For healthcare providers to develop resiliency that wards off burnout, they need skills that allow them to manage the impact of critical incident, improve communication effectiveness, and rejuvenate compassion/empathy for both job and patient satisfaction.

Relational Impact Medicine trainings offer the “Recipe for Resiliency” through interactive workshops for institutions/healthcare settings and one-on-one coaching for individuals. Teaching mindfulness techniques, the art of reflection, empathic and effective communication strategies, and critical incident management skills, RIM shores up resiliency for medical professionals.

RIM Tip #1: Clearing your listening

Before meeting with a patient, take two minutes to clear your listening. Be still and first concentrate on the sounds you hear inside your body. Second, attend to the sounds you hear in the space your are in. Third, listen for the sounds outside of your space. As you listen carefully in each stage, you strengthen your ability to attend by reducing mind clutter and being in the moment.

This "clearing your listening" exercise allows you to create mental space both between patients and in your brain to attend to the next patient more fully. Hearing your patients more fully will allow for more empathic relations and more effective medical care.

Please check back often for more RIM articles on that will offer information and tips on how to better care for yourself, your patients, and your practice.

About the Authors

Ava Diamond, MSW LCSW - Senior Contributing Editors
Ava Diamond

Ava Diamond, LCSW, and Jacqueline Cohen, MADT, have co-founded Relational Impact Medicine (RIM). Each bring unique expertise, to RIM through their 20 years each of clinical and program development work. They joined together through their advanced training at Columbia University’s Narrative Medicine seminars and built their stellar Advisory Board from faculty in both the Columbia University and Yale University medical schools. In 2010, Relational Impact Medicine was offered as an elective course at Yale Medical School.


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