Oncology Social Workers Get Advice on Handling Stress

NEW YORK--Some oncology social workers got a chance to talk about their problems with a psychiatrist at a Cancer Care seminar, and they not only got to ventilate, they got some good advice and some laughs. The psychiatrist was Samuel C. Klagsbrun, MD, executive medical director of Four Winds Hospital, Westchester County, New York, who has been called in to help entire medical school faculties and even hospitals when demoralization sets in.

His compassionate, some might even say rabbinic guidance, was much in evidence as he shared stories from his own career, asked questions, and told the social workers how to fight for their patients, their own mental health, and the well-being of the staff at their hospitals. It was just the sort of afternoon Dr. Klagsbrun prescribes for overworked, health care professionals--what he calls "a schmooze fest."

Dr. Klagsbrun used a story to explain why regular schmoozing is just as necessary as continuing education credits in helping health care workers to grow. Once, he recalled, he had been at a hospital where a group of dialysis nurses and doctors were extremely upset by the behavior of the dialysis patients who would get angry and run across the street after their dialysis to eat forbidden food. Several stressed-out nurses went to Dr. Klagsbrun for counseling.

He decided to hold a weekly meeting with the nurses on the dialysis unit. To accommodate both shifts, it was scheduled for 3 pm to 4 pm. The day shift stayed a half hour later and the night shift came a half hour earlier.

Cookies Are Important

"At the first meeting, we decided to have tea and cookies--cookies are very important--and the whole concept of coming together and eating something turned out to be a terrific idea," Dr. Klagsbrun said.

An unspoken rule for the meetings emerged: The nurses were not allowed to talk about patients during this time. They were supposed to talk about themselves--the good, the bad, and the frustrations.

"Soon the nurses were bringing in hors d’oeuvres and cakes in addition to the cookies," he said. "By the end of the year, the whole hospital had heard that between 3 and 4 in the afternoon, those people in that room were pigging out and having fun."

After a time, the number of requests for consultations by the dialysis nurses drastically decreased. "Why? Because we found a way to take care of ourselves," he said. "It was fun, and the staff’s tolerance for absorbing and managing very difficult patients was much better. So by finding a way to take care of ourselves, the patients got better care."

A Sadder Experience

Dr. Klagsbrun recounted another, sadder experience, about a doctor who had been asked to discuss the care of the dying at a meeting of his medical school colleagues, students, and residents. Dr. Klagsbrun was scheduled to speak directly after the doctor.

"He was a wonderful man, a lovely guy," Dr. Kalgsbrun said, "and he got up and said to the school, to his own students, colleagues, and professors--‘If I had known what my life as a pediatric oncologist was going to be like, I would not have entered the field.’ There was an almost audible gasp from the audience."

The doctor also told them his recurring nightmare--that when he parked his car at the hospital, he had to walk through a path strewn with all the heads of the babies he had treated who had died of their cancer.

"It was really terrible, and I thought to myself--what am I going to say now?" Dr. Klagsbrun said. "So I threw out my notes and basically tried to pick up on the doctor’s lack of self-care. I stressed that if you don’t take care of yourself, you end up suffering."

The consequences of not taking care of one’s self extend beyond the individual, Dr. Klagsbrun said. "When someone ‘burns out,’ it’s a loss to the field of the individual’s accumulated wisdom."

Staff suffering can be measured in turnover rates, the atmosphere of a unit, and patient complaints, he added.

Often the suffering is caused by the pressures of the American health care system. "I think the pressures of medical practice are worse than ever before--pressures on the physician’s time and pressures to discharge patients and to give them the least costly treatments," Dr. Klagsbrun said.

Doctors in the tertiary care system today don’t know their patients the way doctors did in the past, he said. "When I was in medical school, we were always taught it wasn’t the gall bladder in Room 306. It was Mrs. Jones. Today it’s the gall bladder."

In the final analysis, Dr. Klagsbrun said, it is the social worker who has to deal with the results when staff members neglect to take care of themselves. He advised the social workers at the seminar to fight for the right to hold regular weekly meetings at their hospitals so that staff can support each other; to try to change the culture of their hospitals if necessary; and to take political action to fight for their patients.

The main reason social workers and health care providers choose their profession, Dr. Klagsbrun said, is because they want to help people, and they need enough time per patient to experience that satisfaction.

"There is a certain amount of joy in helping somebody, of seeing somebody with a major depression crack a joke with you. There’s nothing that can beat that," he said. At the end of the seminar, the social workers, who had been cracking jokes and schmoozing with Dr. Klagsbrun, were looking pretty happy themselves, even though there was not a cookie in sight.