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GIM Practice

HP Heroes: Arielle Berger MD

Bert Govig for the CSIM Health Promotion Committee.

Corresponding Author: Bert Govig: northerndoc@gmail.com

About the Author: The CSIM Health Promotion Committee promotes knowl-edge, culture, skills, and the practice of Health Promotion by physicians, patients, communities, and health care systems. The HP Heroes series highlights inspirational work in the diverse field of health promotion.

Submitted: 3 November 2021; Accepted: 1 December 2021; Published: 2 January 2022

Doi: http://dx.doi.org/10.22374/cjgim.v16i4.603

All articles published in DPG Open Access journals
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).

Arielle Berger MD

What Sparked Your Interest in Physician Wellness?

Some years ago, I was sitting at my kitchen table scrolling through the latest issue of The Annals when I got to the personal essay section “On Being a Doctor.” It was a rare moment of quiet in the house as I leaned into this story. The author describes witnessing an event that haunted him for years: as a medical student on an OB/GYN rotation, the author had a patient who began hemorrhaging from postpartum uterine atony. Another physician comes and saves this woman’s life via internal uterine massage, but shockingly starts singing and dancing in delight with his hand still inside of her. The author said nothing, and worse, hummed along and swayed to the song. Now years later, he has never shared this story with anyone until he finds himself facilitating a discussion with medical students about the virtue of forgiveness. The essay suggests that in the process of exposing his secret, he can begin to forgive himself for this wrongdoing.1

Something clicked inside of me as I read this piece. I began thinking about what it means to be a doctor, what kind of doctor I wanted to be, and how easy it can be to stray from our original motivations to get into this field. I realized that I had been “raised” in a medical culture that required us to leave our personal selves at the door of the hospital and to become these anonymous, self-sacrificing, altruistic “white-coats.” As a resident, my attendings rarely talked about their weekends, their families, any interests outside of medicine, and I learned that those parts of me were not welcome. However, with time, I began to feel that I could actually be more present and create a deeper connection with my patients when I am true to myself.

Around that same time, very early in my career, I tried to find my focus in medical education. As I processed this article in a conversation with a mentor, I realized that I wanted to start teaching doctors how to be their best selves.

Describe Your Current Wellness-related Work

“Teaching doctors to be their best selves” is a little tricky to operationalize. And trickier still to make into a piece of academic work!

I began my work by looking into what we know about teaching these concepts. Because we need a common language, I decided to focus on medical professionalism, which includes physician wellness, and specifically on how to teach and improve professionalism in residents. I found that there wasn’t much consensus on doing this or even if it could be done. We ultimately published a systematic review of professionalism curricula directed at residents in 2019.2 The big takeaway from this work is that putting physician wellness into the formal curriculum can make a measurable difference in the lives of trainees.

This background helped me develop a professional curriculum that I’ve gradually rolled out in our Academic Half Days. Each session focuses on a different CanMEDS role. For example, we’ve done sessions on professional identity (“the physician self”), leadership, communication skills, and shared-decision making/goal setting. I try to incorporate exercises that foster self-reflection and build resiliency into each session, such as narrative medicine exercises and mindfulness. We have done a series of qualitative interviews with graduated residents to identify what impact this curriculum may have had on their development as physicians. I hope to present those findings soon.

What is Your Most Positive and Negative Memory from Medical School and Residency?

I went to medical school in Tel Aviv, Israel. The thing that stands out the most for me from that time is the incredibly bright, blue, sunny sky. I spent so much time at the university pool, an outdoor Olympic-size pool swimming, studying, or just hanging out. We were working so hard, but got to do it in the most beautiful place! It reminds me of the importance of everything outside of medicine that contributes to our well-being.

Probably the worst moment of my training was when I yelled at my attending in the middle of rounds in a very public place. That was a definite low point of my medical career! I often look back on that moment and think about all the factors contributing to that behavior. It helps me understand that bad behavior does not equate to being a bad person and that with the right environment and guidance, we can help people excel.

What are 3 Things Outside Medicine that Make Your Heart Go Pitter-patter?

  1. Seeing my girls smile. I have three little kids. My house is loud and chaotic. It often feels like somebody is always crying. Catching a moment when everyone is happy is what sustains us.

  2. A word or phrase that expresses an idea perfectly. When I hear one of these, I often just write it down on a random piece of paper or in a note on my phone. I have words and phrases written down all over the place. One day, I listened to a lecture about Toni Morrison’s later fiction (on the subway on my way to work, I should add) and wrote down “a language of care.” I just loved that phrase. (https://podcasts.apple.com/us/podcast/ethics-care-restorative-justice-healing-in-toni-morrisons/id465492751?i=1000452204916)

  3. Jimmy’s coffee. I’m not sure it makes my heart go pitter patter, but it definitely keeps it beating!

How Did the ACP Wellness Champion Training Affect Your Thinking or Your Practice?

First and foremost, it really helped solidify my understanding of physician wellness, burnout, and proven strategies to improve physicians’ lives. I also learned about many practical, evidence-based tools that I continue to use in my teaching.

Second, it connected me to a community that valued this work. This was so helpful early on when I felt uncertain and out of my depths in beginning such a big project. I have followed up with the course faculty for consultation and advice over the years since. That has been a major support.

REFERENCES

1. Anonymous. Our family secrets. Ann Intern Med 2015;163(4): 321. 10.7326/M14-2168

2. Berger AS, Niedra E, Brooks SG, Ahmed WS, and Ginsburg S. Teaching professionalism in postgraduate medical education. Academic Medicine 2020;95(6):938–46. 10.1097/ACM.0000000000002987