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KEY POINTS

  • Your personal well-being drives the quality of the clinical critical care you deliver.

  • Physicians lack self-awareness. This jeopardizes their well-being, and thus their capacity to provide the level of excellent care they are capable of.

  • The data and (limited) evidence for ways in which to maintain or recover well-being center on fostering a professional and personal sense of agency. Intensive care unit (ICU) physicians have a limited understanding of how important this is, and little knowledge of which “actionable” changes can increase this sense of agency in their daily lives and ICU practice.

  • Patients and families will probably remember your presence (or lack thereof), what you said (or didn’t), and how, for the rest of their lives.

  • Maladaptive communication is associated with “iatrogenic suffering” in patients and families.

  • Difficult communications (end-of-life [EOL] or prognosis) burden senior ICU trainees and staff. Recent evidence suggests excluding families from the ICU environment burdens physicians significantly in addition to traumatizing patients and families.

  • Two aspects of effective communication are highlighted within a framework of evidence-based patient and family-centered ICU policies.

INTRODUCTION

This chapter’s final edits are concurrent with the fourth wave of the COVID-19 pandemic. Its impact on critical care practice led to adapting the content of this chapter by adding dimensions specific to circumstances surrounding pandemic to considerations relevant to “usual” daily practice. Stress or strain affects all critical care physicians.1,2 Not recognizing or adapting to this reality leads to deleterious impacts on performance, health, or both.3–6 Understanding general and psychological health, and determinants of burnout, helps to anticipate them and reduces incomprehension, exclusion, and shame when they occur. Physicians’ “blind spots” to the degree stress affects them are identified in many studies highlighting self-awareness gaps.7 In situations where distress stems from institutional sources, physicians often find themselves isolated and uninformed. Sources of moral distress involving organizations, such as poorly managed sentinel events, and institutional or other types of harassment, require an understanding of their characteristics to better prepare for their consequences on individual critical care caregivers.

Communication, whether to discuss prognosis or empathize with patients and families, is best provided by a physician who cares about his or her well-being. This part of the chapter bridges well-being and communication. Recent data describe caregiver distress when family communication is made impossible by forbidding visitors or invoking COVID infection precautionary measures. The broader context in which communication occurs—namely, family presence in the intensive care unit (ICU) and sense-making—frames the practical communication tips. Determinants of what patients and families consider quality communication and the degree to which uncertainty in prognostication can affect their well-being are described briefly in the closing paragraphs of the communication section.

CAREGIVER CARE

The first publication addressing stress in ICU physicians appeared in 1986.8 Burnout, a negative consequence of the individual’s response to stress, is described in 50% ...

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