Learned helplessness — I have heard this term used for years, but never knew (or forgot) its experimental roots. Here is an experiment that I am confident no institutional animal protection committee would approve today:
In the 1960’s, Martin Seligman, a psychologist, performed a series of experiments on dogs to evaluate the behavioral effects of chronic, unavoidable aversive stimuli (The Gale Encyclopedia of Psychology, Second Edition). In the original experiment, dogs were confined in a small box, with no exit. A buzzer sounded, followed shortly thereafter by the administration of a painful electrical shock through the floor of the box. Over time, the dogs, who could not avoid the shocks, learned when the buzzer sounded there was little they could do but cower in a corner of the device and whimper pitifully.
Once trained the painful stimulus could not be avoided, the investigators then opened an escape hatch in one of the walls. Any dog who had not been through the initial training would immediately escape through the opening. The trained dogs, however, would still cower and whimper — having learned that escape was impossible, they were unable to help themselves.
Thus, the concept of learned helplessness was born:
An apathetic attitude stemming from the conviction that
one’s actions do not have the power to affect one’s situation.
In humans, the construct is useful in understanding some forms of depression and anxiety. The phenomenon has further been characterized by “3 P’s”. Permanence — my life situation is bad, and will remain bad forever. Pervasiveness — because this aspect of my life is bad, the rest of my life is bad as well. Personalization — the bad things that are happening to me are directed specifically at me.
I certainly feel for Seligman’s dogs. But I also feel for another group that has a tendency towards learned helplessness — doctors, nurses, allied health professionals and others who work in the US healthcare system.
Pick up a newspaper, read a professional journal, attend a medical conference, watch any commentary from broadcast media (regardless of the political slant) and you will hear about a broken system in need of fundamental change. In my Seligman’s dog analogy, there are myriad electrical shocks: pressure to see more patients while providing more personalized care; incorporating a not-ready-for-prime-time, work-flow-disrupting electronic health record into daily practice, while increasing efficiency and productivity; discharging patients more quickly, while decreasing readmission rates. The list goes on. (See prior postings: Cloud of Healthcare Anxiety Part I and Part II)
Like Seligman’s dogs, the means of avoiding the shock seems to be out of our control. There are proposed solutions, but few an individual can implement. The individual doctor, nurse or therapist cannot start an Accountable Care Organization. They cannot build a vertically integrated regional care delivery system. They cannot develop data aggregation and analytics capacity to manage populations. They cannot assemble a large physician network. As a consequence, a growing body of literature suggests health care professionals are increasingly burned out and dissatisfied.
Obviously, no one has an easy solution to this dynamic. Eventually, the system will stabilize. The privilege working as a medical professional — of impacting the lives of others in a deep and meaningful way — will outweigh the stress created in an environment of change.
In the meantime, it is our responsibility to look for our own way out of our box. I propose we as individuals need to focus on little things we can do to improve our situation that are within our control today. Small actions to take care of ourselves. Activities to help prepare us personally for the future. Small interventions to help build a functional organizational culture. If on Monday morning, a small number of people in your organization committed to doing some positive and achievable thing, and followed through, you could start to replace helplessness with optimism. Intermittently, in future posts, I will suggest some "little things". In the meantime, I invite others to help answer the question (please leave comments): to prepare for a fulfilling future career in healthcare, what little thing can I start to do on Monday?
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