Elements of a Supportive Culture For Medical Practices

Posted on August 7, 2023 by Susan MacLellan-Tobert, MD, FAAC, ACC

Updated August 7, 2023

Physicians face unique challenges as they practice in an environment of extreme stress, systemic challenges and moral injury that may lead to emotional struggles. They also may experience secondary traumas ranging from medical errors to adverse patient outcomes. Their emotional struggles and psychological trauma can be transposed to others and cause a “ripple effect,” in which they pass on their distress, anger and/or dissociation to other team members, patients, and to their own families.

To stem this dangerous effect, I’m calling for a 180-degree shift from a top-down shame-and-blame [medical] culture in which reaching out compassionately to a physician whose suffering is the exception rather than the rule. A total culture change, in other words.


The elements of the supportive culture include:

System changes. Ever since the significant stress and burnout among physicians have been noted and discussed—well before the onset of the pandemic and its harsh effects—there have been calls to change the systemic conditions under which physicians work. Scheduling, patient flow, productivity requirements, electronic recording and other issues have come to the forefront as areas to be redesigned with compassion for the practitioner top of mind.

Formal well-being programs. The easy and confidential availability of peer coaching, psychotherapy and other resources has become a mark of the most forward-looking medical organizations. Younger physicians schooled in the dangers of trauma and burnout are coming to expect and even demand these options.

And one upon which I lay special emphasis:

Informal support from colleagues and leadership. In my experience, the square wheel of medicine moves slowly, if it moves at all, and it may take twenty years for a culture shift. However, the shift can begin today, anywhere in the medical workplace and in the hearts and minds of those of us who live in that culture. It can start with a kind word, a sympathetic question directed to a colleague who appears to be suffering or words of praise freely and abundantly given.

Read my recent article, The Ripple Effect of Trauma in Medical Practice and How to Dampen the Wave, which discusses trauma, the ripple effect, the needed culture shift and two theoretical frameworks for a new vision of support for physicians. Read it here.

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