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
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 doeuvres 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
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 staffs 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
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 doctors lack of
self-care. I stressed that if you dont take care of yourself,
you end up suffering."
The consequences of not taking care of ones self extend beyond
the individual, Dr. Klagsbrun said. "When someone burns
out, its a loss to the field of the individuals
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 physicians time and
pressures to discharge patients and to give them the least costly
treatments," Dr. Klagsbrun said.
Doctors in the tertiary care system today dont know their
patients the way doctors did in the past, he said. "When I was
in medical school, we were always taught it wasnt the gall
bladder in Room 306. It was Mrs. Jones. Today its 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
"There is a certain amount of joy in helping somebody, of seeing
somebody with a major depression crack a joke with you. Theres
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.