JULY 2008


Sharing circles prevent physician burnout

So why are there so few Balint groups in Canada?

The Ottawa Balint group: (clockwise from top left) Drs Stuart Macleod, Kitty Carson, Hazem Hamdy, Christiane Kuntz, leader Barry Dollin, John Shier, Robin Beardsley, Kathryn Gauthier and Miriam Salamon
Photo courtesy of Dr Miriam Salamon

Every other Tuesday morning, nine Ottawa-area family physicians file into a local psychiatrist's office and sit in a circle.

The psychiatrist, Barry Dollin, puts on a pot of coffee. Sometimes someone brings some muffins. And then something unusual happens: the doctors open up about all their professional concerns — things like how to deal with a difficult patient, a patient who committed suicide, boundary issues or complaints about office staff.

"You think you can teach people things just by giving them information in medical school," says Dr Dollin, "but a lot of what you need to learn in medicine are the ethical elements — how we think and feel."

"A special kind of listening"
Longtime Balint group members share their stories

That's been the organizing principle of Dr Dollin's support group, called a Balint group, since it began meeting in 1984.

Despite the burgeoning interest in physician health, however, precious few Balint groups have sprung up in Canada.

The story begins with Michael Balint, who was perhaps the first GP-psychotherapist ever. Born in 1896 in Budapest, Dr Balint began to experiment with Freud's "talking cure." He did influential work in London, where he led efforts to study "the psychological implications of general medical practice" and, as he wrote idiosyncratically in his 1957 book The Doctor, His Patient and the Illness, the "study of the pharmacology of the drug 'doctor.'" His goal: to teach GPs to use their emotions "like a surgeon his knife."

To do that, Dr Balint and his colleagues created the model in use worldwide today: a group of up to a dozen physicians sit in a circle and talk about their emotional experiences treating patients.

A Balint group typically uses a case as a jumping-off point for the participants' discussion. "It might be a case where they felt sad, or angry, or had trouble with what a patient was talking about," says Dr Katherine Warren, who leads a group for psychiatry residents at Dalhousie University. "Not how they managed the clinical care, but how they managed themselves."

Dr Miriam Salamon, a member of Dr Dollin's Ottawa group, once asked the group for advice on how to deal with a leaky water cooler. Reminded of the incident, Dr Dollin laughs and then says, "It represents the fact you can't keep your professional identity in a box. Even though you're a doctor, you have to pay rent. You have problems with your water cooler and your staff and you have to fix your toilets." In other words, doctors are people too, and sometimes people need a bit of support.

Qualitative research has shown that Balint groups help not only with patient care but also with physicians' ability to cope with difficult work, and they may prevent burnout.

Besides the Ottawa group and the Dalhousie group, very few Canadian Balint groups exist. Nineteen countries are members of the International Balint Federation, including Serbia and Montenegro; Canada is conspicuously absent. Why has uptake been so disappointing here?

"Because it is fundamentally messy and it is threatening," says Dr Dollin. "We sometimes talk about the line between professional development and personal therapy. It is a painful line — people might not want to have to face their own foibles and weaknesses."

Dr Warren agrees. "I think it is a vulnerability thing. In medicine, there's that old idea that you are the expert who's very strong and people struggle with the idea they are presenting difficulties. I think people are often concerned their conduct or skill will be criticized. But that is one of the benefits, to help people with things they are struggling with, to normalize it."



back to top of page




© Parkhurst Publishing Privacy Statement
Legal Terms of Use
Site created by Spin Design T.