Navigating Empathy, Burnout, and Long-Term Relationships in Multiple Myeloma

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In “Beyond Diagnosis: Multiple Myeloma,” Cleveland Clinic hematologist Sandra Mazzoni, DO, and host John Mangels continue their discussions on communicating effectively and empathetically with patients facing a complex, chronic blood cancer.

Each monthly installment examines an aspect of multiple myeloma care, including diagnosis, aligning treatment goals, managing side effects, and supporting patients and families through key decision points.

This sixth and final episode focuses on the emotional and professional impact of treating patients, balancing empathy with clinical decision-making, avoiding burnout through compartmentalization and support systems, and the need for better real-world medical training for young doctors in delivering difficult news.

The following is a transcript of their remarks:

Mangels: Welcome to “Beyond Diagnosis,” where we talk with doctors about talking with patients. I’m your host, John Mangels. Multiple myeloma is a complex disease with many decision points over the course of treatment. Today, we’ll explore how a hematologist approaches discussions about diagnosis, therapy, prognosis, and patient autonomy. Our guest is Cleveland Clinic hematologist Dr. Sandy Mazzoni. We’ll talk about how she supports multiple myeloma patients during a difficult journey.

Dr. Mazzoni, thanks so much for being here.

Mazzoni: Thank you, John. Happy to be here and looking forward to our conversation today.

Mangels: Multiple myeloma impacts the treating physician as well as the patient. How has caring for these patients affected you and your professional identity? What have you learned from these patients?

Mazzoni: I’ve learned a lot from my patients. When I started doing this, I don’t think I listened enough. I’ve learned to talk less, listen more, and choose my questions more wisely. I think the other thing I have learned is that patients are incredibly resilient, and trying to instill more of this power into patients to understand the disease has translated into that resilience.

Mangels: Listening is so important, but I’m guessing in a busy practice where you need to kind of move things along, you want to talk, but the instinct to stop and to listen and to really absorb what you’re hearing is so important and so difficult, I’m guessing.

Mazzoni: We naturally will interrupt if you aren’t aware of it. And if someone is having a lot of difficulty with a certain aspect of their life, it may have nothing to do with myeloma, and I was missing that all the time because I wasn’t allowing them to speak about it.

Mangels: Because you were so focused on symptoms and lab results and clinical aspects.

Mazzoni: Correct. I was missing something that was far more important.

Mangels: And probably some of those cues aren’t necessarily verbal. I’m guessing in addition to listening, you’re observing too, right?

Mazzoni: Yeah.

Mangels: You’re a part of a lot of conversations that involve difficult emotions — fear, grief. How do you manage that impact on you? Because I’m sure that that has an impact on you.

Mazzoni: It definitely does. I think physicians, especially young physicians, we don’t take care of ourselves. We don’t. We neglect a lot of our own health. A lot of us have very young families. We have a busy practice. We are navigating how to handle all these stresses simultaneously, how to separate work and life, how to balance work and life, how to prevent burnout. There’s a lot and there’s resources out there that very few of us tap into.

Mangels: I’m guessing you have to compartmentalize. It’s just the nature of the job, but compartmentalizing too much means that you aren’t processing what’s in that compartment. How do you do that? How do you manage that need to compartmentalize, but to process?

Mazzoni: You have to be aware of what you can handle. So all of us have a certain stress threshold and I can handle a lot, but I don’t recognize sometimes that I’ve reached that threshold. And once you hit that tipping point, it starts to boil over more often in your personal life with your family than it does at work. So really spending the time and prioritizing my own health, getting enough sleep, exercise, family.

So choosing my own family, coming home at a reasonable time, spending time with my family. And then to kind of de-compartmentalize the stress of the work aspect, I do have what some consider a bad habit of logging in almost every night for an hour, hour and a half, but it allows me to go through some of my ever-expanding list of things that are really important to do so that there is excellent patient care happening and that I’m de-burdening what’s happening the next day. I think if I don’t do that hour, hour and a half at home, I get set up into not having that aspect de-stressed as much as I can.

Mangels: And it sounds like — we talked earlier about resilience with patients — I mean, resilience with treating physicians is important too. What I’m hearing from you is that you need to sort of set aside some time to check in and to say, “How am I doing?” Not just how is my patient doing, but how am I doing?

Mazzoni: Yeah. I don’t think many of us do that enough. I think that where I’m employed, a lot of us have been here for as long as we have because we do have support system here within our team members, within our colleagues that check in.

I have one in particular that if she doesn’t hear from me at least once a week, she texts, she calls, she checks in because she knows all the things that are going on. So I think you have to have a person or two who you are being very open and honest about and having that dialogue back and forth about everything going on.

Mangels: How great to have a colleague that regularly asks, “How are you doing?”

Mazzoni: Yes, absolutely.

Mangels: And it makes you feel like you can be that colleague for someone else as well.

Mazzoni: Yeah.

Mangels: What would you say important skills or insights are for someone who is in your line of work as a hematologist, particularly dealing with patients that are facing these severe illnesses?

Mazzoni: I think you have to have experienced something in your life so that you really, truly understand what empathy is. Not all of us have had a family member who has had cancer in particular, but something that really pushed you emotionally beyond your comfort zone and you’ve had to learn how to navigate that and be able to truly put yourself in the shoes of either the family member or the patient so that when you’re having these conversations, they’re not robotic. Everyone will tell you not to get too attached or too emotional.

I think that’s impossible to do when you are treating myeloma patients. They’re our patient for their entire lifespan. Many of them have become kind of my family here. I treat them as if they are my father, my mother. Sometimes my patients will joke and say, “Well, how good of a relationship do you have with your mother or father?” I have an excellent relationship with my mother and father, so I want to have that same kind of love and support that exists.

Mangels: That’s so important. I mean, you’re right. You’re with these patients for years. You’re seeing the arc of their life. You’re experiencing family members that are involved in their lives. So you really do develop that relationship, but I imagine it’s something that you have to be a little cautious about because you don’t want to let your personal feelings for that patient affect what clinical decisions you make.

Mazzoni: Yeah, you have to balance it. You really do. So I have to sometimes go through some stages of grief myself when things are not going the way that I had hoped. And it can sometimes help the patient to say, “I feel very much the same way that you guys are feeling. We got to navigate this together and figure out when are we going to kind of transition away from treatment and transition into a comfort-focused care.” I still want to remain a part of their care, but we also have to bring in more additional resources.

Mangels: Sure. And it’s great to be able to say we have resources when you reach that point. And this goes back to the partnership that we’ve talked all along about and the trust that develops and that you work on throughout the course of the disease.

If you could talk to hematologists in training, young people in the early part of their career about what they should be doing to prepare for treating these patients, what would you say to them?

Mazzoni: I would say that this isn’t a career that’s just a cool field to be in because we have all these new therapies coming out. It’s a field where you really need to be in it to establish these long-term relationships because these patients are going to be with you throughout their life. It’s going to be an evolving field. Yes, it’s very exciting because in the near future, we are going to have options probably for the standard-risk patients to provide a cure for a good portion of them.

So there’s a lot of interest when we interview fellows from their residency to come in that are very excited about going into things like myeloma and lymphoma because this is where all the new therapies are emerging, but you have to really know that at some point there’s going to be other diseases that are going to take that over and they’re going to be the new all-stars of oncology.

But I love my patients. I love the whole idea of having a long-term relationship with the patients. That’s what got me.

Mangels: We’ve talked about so many facets of providing care for multiple myeloma patients: the clinical details, processing, navigating, helping patients through the emotional aspects of it. How much of this was dealt with in your training in medical school and residency and fellowship? Did you feel like you were prepared for all of the things that go beyond the clinical care? And if not, what would you say to those who do set that curricula to help produce a better prepared hematologist?

Mazzoni: Yeah. So medical school, it’s really dependent on which medical school you go to. They have all these courses of doctor-patient relationships and they do their best, but a lot of it’s simulated or paid-participant patients.

Mangels: Scripted.

Mazzoni: It’s a bit too scripted, yes. And I think that the years in your third and fourth year that you really need to, as the student, advocate to be in an environment with real patients watching how providers navigate delivering bad news. I don’t think we see enough of that. I think that a lot of the clinicals in third and fourth year are focused on inpatient care of acutely sick patients. And so yes, in the oncology world, even in the inpatient setting, you’re often delivering some bad news.

In the clinic though, I think that aspect is missing. I remember during medical school, during my fourth year, I recall once being in with an oncologist that was delivering the goals of care and trying to navigate the fact that there were no remaining good treatment options and that they were going to recommend hospice. And watching that conversation, it would have been very beneficial for me to have seen more than one example of it so that it would help me when I’m doing it.

Starting in residency, you’re doing it on your own sometimes, and being able to learn how to navigate that and see examples of it. I think that we need to do a better job of bringing in our medical student to those conversations during their third and fourth year of training.

Mangels: There’s nothing like learning in a real-world setting. It’s a whole different world than just being in a lecture and hearing somebody talk about it versus seeing it happen, seeing how someone like you delivers that news and learning about the value of empathy.

Mazzoni: Yeah.

Mangels: Thanks so much for your insights, Dr. Mazzoni. And thank you for joining us on “Beyond Diagnosis,” where we explore not just what physicians know, but how to effectively and compassionately share that knowledge with patients. See you next time.

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