When I say mindfulness, what do you think of?
Did granola, yoga teachers, NPR, and Whole Foods pop into your head?
That’s OK; at least you’re honest. I felt the same way before incorporating mindfulness practice into my day. Now, I am a convert.
The medical literature contains many studies that demonstrate clinical improvement for chronic pain, anxiety, back pain, and depression using mindfulness-based stress reduction (MBSR).1-3 These practices include meditation, body scan, and yoga. A study from 2014 in the Permanente Journal showed decreased primary care, ED, and hospital admissions in patients that underwent an 8-week mindfulness-based intervention (though this study has a pretty low sample size). 4
Mindfulness is hitting the main stream. It seems like physician (and other healthcare worker) wellness is on everyone’s mind, especially with mind-blowing numbers of physicians reporting burnout. In my two chosen specialties, Critical Care and Emergency Medicine, 55% of physicians are burned out, meaning they have lost enthusiasm for work, experience feelings of cynicism, and possess a low sense of personal accomplishment. Even in fields with the lowest rates of burnout, psychiatry (40%), ophthalmology (41%), and endocrinology (41%), the number of percentages with burnout symptoms is staggering.
For residents, burnout may be worse. There are longer hours, less autonomy, and a constant balance of patient care, expanding your medical knowledge, and attempting to “be a human being” in your downtime. Depending on your chosen specialty and rotation, it can be hard, if not impossible, to exercise, eat well, and maintain a normal bowel regimen.
Alas, let us avoid the trap of ‘learned helplessness.’ What can we do about it? How you can you make an impact today?
A recent, systematic review and meta-analysis from JAMA Internal Medicine evaluated interventions to help physicians reduce burnout. This review evaluated all levels (residents, fellows, attendings) and types of physicians (primary, secondary, or intensive). They assessed three questions:
- What types of interventions cured or reduced burnout? They specifically broke down the interventions as “physician-targeted,” meaning specifically focusing interventions on individual physicians with cognitive-behavioral techniques (CBT), MSBR, and/or educational programs, or “organization-targeted,” which focused on efforts to improve the nature and burden of work.
- How does work experience (< 5 years vs. >5 years) effect burnout?
- How does the health care setting (primary care or secondary care) effect burnout?
The study found the particular health care setting and years of experience had a non-significant effect on burnout. Interestingly, organizational-based interventions lead to the largest reductions in burnout. The authors hypothesize that organizational ownership may mitigate self-blame. Self-directed interventions were also shown to decrease burnout with no specific intervention found to be superior.5
How can you improve your perspective today? Here are 5 tips I find extremely helpful for jump-starting my mental and physical well being.
- Practice Meditation or Mindfulness.
This has been a game changer for me. Four times a week, I meditate for 10 minutes a day. I find it most helpful before a shift. Many high-performing individuals, including BEYONCE, practice meditation. Give it a try:
- Headspace – app with 10 free sessions, you can purchase more afterwards
- Fragrant Heart – website with multiple free, guided meditations.
You knew this would be here. The scientific benefits of exercise are well established. It decreases burnout, improves your energy and mood, and gives you an excuse to wear tank tops. What is not to like? Set a goal, such as running a half marathon, an obstacle race, or a long hiking trip, then do it. I love races because they motivate you to train regularly and consistently improve.
Your friends, family, and work colleagues are your biggest supporters. They understand the sleepless nights (or days), difficult cases, and interpersonal conflicts. You do not have to shoulder the entire burden. Speaking with your colleagues allows you to share your experiences and potentially, identify solutions to a problem others face too. For example, as an intern, when we wanted to add on orders, we would log into the patient’s chart, add the order, print the order, and then tube the order to the lab. How inefficient! A simple solution was to fix the way our orders were printed, so they went straight to the lab. Problem solved.
- Appreciate being appreciated.
There is a tendency to relive our experiences with unhappy or rude people. The man dragged out of the department cursing at you lingers much more than the “Thanks Doc” you receive when discharging a patient. Take a brief moment after every pleasant patient encounter to recognize that you are making a difference.
5. Make Folders.
I learned this tip from my father. He taught me to keep two folders, a “happy” folder and a “funny” folder. Whenever you find a funny article, picture, email, etc. print it out and place it into your funny folder. Place praise, complements, “thank-you” cards, and important life pictures into your happy folder.
In life, peaks and valleys are inevitable. When the world is crushing you, pull out your folders and remind yourself that you are a good person, people like you, and that some people make a pretty good living making cat memes.
- Kabat-Zinn J. An outpatient program in behavioral medicine for chronic
pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 1982 Apr;4(1):33- 47
- Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions:
variation in treatment outcomes and role of home meditation practice.
J Psychosom Res 2010 Jan;68(1):29-36.
- Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back PainA Randomized Clinical Trial. JAMA.
- McCubbin T, Dimidjian S, Kempe K, Glassey M, Ross C, Beck A. Mindfulness-Based Stress Reduction in an Integrated Care Delivery System: One-Year Impacts on Patient-Centered Outcomes and Health Care Utilization. Perm J 2014 Fall;18(4):4-9
- Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, Dawson S, van Marwijk H, Geraghty K, Esmail A. Controlled Interventions to Reduce Burnout in PhysiciansA Systematic Review and Meta-analysis . JAMA Intern Med. 2017;177(2):195-205. doi:10.1001/jamainternmed.2016.7674