Easing Physician Burnout with Mindfulness Training
Thursday, October 8, 2015
By Lisa Hardmeyer Gray, Veteran's Medical Center
Lisa will be presenting on mindfulness at the Fall Primary Care Conference October 17-20
The Triple Aim is widely accepted as a guideline for optimizing health system performance. The Three goals of Triple Aim are to enhance patient experience, improve population health, and reduce costs. In The Annals of Family Medicine, Thomas Bodenheimer, MD, and Christine Sinsky, MD, have suggested expanding the Triple Aim to the Quadruple Aim, with the fourth goal of improving the worklife health care of providers and staff. Why?
Research over the last few years has revealed that unrelenting job pressures cause 30-40% of practicing physicians to experience the emotional, mental and physical exhaustion characteristic of burnout. And there are industry predictions that estimate that number rising to nearly 50%. The 3 characteristics of burnout include, emotional exhaustion (being emotionally overextended and exhausted by one's work), depersonalization (unfeeling and impersonal response toward recipients of one's service) and a decreased sense of personal accomplishment (lack of feelings of competence and successful achievement in one's work). Health care workers who are impacted by burnout are at higher risk for substance abuse, disruptive behaviors, mood disorder, broken relationships and even suicide.
Burned out caregivers tend to make more medical errors, score lower on instruments which measure empathy, and have higher job dissatisfaction, all of which negatively impact patient satisfaction and level of care. ( JAMA: 2011, Physician Burn-out: A Potential Threat to Successful Health Care Reform.) The personal costs are great, the organizational costs equally serious. And the cost to an organization to replace a physician can be upwards of $250,000.
Relatively little is known about treating burnout, and programs to reduce burnout before it results in impairment are rare. But recent research shows mindfulness training can alleviate burnout. Mindfulness, which trains the mind to be more present and attentive in the moment, has been shown to help doctors become more focused, more empathetic and less emotionally exhausted.
Mindfulness practices have been around for a long time but are gaining prominence in modern society and medicine because of the compounding research both in survey form and through brain imaging. This evidence-based research is showing the positive effects of Mindfulness practice on health issues such as heart disease, immune response, and pain management. In addition, a vast amount of research connects Mindfulness practices and the activation of certain parts of the brain associated with emotional self-regulation, focus, learning and memory, and increased capacities to be more calm and less stressed even when the external situation remains the same.
Several recent studies specifically with primary care doctors are showing compelling evidence that Mindfulness training can alleviate burnout. While a majority of these studies focus mainly on primary care doctors, there is no reason to believe the benefits of this type of training wouldn’t extend to other medical and mental health care providers.
Two related studies were published in The Annals of Family Medicine. In one study, researchers assessed the baseline mindfulness of 45 doctors, nurses and physician assistants by asking them to respond to statements like these: I tend to walk quickly to where I am going without paying attention to what I experience along the way. I find myself listening to someone with one ear and doing something else at the same time. I forget a person’s name almost as soon as I’ve been told it for the first time. The researcher then observed and recorded the clinicians’ interactions with more than 400 patients and interviewed the patients to assess patient satisfaction of care.
After analyzing the audio recordings and the patients’ responses, researchers found that patients were more satisfied and more open with the clinicians who had experienced mindfulness training. The clinicians were generally more engaging and tuned in during patient interactions, more focused on the conversation, and were better able to establish a more connected relationship with the patient.
Clinicians not trained in mindfulness more frequently missed opportunities to be empathetic and, in the most extreme cases, failed to pay attention at all. Significantly, the doctors who had mindfulness training remained efficient despite extending conversation with patients to explore experiences and relationships.
Mindfulness training programs vary in length, generally requiring a significant time commitment involving weekly classes over a six-to eight week period and one full-day class. However, another study of mindfulness training considered the possibility of good outcomes with less time commitment. It evaluated the effects on 30 physicians of an abbreviated mindfulness course that required only one weekend and two follow-up evening sessions, two weeks apart. In abbreviated trainings it was found that physicians also demonstrated decreased levels of burnout, anxiety, depression and distress. A follow-up study nine months later showed the positive effects still in place.
While more work needs to be done, these two studies add to the growing body of research supporting mindfulness training as a way to improve the health of both doctors and their patients. According to Dr. Mary Catherine Beach, lead author of the study and an associate professor of medicine at Johns Hopkins University, mindfulness gives doctors permission to attend to their own health and well-being while allowing them to help patients by listening more, talking less, and seeing what the patients need.
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