Category Archives: mindfulness

Doctor: Care for Thyself

Helping handBy Charles J. Hatem, M.D.

It is ironic that we commit our professional work to the care of others, yet often fail to care for ourselves as well as for the significant others in our lives. The disturbing reasons that underlie this reality are many, but the “final common pathway” carries the potential for burnout, impacting ourselves, those close to us, and the care we provide.

Burnout, as characterized by Dr. Christina Maslach, is marked by emotional exhaustion, detachment, and a lack of fulfillment. Burnout is pernicious because of the dysfunction and disability it leaves in its wake, making its prevention vital for a personal and professional life that is balanced and fulfilling.

Recalibrating this reality demands that we step back, reflect, and commit ourselves to reengage the commitment that brought us to medicine. Much like our advocacy for prevention in health care, we ought to be focused on initiatives that deal with wellness and forestall burnout before it materializes.

Framework for Well-Being

As Craig Irvine puts it, “We are ethically obligated to care for ourselves.” Linda Clever, M.D., a prominent physician leader in renewal initiatives, issues a similar reminder. “Taking care of yourself is not selfishness, it is self-preservation,” she writes.

Accomplishing this requires attention to advice we liberally dispense to others: getting enough rest, eating sensibly, exercising, cultivating interests outside of medicine, avoiding “chemical coping” as a strategy for dealing with problems, taking regular vacations, and many other beneficial “interventions” well-known, but often ignored, by us. Without the framework for personal wellness in our own lives, we are not in a position to afford aid others.

Caring for Significant Others

How often do we discuss our life priorities with those close to us? How often do we ask for their validation about our plans? We need to remain connected to our family, significant others, colleagues, and friends — connections requiring an appreciation of the centrality of others in our lives.

 Work

Our well-being is intimately connected with our work and comes from remembering and valuing the joy inherent in caring for others. Joy that comes from the daily application of our scientific skills and our talents for listening and caring. As wonderfully stated by Christine Cassel, president and CEO of the American Board of Internal Medicine, “Medicine is, at its center, a moral enterprise grounded in a covenant of trust … dedicated to something other than its own self-interest.

Our first obligation must be to serve the good of those persons who seek our help and trust us to provide it.” Our role as physicians is demanding and asks us for a measure of equilibrium as we confront economic and regulatory pressures. Yet, we are afforded the privilege of caring for others in moments of health and in times of struggle and death.

Values

This most vital and sustaining life lesson, interwoven with a pursuit of kindness, mindfulness, humor, curiosity, a desire to learn, and daily lessons of humility that the practice of medicine brings, all serve to encourage the wellness essential to our lives as practitioners and individuals striving to lead a full life. Without the emphatic attention to all of these issues we cannot sustain our caring for others and ourselves.


Dr. Hatem is chair of the Department of Medical Education at Mount Auburn Hospital in Cambridge, Mass. This article first appeared in the February 2012 edition of the Massachusetts Medical Society publication Vital Signs.

Physician Health Services, Inc., is a non-profit corporation founded by the Massachusetts Medical Society. PHS  provides confidential consultation and support to physicians, residents, and medical students facing concerns related to alcoholism, substance abuse, behavioral or mental health issues, or physical illness. PHS also provides a safe environment where physicians can talk to other physicians about the stress and demands of modern medical practices. For more information, visit the PHS website or call PHS at (781) 434-7404.

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Integrating Mindfulness into Your Daily Routine

Photo by Darragh O'Connor via flickr.com

By Douglas Ziedonis, M.D., M.P.H., Carl Fulwiller, M.D., PH.D., and Makenzie Tonelli

Recent studies have reported on the effectiveness and impact of training physicians on integrating mindfulness approaches into their personal lives and clinical practice. Mindfulness can help improve health, reduce physician burnout, and improve patient satisfaction and outcomes.

Surveys of physicians indicate that two-thirds experience burnout associated with making more errors, having less empathy, substance misuse, and leaving practice. Physicians’ daily routines are challenged by competing tasks, rapidly changing environments, and a flood of thoughts and feelings in the context of our decision-making and interpersonal relationships.

Mindfulness — the state of focusing one’s awareness on the present moment and monitoring the unfolding of experience without judgment — can help us cultivate awareness, compassion, and acceptance.

Mindfulness practice can be both informal and formal. Formal practices occur in structured time periods, similar to physical exercise, devoted to engaging in meditation, yoga, or other similar practices. The informal application of mindfulness to daily experience involves awareness of the present moment, whether pleasant, unpleasant, or neutral, with an attitude of curiosity and acceptance, allowing feelings or thoughts to arise and pass away again without judgment.

In the midst of a stressful clinical encounter, practical techniques can be used, such as taking a short (e.g., one-minute pause) between patients, in which one takes a few deep breaths and becomes aware of any tension in one’s body, without judgment or being critical of taking care of oneself for that moment. Mindfulness during the clinical session helps patients feel heard.

Through mindfulness practice, an enhanced appreciation of pleasant experiences and a greater acceptance of unpleasant experiences emerge. Focusing on the breath and other sensations arising in the body helps to anchor oneself in the present moment. As clinicians, when we are more present, we demonstrate patience, empathy, and an increased capacity to listen. We are also more self-compassionate, handle uncertainty better, and embrace all the moments of our life, including the catastrophic and challenging.

This practice allows for more meaningful interactions with our patients and for opportunities to engage in the patient’s sacred space. A mindful physician encountered by a nervous and concerned patient, is more aware of and empathetic toward the emotional state of the patient, and thus more likely to respond in a way that is most comforting for the patient, such as with eye contact, a calm demeanor, and with language that will resonate with the patient.

Physicians are also well-positioned to help staff and patients integrate mindfulness into their lives. As mindful leaders, we can enhance our ability to focus, be less reactive and more responsive, promote teamwork, and model compassion based on insight.

This article first appeared in the February 2014 edition of the Massachusetts Medical Society publication, Vital Signs.

Douglas Ziedonis, M.D., M.P.H., is professor and chair of the Department of Psychiatry at the University of Massachusetts Medical School and UMass Memorial Health Care. Carl Fulwiler, M.D., Ph.D., is associate professor of psychiatry and director of the Center for Mental Health Services Research at UMass Medical School. Makenzie Tonelli is a project coordinator in the Department of Psychiatry, at the University of Massachusetts Medical School.


Physician Health Services, Inc., is a non-profit corporation founded by the Massachusetts Medical Society. PHS  provides confidential consultation and support to physicians, residents, and medical students facing concerns related to alcoholism, substance abuse, behavioral or mental health issues, or physical illness. PHS also provides a safe environment where physicians can talk to other physicians about the stress and demands of modern medical practices. For more information, visit the PHS website or call PHS at (781) 434-7404.

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