Checking In on the Health of our Doctors

Ivanhoe Newswire Friday, Sep. 25, 2009; 4:17 AM

(Ivanhoe Newswire) -- Primary care physicians who participated in an educational program that emphasized mindful communication reported improvement in personal well-being, emotional exhaustion, empathy and attitudes associated with patient-centered care, according to a new study.

According to researchers, primary care physicians report alarming levels of professional and personal distress. Up to 60 percent of practicing physicians report symptoms of burnout, such as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment. Physician burnout has been linked to poorer quality of care, patient dissatisfaction, increased medical errors, lawsuits, and decreased ability to express empathy.

The authors added that another consequence of physician burnout is a decline in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. "Even though the problem of burnout in physicians has been recognized for years," wrote the researchers, "there have been few programs targeting burnout before it leads to personal or professional impairment, and very little data exist about their effectiveness."

Michael S. Krasner, M.D., of the University of Rochester Medical Center, Rochester, N.Y., and colleagues designed a continuing medical education (CME) course to improve physician well-being. "One proposed approach to addressing loss of meaning and lack of control in practice life is developing greater mindfulness—the quality of being fully present and attentive in the moment during everyday activities," Krasner was quoted as saying.

The course is based on three techniques -- mindfulness meditation, narrative medicine, and appreciative inquiry. "Mindfulness meditation is a secular contemplative practice focusing on cultivating an individual's attention and awareness skills," wrote the researchers. "Both narrative medicine and appreciative inquiry involve focusing attention and awareness through telling of, listening to, and reflecting on personal stories."

Seventy primary care physicians participated in the course, which began with an 8-week intensive phase of a 7-hour retreat plus 2.5 hours per week, followed by a 10-month maintenance phase of 2.5 hours per month. Physicians were surveyed before, during and after the course regarding levels of mindfulness, burnout, empathy, psychosocial orientation, personality and mood.

"Our study demonstrated that primary care physicians participating in a CME program that focused on self-awareness experienced improved personal well-being, including burnout . . . and improved mood," wrote the authors. "They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care . . . such as attending to the patient's experience of illness and its psychosocial context and promoting patient participation in care."

In an accompanying editorial, Tait Shanafelt, M.D., of the Mayo Clinic, Rochester, MN, wrote that physicians will likely face many new challenges over the next decade as the nation reforms its health care system.

"Although many physicians may be tempted to respond to this challenge by retreating from work (e.g., more time off, reduced scope of practice, retirement), the study by Krasner and colleagues demonstrates that training physicians the art of mindful practice has the potential to promote physician health through work. Physicians continue to control the most sacred and meaningful aspect of medical practice—the encounter with the patient and the reward that comes from restoring health and relieving suffering. Reminding physicians of this fact and helping them recognize and enhance the meaning they derive from the practice of medicine may help protect against burnout and promote patient-centered care for the benefit of both physicians and their patients."