An educational program in “mindful” communication produced striking improvements in primary care physicians' symptoms of burnout, according to a recent report.
By enhancing physicians' attention to their own feelings and experiences, the 52-hour program not only reduced participants' distress but also increased their empathy for patients and their ability to deliver patient-centered care, Dr. Tait D. Shanafelt said in an editorial comment accompanying the report.
“Physicians in the United States will face a host of new challenges over the next decade as the nation reforms its health care system,” and the restructuring will likely “increase the already epidemic levels of burnout among physicians and overwhelm those currently near their limits.” In response, some physicians will feel compelled to withdraw from their work. But this study “demonstrates that training physicians in the art of mindful practice has the potential to promote physician health through work,” said Dr. Shanafelt, director of the Program on Physician Well-Being at the Mayo Clinic, Rochester, Minn. (JAMA 2009;302:1338-40).
In the study, Dr. Michael S. Krasner and his associates at the University of Rochester (N.Y.) evaluated a continuing education course that they had designed to “enhance the physician-patient relationship through reflective practices that help the practitioner explore the domains of control and meaning in the clinical encounter” (JAMA 2009;302:1284-93).
The program, spread over the course of 1 year, includes an intensive phase with 8 weekly 2.5-hour sessions plus one all-day session toward the end of this phase, followed by a maintenance phase of 10 monthly 2.5-hour sessions.
Each session begins with a brief presentation of that week's theme and may include guided meditation exercises, large-group discussions, writing brief stories about personal experiences in medical practice, and sharing the written stories in pairs and small groups.
Throughout the program, participants are taught mindfulness—“paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Mindfulness includes lowering one's reactivity to challenging experiences; noticing and experiencing one's thoughts, feelings, and bodily sensations, even when they are unpleasant; and acting with awareness and attention instead of “on autopilot.”
A total of 70 Rochester-area internal medicine, family medicine, and pediatric physicians participated in the program. These study subjects were assessed at five different times before, during, and after the program.
Study subjects showed “striking” improvements in self-awareness and well-being, which included decreases in emotional exhaustion, depression, tension, and fatigue, as well as increases in feelings of personal accomplishment, vigor, and empathy.
The study was funded by the Physicians' Foundation for Health Systems Excellence and sponsored by the New York chapter of the American College of Physicians. Dr. Krasner and Dr. Shanafelt reported no financial conflicts.