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Mindful : October 2014
first comprehensive study of physician burnout and found that nea rly half of doctors in America reported at least one symptom. Doctors who a re burned out are not simply exhausted—they treat their patients as objects, have less empathy for them, and feel a low sense of accomplishment. Disillusioned a nd disengaged, they’re more likely to com- mit errors and leave the profession. They suffer high rates of depression, substa nce abuse, and suicide. Their patients a re suf- fering too, and getting a poorer quality of health care. People who are trying to help phy- sicians manage burnout say there a re several reasons the crisis has reached a tipping point. “The declining quality of life of the average physicia n partly results from increased time demands,” said Dr. Steven Hickman, director of the Center for Mindfulness at the University of California, San Diego, where residents and first-year medical students take mindfulness courses. Shorter appoint- ment times, an avalanche of paper- work a nd emails, and less satisfying encounters with patients—all are having devastating effects on doctors’ ability to provide care. Being in the front lines in the places where suffering people congregate also takes its toll. “The people provid- ing health care are exposed to trauma daily,” said Frank Ostaseski, founder and director of the Metta Institute, an organization in Marin County, Califor- nia, that helps health-care professionals provide more compassionate end-of-life care. “It’s unrealistic to imagine they can be exposed to enormous suffering and not be affected.” Being connected to your fellow caregivers can help with that. Instead, doctors feel isolated. “ I was training pediatricia ns at Kaiser,” said Ostaseski, “when one of the old-time physicia ns said, ‘We don’t have a doctors’ dining room anymore. We used to sit down for lunch and talk to each other, about cases, to seek advice. Now I eat lunch at my computer.’ ” “A lot of doctors have a contemplative, philosophical side,” added Dr. Ronald Epstein, a 59-year-old professor of family medicine, psychiatry and oncology at the University of Rochester who teaches mindfulness, “but the culture of medi- cine can be hard a nd superficial. People are left on their own. There are a lot of unhappy doctors because they’re not finding mea ning in their work.” While the benefits of mindfulness have been well-documented, and the practice is increasingly celebrated for its ability to increase our resiliency amid stressful environments, medicine has been slow to recognize these benefits. In 2009, that attitude began to shift when a landmark study of doctors using mindfulness was published in JAMA. The study, by Dr. Michael S. Krasner and Dr. Epstein at the University of Rochester, involved 70 primar y care doctors who took a year-long course in mindful communication, which included writing exercises, meditation, small group discussions, and sessions on topics such as burnout, g rief and loss, and self- care. They did “slow walking ” and “fast walking,” where they obser ved things around them. They examined what was working in their professional lives, and what wasn’t, and how their emotions and physical reactions influenced care. They confessed mistakes they’d made. They listened. The results were striking. The doctors were more present, less stressed out, a nd more attentive to their patients. But the real surprise was that the benefits lasted. When resea rchers sur veyed the partic- ipants a year later, the physicians were still using mindfulness skills with their patients. Yet ma ny had trouble taking time to meditate or do other activities to alleviate stress. “The docs sta rted telling us that it was really hard to motivate Disillusioned and disengaged, they’re more likely to com- mit errors and leave the profession. They suffer high rates of depression, sub- stance abuse, and suicide. Their patients are suffering too, and getting a poorer qual- ity of health care. Up to 30% higher rates of depression in med students Rates of depression in medical students compared to the general population. 54 mindful October 2014 medicine