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, which in turn may improve clinical outcomes, Dr. Tait D. Shanafelt said in an editorial comment accompanying this 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.
Physicians who participate in a mindful communication program will “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,” Dr. Shanafelt said in his editorial (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 medical education course that they had designed to improve physician well-being. “The program aims to enhance the physician-patient relationship through reflective practices that help the practitioner explore the domains of control and meaning in the clinical encounter,” the researchers explained.
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, yoga-type exercises, large-group discussions, writing brief stories about personal experiences in medical practice, discussing challenges in medical practice, and sharing the written stories in pairs and small groups.
The weekly and monthly topics include understanding self-awareness of thoughts and feelings, examining perceptual biases, dealing with pleasant and unpleasant events, managing conflict, preventing burnout, reflecting on meaningful experiences in practice, setting boundaries, examining attention to patients, exploring self-care, being with suffering, and examining end-of-life care.
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; acting with awareness and attention instead of “on autopilot”; and trying to disregard the labels or judgments applied to experiences in medical practice.
A total of 871 Rochester-area internal medicine, family medicine, and pediatric physicians were invited to partake in the program through the county medical society, and 70 accepted. These study subjects were assessed at five different times before, during, and after the program, using several instruments such as the Maslach Burnout Inventory, the Jefferson Scale of Physician Empathy, the Physician Belief Scale, the Profile of Mood States, and the Big Five Factor Structure personality scale.
Study subjects showed “striking” improvements in self-awareness and well-being, which included decreases in emotional exhaustion, depersonalization, depression, tension, anger, and fatigue, as well as increases in feelings of personal accomplishment, vigor, empathy, and psychosocial beliefs known to correlate with patient-centered behavior.
In previous studies, such changes have been associated with improved patient satisfaction and trust, more appropriate prescribing, fewer medical errors, reduced disparities in health care, and fewer lawsuits. Thus, a mindfulness-based intervention may improve not only physician well-being but also clinical care, Dr. Krasner and his colleagues said (JAMA 2009;302:1284–93).
In his editorial comment, Dr. Shanafelt concurred. Helping physicians “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,” he noted.
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 conflicts of interest.