As healthcare professionals we are trained to recognize, meet and treat the needs of others. Ironically, we are far less tuned into and responsive to our own emotional and physical well-being, making healthcare providers at high risk for the negative effects of work-related stress. Putting off or denying our own needs, can lead to a variety of health problems, depression, anxiety, sleep disorders, burnout, substance abuse, vulnerability to making mistakes, potential litigation, and in some cases, suicide. Finding ways to recognize and address our own stress-levels, improves our energy, focus, sense of vitality, and resiliency in our professional and personal lives.
The first line of defense is Awareness.
Do You Recognize these Stressors and Signs of Burnout or Moral Fatigue?
- Demanding work hours
- Complex patient conditions and treatment needs
- Patient encounters that express and elicit, fear, pain, anger, confusion, self-justification, doubt
- Family pressures including those related to work schedules and demands
- Irregular self-care ~ lack of sleep, eating difficulties, lack of exercise, lack of social support
- Financial pressures
- Unsupportive and equally stressed medical facility administration, peers, staff
- EMR's, record keeping and reporting
- Multi-tasking, distractions and interruptions due to e-mails, phone-calls, paperwork, staff contact
- Medical Malpractice Stress including anticipation, current, or past litigation
Signs of Burnout or Moral Fatigue:
A standard measurement of burnout in the workplace is the Maslach Burnout Inventory (MBI). The three scales used to measure burnout are:
- Emotional Exhaustion - feeling emotionally depleted, strained, overextended
- Depersonalization - feeling detached, disengaged, disconnected or cynical
- Personal Accomplishment - feeling ineffective, diminished sense of accomplishment or satisfaction
Potential Hindrances to self-care:
- Professional training to ignore personal needs including: mental, physical and emotional exhaustion.
- Fear of exposing personal or professional vulnerabilities to one's self or others.
- Fear of repercussions from expressing concerns with co-workers, administration, family.
- Keeping thoughts, feelings and physical responses to one's self.
- Self medicating with drugs, alcohol, high risk behaviors.
- Feelings of guilt and shame.
What is Mindfulness and How Do These Practices Help?
Mindfulness in basic terms is:
The Practice of Intentionally Paying Attention Moment to Moment with Open, Curious, Kind Attention.
Mindful practices help by:
- Fostering 'fresh eyes' to every situation versus relying on habits that may not serve you.
- Reducing distractions.
- Recognizing stressors and their impact on you.
- Recognizing your reactions in difficult situations and developing more options in how to respond.
- Increasing focus and concentration during patient encounters, making diagnoses, setting out treatment plans, and ongoing interventions with patients, etc.
Studies specifically related to healthcare providers have demonstrated that mindfulness practices may help:
- Reduce potential burnout.
- Improve sense of competency.
- Improve listening skills and therapeutic presence.
- Employ skillful and effective treatment.
- Improve patient collaboration, compliance and satisfaction.
There are endless ways to learn and process mindfulness practices. It is important to identify practices that speak to your unique needs.
See Events page for training sessions.
Trainings are also available at your institution for in-house staff meetings and grand rounds.
There is much research in this area, here are some resources to consider:
Books and Articles:
Epstein, Mark (1996). Thoughts Without a Thinker. New York:Basic Books
Enhancing Meaning in Work A Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care JAMA 2009;302(12) 1338-1340 doi 10.1001/jama 200.1385
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. Drasner, MS MD; Epstein, RM MD; Beckman, H. MD, Suchman, Anthony L., Chapman, B. PhD, Mooney, CJ MA, Quill, Timothy, MD. JAMA 2009; 302(1) 1284-1293 doi 10./ jama 209.1384
Doctor's Toughest Diagnosis: Own Mental Health New York Times 7/8/2003 by Erica Goode
Fitch, Starla (2014). Remedy for Burnout, Prescriptions Doctors Use to find Meaning in Medicine
Kabat-Zinn, Jon (1990). Full Catastrophe Living. New York:Dell
Lipsenthal, Lee. Finding Balance in a Medical Life.
Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996
Ofri, Danielle (2013). What Doctors Feel: How Emotions Affect the Practice of Medicine.
O'Reilly, Kevin B. Using Mindfulness to Soothe Physician Stress in American Medical News.com; 2009