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Physician Wellness Mindfulness in Medicine

Physician Wellness Mindfulness in Medicine. Aleksandra Zgierska , MD, PhD Primary Care Faculty Development Fellowship University of Wisconsin, School of Medicine and Public Health, Department of Family Medicine Madison, WI, Nov 12, 2010. Department of Family Medicine. Physician Wellness.

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Physician Wellness Mindfulness in Medicine

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  1. Physician WellnessMindfulness in Medicine Aleksandra Zgierska, MD, PhD Primary Care Faculty Development Fellowship University of Wisconsin, School of Medicine and Public Health, Department of Family Medicine Madison, WI, Nov 12, 2010

  2. Department of Family Medicine

  3. Physician Wellness High quality of care delivered Job satisfaction  stability of workforce Personal quality of life / family life Life Balance

  4. When wellness is compromised: physician burnout Emotional exhaustion Depersonalization (treating patients as objects) Low sense of accomplishment Increased stress

  5. Consequences of Burnout •  quality of life •  quality of care •  sense of accomplishment • Life / work dissatisfaction • Instability of workforce • Divorce • Depression – suicide • Addiction

  6. Primary care “An alarming number of physicians, unable to cope with the pressures of practicing everyday medicine, succumb to the stress. Consider that 300-400 doctors in the U.S. kill themselves every year, or roughly 1 per day. Male doctors have suicide rates 1.4 times that of a general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.” “Help for Today’s Tense, Frustrated Doctors,” K. Pho, D. Farrago, Medscape Business of Medicine, 10/26/09

  7. Primary care • Surveys of PCPs: • up to 60% of practicing physicians report symptoms of burnout, in part due to worsening time pressures and a chaotic work pace, which were strongly associated with low physician satisfaction • Maslow Burnout Inventory Linzer et al, Ann Intern Med, 2009, 151: 28-36; Spickard et al, JAMA 2002, 288: 1447-50; Shanafelt et al: Am J Med, 2003, 114: 513-19.

  8. ‘Pathophysiology’ of Burnout • Burnout may be related to lack of sense of control and loss of meaning Dunn et al, J Gen Intern Med, 2007, 22: 1544-52 • Study of physicians found that the capacity of “being present” with their patients correlated more strongly with finding meaning in their work than diagnostic or therapeutic successes. Horowitz et al, Ann Int Med, 1995, 138: 772-76.

  9. Prevention / Treatment of Burnout Lack of “standardized” treatment Lack of system-wide approaches

  10. “Enhancing Meaning at Work: a Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care.” Shanafelt TD, JAMA, 2009, 302:1338. Prevention / Treatment of Burnout

  11. Prevention / Treatment of Burnout • New initiatives…. • One possible approach to address loss of meaning and feeling of lack of control is through developing greater mindfulness • “AAFP News Now: 'Mindful Communication' Can Help Physicians Deal With Burnout, Says Study.” www.aafp.org/online/en/home/publications/news/news- now/professional-issues/20091109mindful-comm.html 11-2009

  12. What is Mindfulness Meditation ? • Originated in many ancient religions/cultures across the world

  13. Mindfulness Meditation (MM) • Popularity has been growing • As a therapy, it is already used in clinical settings

  14. Meditation • “meditation” = technique of an intentional regulation of attention  focus on the present moment  autopilot

  15. Mindfulness • the way we pay attention to the present moment: • on purpose, non-judgmentally, with acceptance • with openness, curiosity, kindness • practiced by using meditation

  16. Mindfulness Meditation • “being in the present moment” • better recognition of thought patterns, emotions, sensations  mindful response (vs. “autopilot”) • helps act reflectively (non-judgmentally) rather than impulsively

  17. Mindfulness Meditation therapy • mental health problems • stress, anxiety, depression, ADHD, borderline personality disorder, sleep problems, bulimia • addictive disorders • cardiovascular disorders • other chronic conditions: obesity, psoriasis, diabetes, cancer, AIDS

  18. Personal Growth and Well-being: Long-term Practitioners Buddhist monks (R. Davidson’s studies)  gamma brainwave activity suggesting:  intelligence  compassion  self-control  happiness

  19. Meta-analysis (10 studies) evaluating effects of mindfulness training:  stress  ruminative thinking  empathy compassion  spiritually  quality of life Personal Growth and Well-being: Healthy Individuals Chiesa A, J Altern Complement Med, 2009

  20. Personal Growth and Well-being After Mindfulness training:  antibody titer after flu shot  positive emotions brain imaging studies: biological changes ( prefrontal cortex,  amygdala activity) Improved stress biomarkers cortisol, cytokines

  21. Health Care Providers After Mindfulness training, nursing, pre-med & medical students:  empathy  stress  anxiety Shapiro SL, J Behav Med 1998

  22. Primary Care Physicians (N=70) 15 months after Mindfulness training:  burnout  perceived stress  stress coping  emotional stability  empathy  sustained well-being  attitude toward patient care Krasner MS et al., JAMA 2009, 302: 1284-93

  23. Health Care Providers:Better Treatment Outcomes RCT of mental health providers Mindfulness training vs. not Trained providers had better mental health treatment outcomes in their patients Grepmair L, Psychother Psychosom 2007

  24. Mindfulness in Medicine • benefits for providers AND patients • life-long effects & “transferable” skills • high client satisfaction • no side effects • non-stigmatizing • ? cheap

  25. Mindfulness in Medicine • Mindfulness: • “… is a discipline and an attitude of mind” • [its] “practice requires mentoring and guidance.” • … “can link evidence-based and relationship-centered care and help to overcome the limitations of both approaches.” • … “should be considered a characteristic of good clinical practice” Epstein RM: “Mindful Practice”, JAMA 1999

  26. Why Mindfulness …?Personal & professional journey • Secular or religious – flexible • “Better life” • equanimity, happiness • stress management • life-long skills • not a “therapy” • “Better services” as a provider Hokusai, Big Wave

  27. MM-based therapies • Vipassana meditation • Mindfulness Based Stress Reduction, MBSR • Mindfulness Based Cognitive Therapy, MBCT • Mindfulness Based Relapse Prevention, MBRP • Dialectical Behavior Therapy, DBT • Acceptance Commitment Therapy, ACT • Spiritual Self Schema, 3-S

  28. Vipassana meditation • the most ‘traditional’ approach • retreats (many - silent): • 10-day Vipassana(www.dhamma.org) • varied duration: Insight Meditation • (www.dharma.org)

  29. Mindfulness Based Stress Reduction, MBSR • UMass (Center for Mindfulness in Medicine, Health Care, and Society) • Mindful Leadership Program • Retreat:Cultivating Leadership Presence through Mindfulness (good !!!) • next year: in WI • by invitation / application

  30. MBSR • UW-Madison Integrative Medicine • Dave Rakel, MD • Research on preventing / treating burnout • Meditation study for PCPs • meditation course is free (PCPs are paid !) and abbreviated, with weekend / evening* schedule • brochures available • waiting lists for both

  31. Mindfulness Based Cognitive Therapy, MBCT • Designed for relapse prevention in depression • http://www.mbct.com • book: “The Mindful Way Through Depression” • Strong evidence for depression, anxiety • Andrew Moore, MD, WISPIC (UW Psych) • courses designed for depression or anxiety • most insurers cover them 100% !

  32. Mindful Eating • The Center for Mindful Eating (TCME) • http://www.tcme.org • “4 Easy Ways to Prevent Mindless Eating: Simple tips you can use to stop the unconscious munching. No ‘diet’ required.”

  33. Other resources • Lee Lipsenthal, MD • Book: "Finding Balance in a Medical Life". • AAFP video: “Living and Dying with Balance.” (www.aafp.org/online/en/home/cme/aafpcourses/conferences/assembly/cme/plenaries0.html)

  34. Other resources • UW DFM & MBSR website • Mindfulness in Medicine http://www.fammed.wisc.edu/mindfulness • UW MBSR  For Health Professionals

  35. Mindfulness in daily life - stop, take a breath, ‘drop in’ - be aware of what is happening now: body sensations, thoughts, emotions; open to what is here; observe (accept) what arises for you just as it is, moment by moment, without reactivity. Listen deeply. - “What’s called for NOW?” - use mindful speech and action to respond compassionately, and with positive intention. Adapted from www.fammed.wisc.edu/mindfulness Pause Presence Proceed

  36. Thank you ! Aleksandra.Zgierska@fammed.wisc.edu

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