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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

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

physician wellness
Physician Wellness

High quality of care delivered

Job satisfaction  stability of workforce

Personal quality of life / family life

Life Balance

when wellness is compromised physician burnout
When wellness is compromised: physician burnout

Emotional exhaustion

Depersonalization (treating patients as objects)

Low sense of accomplishment

Increased stress

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

primary care7
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.

pathophysiology of burnout
‘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.

prevention treatment of burnout
Prevention / Treatment of Burnout

Lack of “standardized” treatment

Lack of system-wide approaches

slide12

“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

slide13

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

what is mindfulness meditation
What is Mindfulness Meditation ?
  • Originated in many ancient religions/cultures across the world
mindfulness meditation mm
Mindfulness Meditation (MM)
  • Popularity has been

growing

  • As a therapy, it

is already used

in clinical settings

meditation
Meditation
  • “meditation” = technique of an intentional regulation of attention

focus on the present moment

autopilot

mindfulness
Mindfulness
  • the way we pay attention

to the present moment:

    • on purpose, non-judgmentally,

with acceptance

    • with openness, curiosity, kindness
  • practiced by using meditation
slide19

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
mindfulness meditation therapy
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
personal growth and well being long term practitioners
Personal Growth and Well-being: Long-term Practitioners

Buddhist monks (R. Davidson’s studies)

 gamma brainwave activity suggesting:

 intelligence

 compassion

 self-control

 happiness

slide22
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

personal growth and well being
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

health care providers
Health Care Providers

After Mindfulness training,

nursing, pre-med & medical students:

 empathy

 stress

 anxiety

Shapiro SL, J Behav Med 1998

primary care physicians n 70
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

health care providers better treatment outcomes
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

mindfulness in medicine
Mindfulness in Medicine
  • benefits for providers AND patients
  • life-long effects & “transferable” skills
  • high client satisfaction
  • no side effects
  • non-stigmatizing
  • ? cheap
mindfulness in medicine28
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

why mindfulness personal professional journey
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

mm based therapies
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
vipassana meditation
Vipassana meditation
  • the most ‘traditional’ approach
  • retreats (many - silent):
    • 10-day Vipassana(www.dhamma.org)
    • varied duration: Insight Meditation
    • (www.dharma.org)
mindfulness based stress reduction mbsr
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
slide33
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
mindfulness based cognitive therapy mbct
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% !
mindful eating
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.”
other resources
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)
other resources37
Other resources
  • UW DFM & MBSR website
    • Mindfulness in Medicine http://www.fammed.wisc.edu/mindfulness
    • UW MBSR 

For Health Professionals

mindfulness in daily life
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

thank you
Thank you !

Aleksandra.Zgierska@fammed.wisc.edu