This release is available in http://chinese..org/zh/emb_releases/2009-09/jaaj-spf091809.php ">Chinese.
Primary care physicians who participated in an educational program that included an emphasis on mindful communication reported improvement in personal well-being, emotional exhaustion, empathy and attitudes associated with patient-centered care, according to a study in the September 23/30 issue of JAMA, a theme issue on medical education.
"Primary care physicians report alarming levels of professional and personal distress. Up to 60 percent of practicing physicians report symptoms of burnout, defined as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment. Physician burnout has been linked to poorer quality of care, including patient dissatisfaction, increased medical errors, and lawsuits and decreased ability to express empathy," according to background information in the article.
The authors add that another consequence of physician burnout is a decline in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. "Even though the problem of burnout in physicians has been recognized for years, there have been few programs targeting burnout before it leads to personal or professional impairment and very little data exist about their effectiveness."
Michael S. Krasner, M.D., of the University of Rochester Medical Center, Rochester, N.Y., and colleagues designed a continuing medical education (CME) course to improve physician well-being. "One proposed approach to addressing loss of meaning and lack of control in practice life is developing greater mindfulness—the quality of being fully present and attentive in the moment during everyday activities," the researchers write.
The course is based on 3 techniques: mindfulness meditation, narrative medicine, and appreciative inquiry. "Mindfulness meditation is a secular contemplative practice focusing on cultivating an individual's attention and awareness skills. Both narrative medicine and appreciative inquiry involve focusing attention and awareness through telling of, listening to, and reflecting on personal stories."
Seventy primary care physicians participated in the course, which included an 8-week intensive phase (2.5 hours/week, 7-hour retreat), followed by a 10-month maintenance phase (2.5 hours/month). The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material and discussion. Physicians were surveyed before, during and after the course regarding levels and measurements of mindfulness, burnout, empathy, psychosocial orientation, personality and mood.
"Our study demonstrated that primary care physicians participating in a CME program that focused on self-awareness experienced improved personal well-being, including burnout (emotional exhaustion, depersonalization, and personal accomplishment) and improved mood (total and depression, vigor, tension, anger, and fatigue). They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care that has been associated with patient-centered behaviors such as attending to the patient's experience of illness and its psychosocial context and promoting patient participation in care," the authors write.
"The skills cultivated in the mindful communication program appeared to lower participants' reactivity to stressful events and help them adopt greater resilience in the face of adversity," they add. "Further study will be necessary to investigate the effects on practice efficiency, patients' experience of care, and clinical outcomes."
(JAMA. 2009;302:1284-1293. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Enhancing Meaning in Work
Tait Shanafelt, M.D., of the Mayo Clinic, Rochester, Minn., writes in an accompanying editorial that physicians will likely face many new challenges over the next decade as the nation reforms its health care system.
"Although many physicians may be tempted to respond to this challenge by retreating from work (e.g., more time off, reduced scope of practice, retirement), the study by Krasner and colleagues demonstrates that training physicians the art of mindful practice has the potential to promote physician health through work. Physicians 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. Reminding physicians of this fact and helping them 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."
(JAMA. 2009;302:1338-1340. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.