Take-home message: Mindfulness can help physicians manage stress—and may be effective in thwarting burnout.
Burnout is epidemic in medicine. Ophthalmologists may not think of their specialty as being highly stressful, but 50% may show signs of burnout, according to a survey by the American Medical Association at the Mayo Clinic.
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“We all know the path to burnout,” said Jullia Rosdahl, MD, PhD. “Early on, I thought of medicine as a sprint. I just had to get through medical school. Then I just had to get through residency, then fellowship.
“Then I realized that medicine isn’t a sprint, it’s a marathon,” said Dr. Rosdahl, assistant professor of ophthalmology, Duke University School of Medicine, Durham, NC. “And I needed to protect myself for the long term so I wouldn’t run out of steam.”
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Burnout begins with stress, Dr. Rosdahl said, and physician lives are filled with stress. The difference between coping with stress and burning out is a single word: resilience.
“Resilience is building strategies that help you cope with stress,” she said. “One of the ways to build resilience is through mindfulness. And mindfulness is an evidence-based practice that can improve your outlook and your ability to respond in stress. You can’t avoid stress, but mindfulness can help you cope with stress in productive ways.”
Dr. Rosdahl joined Duke Medicine’s in-house mindfulness program that was being developed when she finished training. At its core, mindfulness is simply paying attention to the moment and to your own reactions to situations. Mindfulness gives one the space to alter his or her own response to stresses.
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“One of the first steps was to teach us a few simple, breathing techniques,” she said. “I had never done any meditation and didn’t know that’s what we were learning.
“I was amazed at how much more power and positivity I had just by noticing my breathing and taking a mindful breath,” Dr. Rosdahl said. “When things got stressful, I could give myself space just by breathing. That’s a powerful tool.”
Other simple techniques included positivity practice, a short writing exercise describing a stressful experience and the inner qualities that helped get through the stress, and group discussions. Everyone develops their own coping techniques that others can use.
“One of the practical things I heard about and incorporated was just taking a breath before you go into the patient room,” Dr. Rosdahl said.
“When you touch the door handle or start to knock, just take a breath and feel the wood, feel the handle, let it pull you out of whatever you were thinking about,” she said. “It is powerful—that little pause that reminds you to pay attention to the patient even though you have a thousand things waiting for your attention.”
The training program took just about an hour once a month, something that might fit into the harried life of a resident. New physicians learn habits and thought patterns for a lifetime during residency. The right habits can build a successful career.
Dr. Rosdahl created a mindfulness program for resident-physicians with Karen Kingsolver, PhD, assistant professor in psychiatry and behavioral sciences, as well as community and family medicine, Duke University. The pair piloted the program with ophthalmology residents, and then expanded to other specialties.
The program showed no significant short-term effects in stress and burnout scores, Dr. Rosdahl said, but there were clear trends for positive effects. A health coaching intervention for attending physicians had more immediate results.
Health coaching helped physicians learn to set boundaries and priorities, build self-compassion and self-care, and enhance self-awareness. The resulting insights led to behavior changes that had indirect-but-positive impacts on patient care.
A health coach is a professional with the skills, expertise, and time to enhance client activation and engagement, Dr. Rosdahl said. Rather than giving orders, a health coach partners with clients to create successful, ongoing health behavior change.
Health coaching may be ideal for physicians. Those with time and money might invest in a formal program, such as the program in Mindfulness-Based Stress Reduction, first developed at the University of Massachusetts and now offered all over the world.
Physicians with might try home study, such as Jon Kabat-Zin’s Full Catastrophe Living, or go online. “Monday Morning Mindfulness” is a series of free YouTube videos.
“No matter where you live or how much money you don’t have, there are options to avoid burnout,” Dr. Rosdahl said. “Don’t wait until you are burned out.
“Look at yourself and think about your values and vision for your life, focus on your own wellness, both for your own health as well as for the benefit of your patients,” Dr. Rosdahl said. “If you are a healthier person, you are going to take better care of your patients.”
A selection of resources to help ophthalmologists understand burnout and build resilience:
• Burnout rates in different medical specialties
• Free burnout questionnaire for self-assessment
• Stress-reduction course from the University of Massachusetts Medical School (Similar courses are offered worldwide)
• North Carolina group helping physicians and physician groups
• Duke Medicine health coaching services
• VIDEOS “Monday Morning Mindfulness” with Jeffrey Brantley, MD on YouTube