Attending To Presence: Improving Physicians’ Interpersonal and Professional Well-Being through Mindfulness Training by Wendland, Mooney, Krasner, Beckman

Attending To Presence: Improving Physicians’ Interpersonal and Professional Well-Being through Mindfulness Training Melissa Wendland, BS, Christopher Mooney, MA Michael Krasner, MD, FACP Howard Beckman, MD, FACP, FAACH ICCH -Miami October 3, 2009

Introduction

Primary Care Physicians report widespread personal and professional dissatisfaction.

They describe feelings of :

Burnout

Loss of Professional Meaning

Isolation

Krasner, et al. Findings*

After completing a year-long mindfulness training program, p racticing Primary Care Physicians’ self-reported statistically significant:

Decreased Levels of Burnout

Increased Empathy

Reduced Stress Levels

*JAMA, September 23/30, 2009-Vol 302, No.12

Research Question

What led to the observed changes in physician’s professional attitudes or perceptions of how they relate to themselves, their patients, colleagues,

family and others ?

Methods

A convenience sample of 70 PCP’s Participated in a year-long continuing education program in mindfulness training :

8-weekly intensive 2 ½ hour session

monthly sessions for 10 months

one-day silent retreat

The program included Guided Meditation, Appreciative Inquiry and Narratives

Methods

20 randomly selected physicians were solicited by phone to be interviewed after 6 months of completing the mindfulness program

A semi-structured interview of open-ended questions was used to seek experiences and perceptions

Interviews were audio taped and underwent individual and group review for thematic analysis

Reviews continued until saturation occurred

Results Most Frequent Themes 1 – Being together in a community was most meaningful; having the chance to talk about the complexities of practice with colleagues 16 2 – Appreciation for dedicated time to think, reflect and communicate 9 3 – Improved listening skills; without assuming the responsibility to fix something 8 4 – Extended silence was valuable in deepening self-awareness 8 5 – Becoming more self-aware improved communication with self and others 8 6 – Feeling less rushed and more focused and present in the moment 6 7 – Exploring own issues after the course concluded 6

Results – Thematic Clusters

1 – Physicians expressed a compelling desire to re-establish a sense of community among peers

2 –Physicians expressed a profound desire to improve personal and professional attention and presence

3 – Physicians were troubled by the conflict between the desire for personal time and space and guilt in taking that time

Theme One: A Compelling Desire to Re-establish a Sense of Community

“ The most meaningful part was being with other physicians, sharing and discussing some of our experiences and being able to have the immediate understanding of peers with respect to the struggles that we all have.”

“… Simply gathering, especially primary physicians who tend to be isolated in their practices; Gathering them together into a meeting place where they were invited to reflect more deeply; Just that is tremendous, and that it happened over a year’s time, I think, was very significant. It takes time for those stories to unfold. That seemed to me, a real engine for both developing community and fostering introspection.”

Theme Two: A profound desire to improve personal and professional presence

“ One of the things that comes out of this too, is that when you establish a practice of thinking more honestly, thinking more clearly, speaking more honestly, that definitely leaks out into your work everyday...it certainly opens you up to being more ready with patients, colleagues, family, to have those kinds of conversations and to have that kind of a more intimate, more honest interaction with people and that certainly was the case for me that came out in the rest of my work...It certainly made it much more immediate and easy to do in {my} practice”

Theme Three: Conflict between the desire for personal time and space and guilt in taking that time

“ You’d leave his course at night and you’d feel pretty good………..I felt this guilt about being there and not being at home, and my wife didn’t even make me feel guilty, it’s just me”

“ For that brief period of time, I felt more wholly me...it wasn’t about anybody else.”

“ The reality is that I was stepping back and just assessing my life, which is really probably what we doctors need to do”

“ It’s just helpful to have time to reflect and I tend to just go, go, go, and I don’t take a moment to pause. And when I have tried in the past to deliberately create those times I’m not, I do much better with a group.”

“ Medicine and my practice had become very stressful and it was getting extremely difficult to try and find ways to cope with the stress that didn’t either add more stress or was rarely successful at alleviating it. I felt like I was caught up in a negative circle of action and and reaction to what was going on in the office and a true sense of a loss of enjoyment of practicing medicine.”

Conclusions

1 – Sharing personal experiences with colleagues is meaningful to physicians’ and addresses feelings of isolation

2 – Mindfulness skills training improve physicians’ perception of their ability to listen and respond more effectively

3 - There is a prevailing contradiction between physicians’ feeling isolated and guilt in taking time they need.

Implications

The profound value physicians’ placed on community suggests that there is merit in creating a structured venue to share experiences and receive support and guidance from colleagues. In parallel, regularly scheduling time and space for personal reflection might increase physicians’ resilience or tolerance for change; adaptive reserve.

Next Research Questions