Mindfulness, Self-Compassion, and Personal Resiliency in ... You must include ONE of the statements

Mindfulness, Self-Compassion, and Personal Resiliency in

Medicine

Tina Runyan, PhD, ABPP Professor

Department of Family Medicine & Community Health Christine.runyan@umassmemorial.org

Practice

Faculty Disclosure

No relevant financial relationships during the past 12 months.

I am the current president of the board for CFHA.

Presenter Presentation Notes You must include ONE of the statements above for this session.

CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.

The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.

Objectives

• Clinician Burnout – Define, Prevalence, Why It Matters, Causes

• Antidotes to Burnout (and the evidence) • Organizational Approaches • Personal Strategies

– Mindfulness – Self-Compassion – Resilience

• Skills Practice Throughout • Discussion

"There is a pervasive form of modern violence to which the idealist...most easily succumbs: activism and over-work. The rush and pressure of modern life are a form, perhaps the most common form, of its innate violence.

To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything is to succumb to violence.

The frenzy of the activist neutralizes his (or her) work... It destroys the fruitfulness of his (or her)...work, because it kills the root of inner wisdom which makes work fruitful."

~ Thomas Merton

Burnout

Presenter Presentation Notes Over the past 10 years, there has been a surge of literature on the emerging trend towards an increasing rate of burnout in faculty, particularly in primary care. Burnout has been defined as “a loss of emotional, mental, and physical energy due to continued job-related stress (Fortney). It has also been defined as the absence of so-called “wellness”, having several key components: emotional exhaustion and loss of empathy/compassion, depersonalization and personal accomplishment. A 2013 review in the Family Practice Management journal reported that half to one-third of physicians at that time met burnout criteria. Interestingly, they noted a trend where female physicians were 1.6 times more likely to experience burnout than their male counterparts (Nedrow). Primary care physicians have been noted to be at the highest risk for burnout amongst physicians (Fortney), which has dire consequences on the health care system through poor quality patient care and safety, higher attrition rates and inefficiency. There is growing understanding that medical culture, which starts to be ingrained in physicians during medical training, plays a significant role in physician burnout. Trainees may adapt maladaptive characteristics during training under the impression that it is time-limited, often have difficulty un-learning these habits, and may need support as they move out of training to re-learn self-care and work habits/characteristics that will foster their well-being

Emotional Exhaustion

Depersonalization

Decreased Efficacy & Personal Accomplishment

Presenter Presentation Notes 2011 study: 51% med students, 36% residents, up to 81% interns. 2014 survey: 54% had 1 sx of burnout, and 51% of FM docs BURNOUT IS NOT THE SAME AS STRESS. What starts as burnout

burnout has been linked with increased medical error and cost, and decreased patient satisfaction. For physicians themselves, burnout is associated with an increased risk of substance abuse, unprofessional behavior, and suicide. Suicide accounts for 26% of deaths in physicians aged 25-39 years, compared to only 11% in the general population of the same age group. Being a physician has been called by some “an occupational work hazard”.

Physician dissatisfaction is extensive and growing with 54% of US physicians reporting at least one symptom of burnout in 2014; up from 46% in 2011.

Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13.

Source: Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13.

Burnout is Associated With …  Absenteeism  Decreased Empathy  Decreased Job Satisfaction and Attrition  Suboptimal Patient Care  Increased Medical Errors  Decreased Patient Adherence  Decreased Patient Satisfaction

Linzer et al. Annals of Internal Medicine 2009;151:28-36 Dyrbye, JAMA 2011;305:2009 Murray et al, JGIM 2001:16,452 Landon et al, Med Care 2006;44:234 Bodenheimer, Sinsky, Ann Fam Med 2014;12:573.

Burnout is EXPENSIVE

• Malpractice Risk • Part Time Providers • Physician and Staff Turnover

• Costs about $250,000 - $300,000 to replace a physician

The Doctor: 1891 Undivided Attention

Continuous Partial Attention

The Doctor Now

The “big 4” factors contributing to stress and burnout:

1.Lack of control over work conditions 2.Time pressure 3.Chaotic workplaces / visits 4.Lack of alignment of values (around

mission, purpose and compensation) between providers and their leaders

Primary Driver of Physician Satisfaction is Delivering High Quality Care (RAND Corp) …

When that is threatened or compromised, satisfaction dwindles.

“Burnout is an erosion of the soul.” Not being given adequate time to provide excellent care to patients, but expecting me to provide "exceptional care without exception", increases my burnout. – PGY3 FM Resident

Presenter Presentation Notes “I suspect that the most basic and powerful way to connect to another person is to listen.  Just listen.  Perhaps the most important thing we ever give each other is our attention.  And especially if it's given from the heart.  When people are talking, there's no need to do anything but receive them.  Just take them in.  Listen to what they're saying.  Care about it.” ~ Rachel Naomi Remen

Summary Risk Factors for Burnout Individual – The Vulnerability Side of

Strength Environmental

Perfectionism & Overachievement – Type A, fear of failure/inadequacy

Lack of control & autonomy – decisions, schedule

Compulsiveness (Need for control) Difficult work – nature, volume “Physicians don’t have needs” “Emotions = weakness”

Lack of feedback/validation – “feeling valued”

Introversion Relationship & work-home strain Rigid thinking Sleep deprivation

Reluctance to ask for help Lack of mentorship & support

Being Female (OR 1.29) Culture of medicine Uncertainty – patient management, personal & professional future

Presenter Presentation Notes Today’s generation of family medicine residents have many of these: mostly female, perfectionist personality traits, risk for decreased perception of control of work/life schedule, and others. Of note, working hours has been consistently shown as NOT to be an independent risk factor for burnout – instead, it’s perceived control over the time spent working.

Integrated BH Clinicians Measured by making other’s lives better We don’t get the mental health equivalent of an

ear infection Underserved populations Vicarious trauma Ethical Challenges Solo practitioners We are supposed to know how to do this ... This is

what we teach, right? Services for support focus on MDs

Meaningful Measurement

• Maslach Burnout Scale ($) • Jefferson Empathy Scale ($) • Physician Well Being Index • Physician Wellness Inventory • Mini Z Burnout Assessment (AMA) • Self-Compassion Scale (public domain) • Copenhagen Burnout Inventory (public domain) • Compassion Fatigue Scale (public domain) • Mindfulness Attention Awareness Scale (public domain) • Five Facet Mindfulness Questionnaire (public domain)

Reflection: Your relationship to your work

Risk Factors

Protective Factors

Early warning signs and Prevention

Presenter Presentation Notes How have you changed because of your work? What are some ways that caring about people who have been hurt affects you? Are there ways in which your sense of commitment and responsibility to