By Dr. John Schorling
Burnout affects more than half of all practicing physicians in the United States, with 54% meeting standard criteria in an American Medical Association national survey. Rates of burnout are also high for other healthcare providers, including nurses, social workers and clinical psychologists. Why is this so?
Several explanations for this have been postulated. For example, two principal work-related factors that contribute to burnout are high workload and low control over work. Both of these describe the current work environment for many physicians and other health care providers.
System issues are important, but individual factors can also contribute to burnout, and mindfulness training has been shown to decrease burnout among healthcare providers in a number of studies. Mindfulness is defined as intentional present-moment awareness without judgment. Healthcare providers often spend time caught up in thinking, planning, worrying, and judging themselves and their experiences. Stressors, such as the burden of the electronic medical record, time constraints, and our own expectations, can detract from the ability to attend to experiences in the present moment.
In contrast, when we intentionally focus on our present moment experience, we can begin to assess how we are feeling, both physically and emotionally. When we pause to observe how we are feeling, we can then choose our responses rather than be hijacked by our feelings. For example, if we know we have to work with someone who is challenging and whom we may have found difficult to deal with in the past, we may easily slip into telling ourselves a negative story about them. This might include thoughts about how they are demanding and don’t listen, and we may feel that we just don’t have time to deal with them. By the time we do interact, we may already be activated and defensive, and may find it hard to be empathic. In addition, we may judge ourselves for having these negative feelings.
On the other hand, if we take time to pause first to pay attention to our feelings and realize we’re tensing up, we can then choose to take a few breaths, and acknowledge the conflict between our negative emotions and the need to engage with the other person. We can recognize that being activated before beginning the encounter is unlikely to achieve our goals of being efficient and empathic. It is helpful to understand that feelings, which arise from the limbic system, are not under conscious control. Therefore, any guilt we feel as a result of having these negative emotions does not make physiologic sense. Emotions arise without our being able to control them.
What we do have control over is our response to the emotions and the situation once we recognize the feelings. We can pause to decide how to respond most effectively. This enables us to also reduce any guilt we experience as a result of these feelings and, rather than judging ourselves, accept that the situation we are in is difficult.
We may also find ourselves getting caught in ruminative thoughts, thinking over and over again how we wish things were different than they are, perhaps wanting to have responded differently when angry. This type of thinking can be very stressful, and recognizing these patterns and developing the capacity to redirect our attention elsewhere can help reduce stress. Getting caught up in thoughts takes our attention away from our actual experience, and with practice we can learn to shift out of the trance of thinking into present moment awareness.
The concept of paying attention to our present-moment experience without judging it may be simple, but in practice is not easy. We can cultivate this ability through meditation, or formal mindfulness practice. This is called practice because it requires repetition to change neural pathways and gain the capacity to apply this skill real-time, in the moment, during our everyday lives. Taking a mindfulness course, such as the Mindfulness for Healthcare Providers course, is an ideal evidence-based way to learn these techniques. The Mindfulness Center, in conjunction with the Be Wise program, is offering a free eight-week course for all UVA Health System employees starting February 19 and running through April 10. See below for more information.
As a past participants noted “The course exceeded my expectations, I believe all healthcare providers could use a course like this. I’ve already had more positive interactions with patients than before and have more insight into my interactions with others.”
Filed Under: Monthly Musings, News and Notes