Vertical work. The need for programs that teach us how to be, not just how to do.

The Journal of the American Medical Association reports on an intensive educational program in mindfulness, meditation, meaningful communication, and self-awareness exercises given to 70 primary care physicians in Rochester, New York.

The course consisted of an 8 week intensive workshop phase followed by a 10-month maintenance phase.

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. We hypothesized that intensive training in attention, awareness, and communication skills would increase physician well-being, reduce psychological distress and burnout, and promote positive changes in physicians’ capacity to relate to patients as indicated by increased empathy and patient-centered orientation to care.

The workshop phase ( 2.5 hr weekly sessions plus one 7hr session) explored a different theme each week including awareness of thoughts and feelings, perceptual biases and filters, preventing burnout, reflecting on meaningful experiences in practice and being with suffering.
During some sessions doctors were asked to write and then discuss short stories about personal experiences at work and then explore ways in which they successfully worked through difficult or challenging situations.

Here are some examples of the ways they explored these topics:

• Awareness of pleasant or unpleasant sensations, feelings, or thoughts.
  Your story: A pleasant or an unpleasant experience during clinical work and its effect on the patient-physician relationship.
• Perceptual biases and filters.
  Your story: A suprising clinical experience (an experience that differed significantly from what you expected).
• Burnout.
  Your story: An experience of noticing and responding to your own emotional exhaustion, depersonalisation, and low sense of personal accomplishment.
• Meaning in medicine:
  Your Story: A clinical encounter that was meaningful to you; what made it meaningful, what personal capacities did you have that contributed to the meaning.
• Boundaries or conflict management.
  Your story: A time when you effectively said, “No!” or set a clear boundary in clinical practice and still maintained a healing relationship.
• Attraction in the clinical encounter.
  Your story: A time when you were aware of attraction toward a patient and its influence on the dynamics of the physician-patient relationship.
• Self care.
  Your story: A time when you faced choices about caring for yourself as apposed to caring for others.
• Being with suffering.
  Your story: A clinical encounter involving being present to suffering, sadness, pain, uncertainty, end of life and the awareness of your role as physician.

This is some pretty powerful work. And you can easily see how this would transpose to the nursing profession.

Participants completed several surveys before, during and 3 months after the course ended.
Although the authors admitted that their study had several limitations, the results showed an experience of  improved sense of personal wellbeing, improved mood, greater resilience to burnout and a heightened sense of empathy or patient centred orientation to medical care.

From my own experiences, and from interactions with my colleagues, I would say there is great need to develop more programs such as these.
In fact I believe the need to find ways to build resilience, to give our clinicians some reflective space,  to share stories (and by doing this, recognise that our deep clinical experiences and feelings are therapeutically mutual)  and to provide care and support for our carers, is no less urgent than embedding the latest medial technology, or discovering the next generation antibiotics, or solving hospital overcrowding.

With the high rates of disillusionment, cynicism,  bullying and harassment, suicide, depression, drug taking and burnout that mercilessly stalks amongst our professions, there is little time to waste.

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Reference: Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians