9.5 million entries on Google for “physician wellness” speak to what a big topic it’s become. Hospitals, medical groups, and medical associations are including an increasing number of programs on physician wellness.
So why do 300-400 physicians continue to take their own lives each year?
Because, for many of us, our own wellness is at the bottom of our list.
We need to recognize that our well being is the foundation of good medical care. When physicians are stressed or suffer from depression or anxiety, the quality of our care is negatively impacted. Our productivity diminishes. We leave our profession, or we leave our lives. Wellness is like the people on the bottom of a human pyramid. Although we tend to focus on the person at the pinnacle of the pyramid – look at their grace, balance and poise! – without a firm foundation, they would topple. The same is true of our own personal wellness.
In her excellent article, Danielle Ofri cites the ongoing culture of perfectionism. Clearly, one needs to be fairly perfectionistic to obtain the grades and scores to get into medical school, to acquire exponentially increasing amounts of scientific knowledge and understanding, and to conform to high standards of practice. Knowing the stakes are high compels us to drive ourselves and keeps our anxiety levels high. As perfectionists, we focus on our small mistakes, our less-than-perfect outcomes, when a more balanced appraisal of our performance would be more accurate – and healthier. We can improve our well being on a personal level by keeping a journal of our successes and asking ourselves, “What did I do WELL today?” as each day comes to a close. This will provide a broader view of how we’re doing and allow us to balance our inevitable shortcomings with the many excellent actions and outcomes we provide.
As a group, we can address systemic problems – the inefficiencies of the EHR, a focus on productivity over quality of care, insensitivity to individual physicians’ needs. Arranging exam rooms so physicians can see both the computer screen and the patient should be imperative. Physicians’ requests to adjust their schedules so more complicated patients are given longer appointments or to allow for family or personal needs should be easily accommodated. Support staff such as scribes should be immediately incorporated into the routine and culture of healthcare, just as the EHR has been incorporated. This will help to alleviate some of the stress and will allow physicians to feel as if they are being supported by their organizations.
There are excellent, evidence-based interventions that build resilience and restore physician wellness. Shanafelt et al showed statistically significant improvement in all measures of burnout when groups of physicians met biweekly for an hour for mindfulness, reflection, shared experience and small group learning. The groups continued for 9 months and improvements were sustained at 12 months. The benefits of mindfulness practices and exercise are well known. We all know that nurturing outside relationships and passions improves our state of mind and lowers our stress. What’s missing is our own prioritization of these things in our lives.
When we give ourselves even a small amount of time to focus on us – personal reflection, activities that nurture our soul or reconnect with ourselves such as meditation or walks in nature, time with those we love, eating healthy foods – we tell ourselves that we are important. Good decisions like this lead to other good decisions during the day.
What will it take to make your own well being a priority? What small step can you take today to support yourself? Give yourself 30 minutes a day for your own wellness, and watch your life immediately improve.
(Hint: For some ideas, click here)