We all know the stats about physician burnout. We all experience the causes: lack of control, moral injury, lack of resources.
Patients see us as walking prescription pads simply to fill out medications they deemed they need after doing their “research” with Dr. Google. Employers and insurance companies see us as scapegoats and lie detectors to deny our patients
sickness claims. Our actual clinical work—the practice of medicine, is reduced to a minority of our day’s work as patients see their phones as more medically astute than our years of training and experience
Even our associations and colleges have implicitly and explicitly told us that our deduction skills are no longer required, and instead follow the clinical checklists and algorithms set out.
Patients are no longer patients. They are consumers. Doctors are no longer doctors. We are providers. As consumers, patients get to dictate what they want, even if it is not in their own best interest, be it needless tests because they want to “rule out everything”, or needless medications because it is easier to take a pill than resolve it with simple lifestyle modifications. But alas, they have no time for lifestyle modifications as they sit binge watching Netflix because they are too depressed and stressed out from life. Doctors themselves either don’t know how, or don’t have the time to give them the tools and agency to emerge from their downward spiral.
The reason many of us chose to work in healthcare, to help others and connect deeply, is being snuffed out by the current system. We grief the loss of our autonomy, respect, and self worth while taking in a diet of moral injury.
Doctors are perfectionists forced to practise mediocracy due to lack of resources.
One of the risk factors for burnout is perfectionism. Guess who that describes. Us! Isn’t this how we managed to get into and through medical school? Isn’t this a revered trait we were told to cultivate during our training?
We lose compassion not just for our patients, but also for ourselves. We develop coping mechanism through denial, avoidance, withdrawal. Tragically, the ultimate price for too many of us is suicide. Physician suicide in one of highest in any profession: three times that of the general population, which may be an underestimate because we know how to hide suicide.
Three Pillars of Optimal Health
Here are what I consider to be the three pillars of optimal health for our wellbeing:
- Mindfulness Training
- Social Connection
In this article, let me focus on Mindfulness.
Mindfulness as an antidote to burnout
As one of the most powerful tools for resilience and wellbeing, it is quite shocking how little knowledge most physicians have about mindfulness. After all, we are in the business of health and wellbeing, aren’t we?
First, let’s talk about what it is not. It is not just about meditation, although I see meditation as a conduit to help us achieve mindfulness. Dr. Jon Kabat-Zinn, often credited as the scientist who introduced mindfulness to the western world, defines mindfulness as the practice of being in the present moment, without judgement. For many of you, this definition likely feels meaningless until you start practising it and start experiencing it for yourself.
The reason we are now in a mindfulness revolution is because of the explosion of compelling scientific data and studies on its benefits. Here is a brief list of its rewards, which is by no means inclusive as there simply is not enough room in this article to list everything.
Mindfulness training shows improvements in:
- Immune system
- Emotional intelligence, including self-control and self-awareness
- Pain control, including conditions from fibromyalgia, arthritis, neuropathy
We see these benefits on bloodwork, neuroimaging studies including MRI’s and
EEGs, and psychological tests.
For example, studies from Dr Elizabeth Blackburn, who won the Nobel Prize for her work on telomeres, showed that mindfulness training can reduce the shortening of telomeres, meaning it can slow down biological cell aging.
Dr Jud Brewer, a psychiatrist and neuroscientist, showed that mindfulness training is more effective than medication for treatment of anxiety. Specifically, in a randomized control trial, he and his team of researchers demonstrated that while NNT was 5 for medications, but it was only 1.6 for mindfulness training.
Let’s think about this for a moment. No medication side effects or costs, and we develop the agency for personal growth and have this tool for life!
Mindfulness training is the gateway drug to other habits of wellbeing
You may be asking yourself, why is there only 3 pillars? What about things like diet and sleep?
Here’s the beautiful thing about habits. When we develop a habit, like mindfulness meditation, we reap the benefits which lead to the other important habits.
For example, when we practice mindfulness, we become calmer, less reactive. As a result, we make better food choices instead of eating mindlessly. Much of poor
eating habits are due to mindless eating (nibbling on food when we are not even hungry), or emotional eating (turning to food for comfort).
“I don’t have time to do mindfulness training”
Mindfulness training doesn’t take time. It gives you time back.
You read earlier that mindfulness training improves sleep. We all know the detrimental effects of hypnotics for our brain health, such as increasing our risks of dementia and dying in accidents. Studies show patients can reduce their use of sleeping pills or stop them completely after undergoing mindfulness training.
And for those not on sleeping pills? Because mindfulness improves our sleep quality, we wake up more refreshed, with more energy. More energy to add other healthy habits like exercise. Can you see how this becomes an upward spiral?
You also read in the list above that there is improved productivity with mindfulness training. How often have you read the same pages of reports, only to re-read them because you don’t recall what you read? This is time wasted. Now, instead of taking twelve hours to complete your work, you complete it in ten hours. Imagine what you can do with an extra two hours a day! Perhaps spend quality time with people you love?
“Be the change you want to see”
We may not be able to change all the systemic issues which resulted in the present state of medicine. We are in the healing profession, yet we fail at healing ourselves. When we start to heal ourselves, we are in the position to heal our patients.
Knowing is different from feeling. We can read all the books and scientific papers about mindfulness, but we need to practise it to feel it. Perhaps we can start by taking a course such as Mindfulness-Based Stress Reduction (MBSR). It is a structured, scientifically validated program.
Despite all the doom and gloom, many patients still turn to us for guidance, for
that deep connection. We can’t provide that if we do not care for ourselves first.
If each of us can change, one physician at a time, eventually we can change the culture of medicine.