For healthier patients, create happier doctors

Mar 6 2007

Rochester doctors are putting to the test the idea that less stressed, more fulfilled physicians offer improved care to their patients.

Thanks to a three-year, $462,000 grant from the Boston-based Physicians Foundation for Health System Excellence, 75 doctors in the Rochester area will take part in a program designed to reduce their stress levels and make them less prone to burnout.

While on the surface the program is designed to improve the well being of those doctors, the project is ultimately aimed at improving the lives of thousands of patients in the Rochester area. The idea is to improve patient care by training doctors to be more attentive to what’s going on around them as they deliver care to patients. A team of physicians sponsored by the New York Chapter of the American College of Physicians, working together with the Monroe County Medical Society and the Rochester Individual Practice Assn., will measure not only the physicians’ fulfillment, but also the effect of the program on the quality and efficiency of the care they provide.

The project is led by primary care physician Michael Krasner, assistant professor of Medicine at the University of Rochester Medical Center and a partner in the Olsan Medical Group. The Rochester team received one of 15 grants recently awarded by the Physicians’ Foundation for Health System Excellence, which supports programs to educate physicians and help them improve the care they deliver to their patients.

The project is built around a practice known as “mindful communication,” which draws on techniques commonly found in meditation to help people maintain an open and nonjudgmental outlook as they tackle everyday tasks. In the health care setting the approach is designed to help doctors and others to be aware of how they are feeling and how events in their own lives might be influencing how they react to patients. Doctors say that a mindful approach helps keep them flexible to adjust to constant changes in their workday, helping them pay attention to patients and treat them with respect.

“What’s going on in the back of our minds, just underneath our awareness, has a tremendous impact on our behavior,” said Krasner. “If we’re not aware of our own emotions, we aren’t attending as well as we could to our patients, and we react without knowing where that reaction is coming from.

“But if we become aware of our thoughts – for instance, if a doctor is on edge because he’s worrying about the condition of the patient he just saw – we’re better prepared to be truly present and engaged with the next patient. If we communicate clearly with the patient and truly listen, we’re more likely to get at the root of the problem that is the reason for the patient’s visit. This is likely to result in a more effective and efficient visit.”

For the last 25 years the move toward mindfulness has swept through the medical field. More than 5,000 doctors and other health-care professionals have gone through the training at the institution widely recognized as founding the field, the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts School of Medicine at Worcester. The techniques are now taught in more than 200 medical centers and hospitals, including the University’s School of Medicine and Dentistry.

During the past seven years, Krasner has trained approximately 500 people in Rochester, many of them doctors and other health care workers, in mindfulness practice, including 39 health professionals currently taking his class at the Rochester Academy of Medicine.

Krasner had practiced meditation for several years when he became more interested in the concept of mindful communication in the medical field about a decade ago. At the time, Krasner’s father was diagnosed with pancreatic cancer, and one of the means his father used to deal with his illness was what he discovered in a book written by Jon Kabat-Zinn, who has led the move to bring mindfulness into medicine. The book was Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness.

“The book had a huge impact on my father’s experience of his illness,” Krasner said, “and suddenly the work became much more personal for me.”

The current project marks the first time Krasner knows of that anyone has tried to measure the impact of mindfulness among doctors on patient care. The effect on physicians will be measured by monitoring their stress levels and their risk of burnout. But the impact on patients will also be measured by the study team through patient satisfaction surveys, how well the patients adhere to guidelines to prevent disease, and how efficiently they provide health care to their patients.

The new program will train 75 doctors in mindful communication through a one-year program, with one group starting in the spring and another in the fall. The physicians will meet together for about two hours each week for eight weeks, then will have an all-day retreat, all the while learning meditation and mindfulness techniques and sharing both the highlights and the not-so-high moments from their practices. They’ll share stories from their clinical experiences and use “appreciative inquiry,” an approach to the exploration of change that focuses on successes and strengths already present in their work. Then the groups will continue to meet once each month to share experiences and continue their training.

In addition to Krasner, other local physicians involved include Ronald Epstein, M.D., professor of Family Medicine and associate dean for educational evaluation and research at the University’s School of Medicine and Dentistry; Timothy Quill, M.D., director of the Center for Palliative Care and Clinical Ethics at the Medical Center; Howard Beckman, M.D., medical director of RIPA; and Anthony Suchman, M.D., a national leader of a partnership-based clinical approach called relationship-centered care.

Another mindfulness effort at the University recently received additional support as well. An educational project led by Epstein to teach all third-year medical students and residents in selected residency programs about mindful practice is underway. The project is supported by the Arthur J. Mannix Jr. Award for Excellence in Medical Education and a grant from the Arthur Vining Davis Foundation. These awards will assist Epstein and colleagues to share their program, geared to medical students and residents, with other medical schools around the nation.