Professional and personal distress levels high in primary care physicians

Sep 23 2009

Primary care physicians who participated in an educational program that included an emphasis on mindful communication reported improvement in personal well-being, emotional exhaustion, empathy and attitudes associated with patient-centered care, according to a study in the September 23/30 issue of JAMA, a theme issue on medical education.

"Primary care physicians report alarming levels of professional and personal distress. Up to 60 percent of practicing physicians report symptoms of burnout, defined as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment. Physician burnout has been linked to poorer quality of care, including patient dissatisfaction, increased medical errors, and lawsuits and decreased ability to express empathy," according to background information in the article.

The authors add that another consequence of physician burnout is a decline in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. "Even though the problem of burnout in physicians has been recognized for years, there have been few programs targeting burnout before it leads to personal or professional impairment and very little data exist about their effectiveness."

Michael S. Krasner, M.D., of the University of Rochester Medical Center, Rochester, N.Y., and colleagues designed a continuing medical education (CME) course to improve physician well-being. "One proposed approach to addressing loss of meaning and lack of control in practice life is developing greater mindfulness—the quality of being fully present and attentive in the moment during everyday activities," the researchers write.

The course is based on 3 techniques: mindfulness meditation, narrative medicine, and appreciative inquiry. "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."

Seventy primary care physicians participated in the course, which included an 8-week intensive phase (2.5 hours/week, 7-hour retreat), followed by a 10-month maintenance phase (2.5 hours/month). The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material and discussion. Physicians were surveyed before, during and after the course regarding levels and measurements of mindfulness, burnout, empathy, psychosocial orientation, personality and mood.

"Our study demonstrated that primary care physicians participating in a CME program that focused on self-awareness experienced improved personal well-being, including burnout (emotional exhaustion, depersonalization, and personal accomplishment) and improved mood (total and depression, vigor, tension, anger, and fatigue). They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care that has been associated with patient-centered behaviors such as attending to the patient's experience of illness and its psychosocial context and promoting patient participation in care," the authors write.

"The skills cultivated in the mindful communication program appeared to lower participants' reactivity to stressful events and help them adopt greater resilience in the face of adversity," they add. "Further study will be necessary to investigate the effects on practice efficiency, patients' experience of care, and clinical outcomes."