As someone in the helping profession, I can attest to the weight at times of care giving and without mindfulness or a space to process this, I would be a high candidate for burnout. This is what many people in our helping professions face today. That is why I am pleased to bring to you a dialogue Mick Krasner, MD, Associate Professor of Clinical Medicine at the University of Rochester School of Medicine and Dentistry and has been teaching mindfulness to over 1400 physicians over 12 years. He was the project director of a study published in the Journal of the American Medical Association on the efficacy of “Mindful Communication” with physician burnout. He speaks nationally and internationally on this topic. You can find Dr. Krasner live on May 11th for a daylong of Mindfulness in Clinical Practice: Our Patients, Ourselves.
Today Dr. Mick Krasner talks to us about the state of affairs of physician burnout, how the approach of “Mindful Communication” is effective in healing, and thoughts he might lend to us some of our wounded healers.
Elisha: Can you share with us the current state of affairs with physicians in regards to burnout, emotional stability, and stress?
Mick: The current state of affairs regarding physician stress, burnout and emotional stability is not good. A recent study reported in the Archives of Internal Medicine of over 7000 physicians report that nearly 1/2 had symptoms consistent with burnout. Job stress leading to burnout may account for the excess suicide rate for physicians compared with the general population. As disturbing as that is, burnout also seems to be associated with medical errors. Burnout is not isolated to practicing physicians, but has been measured in trainees in residency and in medical students. It is my opinion that burnout, in a lot of ways, is culturally determined- North American culture which places high value on achievement, material success, competition, and personal independence may be among the determining factors. So, if we were to look at primary and secondary school children, and had instruments designed specifically for that population, I would predict that we would discover burnout, stress, and emotional instability there as well.
Elisha: What role do you see mindfulness playing in this and what is “Mindful Communication?”
Mick: Mindfulness in my opinion is a core competency for medical professionals, and in particular physicians. The entire diagnostic process rests upon the ability to bring clear communication and observation skills into the patient encounter. The potential for cognitive errors is larger when attention and awareness are smaller. Not only is attention to detail important, but so is the larger picture. My pathology professor in the first year of my medical education use to say “low powered microscope, high-powered brain.”
Recognizing the role that mindfulness plays as a core competency for medical professionals, and knowing that physicians are especially at risk for burnout, my colleagues and I developed a mindfulness-based intervention we call “Mindful Communication.” In this approach, one could consider the container of the intervention or the field in which the intervention occurs as mindfulness, cultivated by training in mindfulness meditation. Within this container, we focused on narratives from clinicians’ own practice experiences, centered on challenging themes such as conflict management, self-care, being with suffering, and meaning in medicine. These narratives, reflected upon by individual practitioners, and held in awareness with the qualities of mindfulness, were then shared in dialogues with colleagues. This sharing took on a particularly nuanced form, one that is influenced by Appreciative Inquiry, in which challenges, successes and capacities are focused on, even when considering difficult challenges.
The response to these appreciative dialogues, reflections on clinical experiences, and mindfulness training, has been remarkable, with improvements demonstrated in burnout, empathy, well-being measures, and patient centered qualities. Not only that, practitioners have found the approach highlights the importance of a collegial community, of the contemplative reflections in medical practice, and of self-care as a way of building professional and personal resilience in combating burnout.
Elisha: What role does it play in the medical profession?
Mick: Mindful communication is just one of what I hope will be many options for practicing physicians to turn to for assistance in building adaptive reserve for the challenges placed now and in the future.
Elisha: If you were sitting across the table from of a physician on the brink of burnout, what approach would you take and what would be your parting words?
Mick: The first thing I would do would be to listen deeply to the concerns of this physician, and hear about the felt experience that he or she is currently struggling with. I would then asked her or him to reflect for a moment on a challenging clinical experience that in some ways epitomizes their difficulty, and speak with me about what qualities they notice about themselves that have helped her or him to get as far through this challenge as they have. At this point, I do not think I would have so-called parting words, but rather I would rely on my faith in their own potential for discovering themselves their own skill, their own genius, and there own capacity, already present, for meeting this and future challenges.
Elisha: Thank you so much Mick for your incredible work in this field that has ripple effects on us all.
As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.