Am Fam Physician. 2013 Mar 15;87(6):402.
Difficult clinical encounters add to other persistent sources of stress for physicians today, increasing the risk of burnout. In this issue of American Family Physician, Cannarella Lorenzetti and colleagues address these challenges by encouraging physicians to review contributing factors to difficult clinical encounters, and to use listening and communication skills to better handle challenging patients.1 Given the predictable nature of these difficult encounters, it is critical that physicians develop skills that will help them manage these situations and their own stress levels effectively.
Cannarella Lorenzetti and colleagues emphasize the importance of physician self-awareness and self-care in coping with challenging patients.1 Interventions focusing on mindfulness, or the ability to be purposefully attentive and present in every moment,2 are promising tools to help physicians manage difficult clinical encounters and improve their own overall sense of wellness. An intervention focusing on mindfulness-based training has been shown to result in the perceived longitudinal benefits of decreased burnout and improved empathy in physicians.3 Similarly, a randomized controlled study showed that the use of mindfulness techniques resulted in decreased stress and anxiety in third- and fourth-year medical students.4 A meta-analysis of mindfulness-based group interventions in general nonphysician populations suggests that the interventions can improve overall quality of life, depression, and anxiety.5 Although these studies are limited by variability in interventions and populations studied, they support the value of mindfulness-based approaches to managing challenging situations overall.
To implement these ideas within a busy practice, physicians could use mindfulness techniques in simple ways. Taking a few minutes to practice centered breathing techniques to refocus after a difficult encounter, and saving time at the end of a busy day to reflect about a meaningful encounter are examples of how mindfulness can be applied in daily practice. Physicians who are having trouble regulating stressful thoughts and emotions may consider continuing education opportunities, self-study, or consultation with a mental health professional regarding mindfulness training. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life6 and The Miracle of Mindfulness: An Introduction to the Practice of Meditation7 are resources for learning about mindfulness techniques.
More research is needed to determine which elements of mindfulness-based training are most effective for physicians, and at what point in a physician's career this training would be most beneficial. Viewing difficult encounters as a predictable occurrence may help practicing physicians and medical educators take a proactive approach to developing a lifelong skill set for managing these situations.
REFERENCESshow all references
1. Cannarella Lorenzetti R, Jacques M, Donovan C, Cotrell S, Buck J. Difficult patient encounters: understanding physician, patient, and situational factors. Am Fam Physician. 2012;87(6):419–425....
2. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Delacorte Press; 1990.
3. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284–1293.
4. Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ. 2011;45(4):381–388.
5. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57(1):35–43.
6. Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York, NY: Hyperion; 1994.
7. Thilch NH. The Miracle of Mindfulness: An Introduction to the Practice of Meditation. Boston, Mass.: Beacon Press; 1987.
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