'Mindful Communication' Can Help Physicians Deal With Burnout, Says Study

Research has documented that primary care physicians report troubling levels of professional and personal distress, with more than half of practicing physicians in some studies reporting symptoms of burnout. Physician burnout, in turn, has been linked to lower quality of care and more medical errors.

But training in techniques of mindful communication may help physicians improve their sense of well-being and capacity for patient-centered care. That's according to a family physician who is co-author of a recently published study that examined the effects of a CME course about mindful communication on physicians' attitudes.

"We find ourselves encountering situations that are stressful and backing away from them. This (mindful communication) technique teaches us not to withdraw but to manage those thoughts and feelings," said study co-author Ronald Epstein, M.D., of Rochester, N.Y., who is a professor of family medicine, psychiatry and oncology at the University of Rochester School of Medicine & Dentistry and director of the Rochester Center to Improve Communication in Health Care.

Alfred Tallia, M.D., M.P.H., of New Brunswick, N.J., agrees that mindfulness is important in caring for patients, and he points out that it also can be key to maintaining a well-functioning practice. A professor and chair of the department of family medicine at the Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey, New Brunswick, Tallia was co-author of an article on the role of mindfulness in practice work relationships that was published in the January 2006 issue of Family Practice Management.

"Mindfulness was important for work relationships in successfully functioning practices," he told AAFP News Now. "With all the stresses family physicians, their colleagues and staff find themselves under in an often dysfunctional healthcare system, mindfulness is important."

In the University of Rochester study, which was published in the Sept. 23/30 issue of the Journal of the American Medical Association, as many as 60 percent of practicing physicians and nearly half of all third-year medical students report symptoms of burnout, which the study defined as "emotional exhaustion, depersonalization -- treating persons as objects -- and low sense of accomplishment."

Because earlier research has linked burnout to loss of meaning and a sense of lack of control, the researchers sought to address these factors through developing greater mindfulness -- "the quality of being fully present and attentive in the moment during everyday activities."

The course used three techniques: mindfulness meditation, narrative medicine and appreciative inquiry. Epstein said the meditation component is secular and cultivates a physician's attention and awareness skills. The other two components focus on telling and reflecting on personal stories, he said.

"We give the practitioners tools -- the meditation exercises and the narrative exercises. It's not just talking about your patients, but how are you going to be with them when you're actually there," Epstein said.

The 70 primary care physicians -- including 29 family physicians -- involved in the study participated in eight weekly 2.5-hour sessions plus an all-day session that functioned as a kind of retreat to engage in mindfulness practices. Participants then completed a "maintenance" phase of 10 monthly 2.5-hour sessions.

Fifteen months after the intervention, physician participants measured less emotional exhaustion and depersonalization and a greater sense of personal accomplishment on the Maslach Burnout Scale. They experienced greater empathy and gave more compassionate care, the study authors said.

In addition, participants experienced substantially fewer mood disturbances, including less tension, depression, anger, fatigue and confusion, and they reported more vigor.

"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 researchers said. "Furthermore, these patient-centered behaviors have been associated with improved patient trust, appropriate prescribing, reduction in health care disparities and lower health care costs."

Epstein said that techniques to deal with stress, including mindful communication, are particularly important for family physicians, who often are the first health care professionals to connect with patients. At the same time, however, physicians are dealing with time pressures, insurance hassles and other issues.

For example, he said, some physicians might divide their panels into "patients I enjoy seeing" and "patients I dread," and they build up anticipatory feelings even before the visit has started. But they don't have to think about their patients in this way, Epstein added. They can discover something compelling and engaging about each situation that invites curiosity rather than judgment.

"The idea is to find some simple way to get doctors in touch with what they are thinking and feeling," Epstein said. "Mindfulness teaches you to have a choice. We can be curious about what is going on, instead of thinking 'My palms are sweating, my heart rate has gone up, I don't want to be here.' We talk a lot about responding to stresses rather than reacting mindlessly."

Family physicians can easily incorporate mindful communication into their practices, he said. "It's a certain quality of listening and presence to their patients.

"We suggest that when physicians go from one room to the next, when they put their hands on the door knob, they should take a breath and use that second to set aside concerns from the previous patient and clear their minds for the next."