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How to ACE Daily Stressors in Medical Practice

CATHERINE FLORIO PIPAS, MD, MPH, FAAFP
HANI CHAABO, MD, FAAFP, ABOIM
JOEDRECKA S. BROWN SPEIGHTS, MD, FAAFP, ABFM, ABLM, ABOM

FPM. 2024;31(1):12-16.

Author disclosures: no relevant financial relationships.

Maladaptive responses to stressors are ingrained in our profession, but we can unlearn them and embrace a culture of well-being.

Physician well-being has received growing national attention over the last 15 years, but despite these efforts, we continue to experience high rates of stress and burnout. Changing the system requires advocacy, leadership, and time — and changing the culture requires additional tools and permission. While institutional leaders and health professionals work to alleviate unnecessary system-based stressors, we must simultaneously unlearn culturally ingrained, maladaptive responses that contribute to burnout. Our focus on empowering individuals does not detract from the need for system change.

The purpose of this article is to explore the following:

  • How the culture of medicine shapes our stress responses,
  • How to apply the “ACE” (accept, choose, and embrace) framework to our stressors and integrate it with three evidence-based well-being strategies.

KEY POINTS

  • Maladaptive responses to stressors are modeled in training and ingrained in the practice of medicine, contributing to physician burnout.
  • The ACE framework — Accept authenticity, Choose meaning, and Embrace positivity — can help physicians unlearn destructive coping mechanisms and respond more effectively to stressors.
  • This framework can support evidence-based techniques such as emotional intelligence, cognitive reframing, and appreciative inquiry.

THE CULTURE OF MEDICINE

Culture is a set of rules, often unspoken, to which anyone who wishes to fit in with a certain group of people will adhere. What is the culture of medicine? Some call it the “hidden curriculum” in our training that compels us to withhold all signs of weakness, give all we have and then give more, place others’ needs ahead of our own, and model these traits religiously until we’ve proven our worth to patients, colleagues, family members, and ourselves. Medical culture is notorious for deferring basic human needs including nutrition, hydration, and sleep; and for shaming and blaming individuals for system-level inadequacies.1 This culture begins in training and persists in the practice environment, and it greatly contributes to the deterioration of our physical and mental health. The higher we rise in the “superhero” culture, the deeper we sink in caring for ourselves.

The antidote to this damaging culture is self-valuation — prioritizing personal well-being, rather than deferring it, and adopting a growth mindset in response to errors and imperfections, rather than self-condemnation.2 Yet in one study, physicians were 50% more likely than other workers to respond to their mistakes with self-condemnation and 3.5 times more likely to defer self-care.3

Dr. Pipas is professor of Community and Family Medicine at Dartmouth’s Geisel School of Medicine in Hanover, N.H., co-chair of the AAFP Leading Physician Well-Being program, chair of the AAFP Physician Health First initiative, and chief wellness officer for CaseNetwork.

Dr. Chaabo is medical director of well-being at Ridgecrest Regional Hospital in Ridgecrest, Calif., where he practices integrative medicine, chairs the well-being committee, and directs the integrative stress-reduction clinic.

Dr. Brown Speights is professor and chair of the Department of Family Medicine at the Florida State University College of Medicine in Tallahassee, founding co-chair and current member of its wellness committee, and Atlantic Fellow for Health Equity.

Send comments to fpmedit@aafp.org, or add your comments to the article online.

Author disclosures: no relevant financial relationships.

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