The process can start with one small action – perhaps a moment to reflect before talking to patients. A big factor involves developing a sense of mindfulness.
As an OB-GYN, Evangeline Andarsio, MD, developed a ritual that helped her stay focused and present while treating patients.
She would hold her patient’s chart, review what she wanted to discuss with the patient and then place her hand over her heart.
“I would remind myself, I am about to walk into a sacred container where someone is trusting me and breaking open their stories with me of something very important to them,” Andarsio said.
Andarsio is director of the National Healer’s Art Program at the Remen Institute for the Study of Health and Illness. The institute is housed at the Boonshoft School of Medicine at Wright State University in Ohio.
This small moment of intention only took a few seconds, but Andarsio said that it helped her focus on the reason that she went into medicine: to walk alongside her patients at some of the most difficult times in their lives and be present for them.
“In the busyness of our day, of course, people can get cynical and bogged down with the duties of a job,” she said. “There are things that we do with our work that is career oriented, but then there is a piece of work that is essentially calling and having that sense that you are born to do this work.”
Through the Remen Institute, Andarsio works to teach physicians tools to find the meaning woven throughout their work, and she trains physician leaders to take those tools and teach their own teams. The first step, Andarsio said, is for physician leaders to see the search for meaning as a value.
This is not just some fluffy type of thing. This is important.
Evangeline Andarsio, MD
“I want to challenge leadership,” she said. “I feel the challenge is to acknowledge that is an important aspect of our work. This is not just some fluffy type of thing. This is important.”
The institute teaches physician leaders how to help their teams reconnect with the meaning behind health care work during the workday. It’s a process that requires people to be ready to reflect on their own lives and the way they approach their work.
“It can be very intimidating,” Andarsio said. “What we say is to just start with one thing; one little difference that you can make.”
For Andarsio, that was taking a moment to reflect before talking to patients. For others, it could be working meditation or yoga into their daily lives.
The Remen Institute focuses on helping physicians reconnect with their own personal meaning, but Andarsio recognizes that this is just one piece of the puzzle. Another big factor is cultivating mindfulness.
“Mindfulness really means the ability to find space and, within that space, to be able to make choices that are concordant with one’s values and the things that are important in your life,” said Ronald Epstein, MD, director at the Center for Communication and Disparities Research at the University of Rochester School of Medicine and Dentistry in New York, and author of Attending, a book about mindfulness in medical practice.
“In my view, the whole distress about burnout and stress in health care really has to do with a sense of disconnection,” Epstein said. “Most people going into medicine, the vast majority, have very altruistic motives and want to help people, want to bring the best of who they are to their practice, and for various reasons, don’t feel that they are able to do so.”
Epstein has developed a set of recommendations that can help physicians and other health care workers develop a sense of mindfulness, many of which are directed at physician leaders.
The first is to clarify one’s own intentions. For physician leaders, this can mean asking team members what gives them a sense of meaning or purpose. Epstein emphasized that even just showing that this is a value can make a huge difference.
“This is as true as if you are a psychiatrist as if you are a surgeon,” he said. “People want to feel understood. It makes them feel less frightened.”
Next is to engage in deep listening. Though this sounds simple, Epstein said that many conversations occur without one person really attending to what the other person is saying.
“Patients love it when you are present for them in that way,” Epstein said. “As health care practitioners, we like that sense of having been understood as well.”
Third, is to decide where to place your attention. Is it the computer screen, a list of lab tests or the emotions of the patient? Epstein said there are many moments throughout the day that require a physician to decide the most urgent thing to get his or her attention.
“It’s not that one is right or wrong, but at least asking yourself those questions, finding those little spaces in your workday and asking what is the most important thing that I need to do right now,” he said.
Epstein also stressed that community — a sense of common purpose or meaning — and leadership are important aspects to cultivating mindfulness. For leaders, Epstein said, one part of the equation is to model the act of valuing meaning in medicine.Another part is to pay attention to team members and be aware when they are starting to show signs of burnout.
“At a certain point of cognitive and emotional load, our functioning improves and beyond that point our functioning starts to deteriorate,” he said. “You really want to find the sweet spot with your team where the challenges are robust enough so that they can perform at their best but not so excessive that they start becoming less effective.”
Helping those physicians reconnect with a sense of meaning can serve as a way to rejuvenate their performance and morale.
“When people are feeling a sense of purpose and meaning, they can work really, really hard. They can be tired, but they are not burned out,” he said.
As a leader in medicine herself, Andarsio hopes to see more hospitals valuing tools and training that help physicians find meaning in medicine. Though the idea is catching on in some organizations, Andarsio’s hope is that every hospital system will develop a well-being committee with a physician serving as director.
“It’s not commonplace that there are these committees, and it should become commonplace,” she said. “It really is important. And when I say well being, it’s not about money, it’s about joy. The sense of joy that you have and pride coming into your work place.”
Hannah O. Brown is a freelance reporter based in Florida.