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being a doctor
1
Settling in…
- Release
- Balance
- Calm
• What happens in Vegas… ends up on Facebook.
• So, let’s keep it between the team.
Jen Carlson
3 Things and Choice
• #1
• Discuss the concept of stress in
the workplace and how it has
evolved into the wellness
conversation
• Recognizing the signs of professional
exhaustion
• #2
• Discuss some core concepts of
being well: resilience, happiness,
mindfulness
• Practice…
• #3
• Discuss how to pass it on (but
mainly let’s start with taking care of
ourselves)
Stress… in the 20th century
Stress: Fight or Flight – 1915
• Bodily Changes in
Pain, Hunger, Fear
and Rage: An Account
of Recent Researches
into the Function of
Emotional Excitement
Hans Selye
Stress: seen and unseen
The Stress System Brain
(Wallace, 2009)
Burnout
• Why is it happening • “I swear by Apollo
to doctors? To the Physician and
people who choose to Asclepius and Hygieia
become doctors? and Panaceia and all
the gods and
goddesses, making
them my witnesses,
that I will fulfil
according to my ability
and judgment this oath
and this covenant:”
Hippocratic Oath
Declaration of Geneva of the World Medical
Association: (adopted 1948, amended 1966 and 1983)
• I solemnly pledge myself to consecrate my life to the service of
humanity;
• I will give my teachers the respect and gratitude which is their due;
• I will practice my profession with conscience and dignity;
• The health of my patient will be my first consideration;
• I will respect the secrets which are confided in me, even after the
patient has died;
• I will maintain by all the means in my power, the honor and the noble
traditions of the medical profession;
• My colleagues will be my brothers;
• I will not permit considerations of religion, nationality, race, party
politics or social standing to intervene between my duty and my
patient;
• I will maintain the utmost respect for human life from its beginning
even under threat and I will not use my medical knowledge contrary to
the laws of humanity;
• I make these promises solemnly, freely and upon my honor.
(Nedrow 2012)
Compassion Fatigue (CF)
Definition Contributing Factors
(Wallace, 2009)
Heading off the rails…
well. • In marriage
• In balanced nutrition
• In life…
Being well
10 commandments of physician wellness
I. Thou shall not expect someone else to reduce your
stress.
II. Though shall not resist change.
III. Thou shall not take thyself in vain.
IV. Remember what is holy to thee.
V. Honor thy limits.
VI. Thou shall not work alone.
VII. Thou shall not kill or take it out on others.
VIII.Thou shall not work harder. Thou shall work
smarter.
IX. Seek to find joy and mastery in thy work.
X. Thou shall continue to learn.
(Krall 2014)
Choice…
• #1: Thou shall not • “Between stimulus and
expect someone else to response, there is a
reduce your stress. space. In that space is
our power to choose
our response. In our
response lies our
growth and our
freedom.”
• Viktor Frankl.
• Man’s Search for
Meaning
Habit
• Common sense and
common action
• Just because we know
what to do doesn’t mean
we do it.
• Tetris
• We are what we
repeatedly do.
Aristotle
Wellness Strategy
Resilience: Self- compassion
• Fear of failure • I am trying… and that
• Fear of inadequacy is good
• Disappointing… • I am a good… parent,
colleagues, friends, friend, sibling,
family colleague, etc.
• I love my family and I
don’t have to show it in
just one way.
-May you be
happy.
-May you be
healthy.
-May you be free
from internal and
external harm.
-May you
experience love, joy,
and wonder just as
it is.
-May you have
ease of the day.
Resilience: Reframing
• The “black cloud” • Language frames our
• Why are all the difficult thoughts and thoughts
patient’s drawn to me? frame our language
Resilience: Appreciation and Gratitude
• Gratitude journal • Deliberately make
• Performing kind acts connections during the
and writing it down day with colleagues
and with patients
• Use humor; look for
something particular or
unusual in the patient’s
room; or notice the
patient’s birth date or
age.
When are we happy?
• When we are in the present.
• When we get what we want AND when we want what we
have.
• When we have slept.
• When we have eaten well and consistently.
• When we have manageable work loads.
• When we have healthy connections to others.
• When we are kind.
• And many more reasons…
(Achor, 2010)
(Hanson, 2009)
Partner up
• 10 seconds
• Discipline
• Resolve
• Strength
Jon Kabat-Zinn
Dan Siegal
Benefits of Meditation
• The primary health benefit • Depression
from meditation practices • Anxiety
appears to be a general shift • Sleep
in the autonomic nervous
system that decreases • Immune Function
sympathetic tone and • Cortisol Levels
increases parasympathetic • Decision Making
tone. • Coping
• As the parasympathetic
system is stimulated, heart
rate and breathing slow,
stress hormones decrease,
blood vessels dilate, and
digestion is facilitated.
PIMR (2016)
The Brain of Meditators
• Hippocampus –
increased gray matter
• Governs learning and
memory
• Decreased in depression
and PTSD
• Amygdala
• Decreased gray matter
• Smaller amygdala
• Participants had less
reported stress
Brain Training
Anchor
attention with
breath
Return attention
Attention
to the sensation
wanders
of breathing
Choosing the
reaction Notice that
Notice our
- Frustration reaction
attention has
vs. wandered
compassion
Juliet Adams – UK
The Mindful Brain – Physiology
• Gray Matter
• Limbic System
• Autonomic Nervous
System
Lazar (2005).
Hutchinson (2008).
Hanson (2009).
Holzel (2011).
Murakami (2012.
Adams (2013).
Seigal (2013). Zeidan (2013).
Sanger (2015).
48
The Practitioner and Health Care
• Interestingly, studies in psychotherapists in training who
received mindfulness training showed an improvement in
the efficacy of their counseling skills in this area as
compared to controls—mirroring the outcomes of
studies showing physicians who have adopted a
healthy lifestyle as more efficacious counselors to
their patients
Grepmair (2007)
Frank (2000)
What does self care look like for you…
• Self-compassion
• Reframing
• Gratitude and appreciation
• Humor
• ? Financial goals
• Time for yourself
• Sleep
• Food
• Aligning with your values
Stanford WellMd: http://wellmd.stanford.edu/.
Faculty and Staff Help Center – 10 Free Counseling Sessions
Attention increases
BUT Pre-frontal cortex
activity (emotional
responses,
planning, decisions, etc.
decreases )
Activate d
- Assign emotional
significance to our
experiences – modify
Changes in limbic system leads to modified activity of nervous
activity of the autonomic nervous system system
Compassion
• Virtue? Moral Tenet? Fundamental to provider-patient
relationship? Role Requirement for a Health Care
Professional?
• Compassion Satisfaction:
• Positive sentiment the provider experiences when able to
empathetically connect and feel a sense of achievement in the
care-providing process
• Positive reinforcement with patient’s improve and belief that
provider has made a positive impact
• Emotionally fulfilled by one’s work in the “human service fields”
Research in cognitive neuroscience
• J. Decety: Physicians
and down regulation of
the pain-empathy
response
• Additional Research
• R. Davidson:
• resilience and stress,
prefrontal cortex vs. limbic
system
Fig. 2. Expertise effects on the cortical responses elicited by the perception of body
parts pricked by a needle and body parts touched by a Q-tip. (a) N110 at FZ. (b) P3 at Cz.
(c) P3 at Pz. The ERP responses are significantly different when the Controls watched
the painful relative to the non-painful stimuli. No significant differences were detected
in the Physicians. Values are expressed as mean±SE (⁎Pb0.01).