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As a psychiatrist, department chair, spouse and parent, Dr. Lizica Troneci has become increasingly mindful of the effects of stress and physician burnout.
She started to raise the issue and discuss interventions at her departmental meetings, at times by suggesting that participants take a few minutes of quiet time to meditate or take in their surroundings.
“Some enjoy it, and yet some are clearly uncomfortable, sitting on the edge of their seat waiting for those minutes to end,” says Dr. Troneci, chair of SBH’s Department of Psychiatry. “It’s as if they’re saying, ‘I don’t have time for this.’”
At a time when fatigue, burnout and lack of self-satisfaction are growing concerns within the physician community, research into meditation and mindfulness has shown important physical and mental benefits. What is mindfulness? UCLA Mindful Awareness Research Center defines mindful awareness as “paying attention to present moment experiences with openness, curiosity, and a willingness to be with what is . . . It invites us to stop, breathe, observe, and connect with one’s inner experience.”
Leading advocates of the mindfulness technique argue that by learning to pay attention to each moment, physicians can ease burnout, reduce stress, enhance attention and concentration, grow self-awareness and emotional regulation skills, and improve both the quality and quantity of the attention clinicians give to their patients. According to a narrative review in the Journal of Clinical Medicine, “Mindful efforts to improve the healthcare culture and develop personal support systems can help physicians become more resilient and provide higher quality patient care.”
Recognizing the increased personal and professional demands and expectations of its employees, SBH started offering hospital clinicians and staff free, weekly 30-minute meditation sessions. The goal is two-fold: to offer staff additional skills to cope with stress and pressure and, by experiencing the benefits, have them help promote meditation and mindfulness to patients once the hospital’s Bronx Center for Healthy Communities opens in 2019.
“The rate of physician burnout continues to increase as the demands continue to increase,” says Dr. Troneci. “While the electronic medical record, for example, has made sharing information readily and efficiently available, it also has contributed to burnout by further isolating us and restricting human interaction. Everything is so rushed today, and pressure from insurance companies, regulatory and licensing agencies, all adds to a busier, more stressful day.
“Mindfulness meditation helps us become more centered, caring and empathic by teaching us to become more conscious of the present moment. We can only give as much as we have. In addition, how can we promote these techniques to our patients if we have not experienced their benefits?”
A new book, Attending: Medicine, Mindfulness and Humanity examines the problem of physician burnout and champions the benefits of meditation and mindfulness. “Even the most compassionate doctors are being pressured to see more patients, do more paperwork, and juggle more responsibilities every single day,” writes the author, Dr. Ronald Epstein, professor of Family Medicine, Psychiatry, Oncology and Medicine at the University of Rochester School of Medicine and Dentistry. “Not only are those requirements exhausting, but they are also socially isolating.”
He goes on to write, “Burned-out physicians are more likely to take shortcuts, make diagnostic errors, and prescribe recklessly. They order too many tests and refer more, just because it takes too much effort to think through problems themselves.”
While in agreement with Dr. Epstein’s findings, Dr. Troneci appreciates the challenges of teaching and practicing meditation and mindfulness to physicians while not making it yet another task. This is why she strongly believes that rather than feel pressure to incorporate meditation mindfulness per se, physicians could adopt the techniques that work for them. For example: pay attention to your breath, the sky, the trees, and the smell of freshly trimmed grass as you walk through the campus; decide not to play the radio while driving and simply be with yourself; at the end of the workday, try to remember the day’s activities and congratulate yourself for the accomplishments.
Physical Brain Changes
A recent study by Massachusetts General Hospital and Harvard Medical School found that meditation can physically change the brain. Researchers found that long-time meditators have an increased mount of gray matter in the auditory and sensory cortex and the frontal cortex, which is associated with working memory and executive decision making. While it has been well-documented that the cortex shrinks in size as one ages, they discovered that 50-year-old meditators had the same amount of gray matter as healthy 25-year-olds.
Additionally, researchers found thickening in five regions of the brain among those in the group who had completed eight weeks of meditation.
This included the posterior cingulate, which is involved in mind wandering and self-reliance; the left hippocampus, which assists in learning, cognition, memory, and emotional regulation; the temporo-parietal junction, which is associated with perspective taking, empathy and compassion; the brain stem called the Pons, where many regulatory neurotransmitters are produced; and the amygdala, which is important for anxiety, fear and stress.
Dr. Troneci says she’s personally noticed changes in physicians who are long-time meditators. One colleague, for example, who often exhibited impulsive, angry and irritable behavior, had become almost unrecognizable as one who was now “chill and collected.”
There also is ample research that shows that meditation and mindfulness are beneficial to another group – those affected by psychiatric illnesses. This includes those suffering from bipolar disorder, borderline personality disorder, attention deficit, and substance abuse.
Dr. Jeffrey Lazar, vice chairman of the Department of Emergency Medicine at SBH, is another proponent and practitioner of meditation. He sees it as a potential tool towards achieving the hospital’s Quadruple Aim – specifically, targeting the fourth tenet promoting health care provider satisfaction and wellness. “What I appreciate about meditation is that it trains one to block out noise, and focus on the moment,” he says. “We have so much noise, both literal and metaphorical, in medicine. The skills called upon to focus and be present during meditation can assist providers in focusing on and being present with their patients despite the abundant distractions.”
He says he first became intrigued by meditation after watching a TED talk by Matthieu Ricard, a French molecular biologist turned Buddhist monk, as well as via a friend, a successful corporate executive who incorporates meditation into her life and who became a mentor of sorts. This led him to taking regular meditation classes near his home, and developing his own practice.
“The more I do it, the more resilient I feel,”he says. While he keeps a meditation pillow – one filled with buckwheat hulls – in his office, he admits that a hectic administrative schedule has limited him to meditating at the hospital only a handful of times over the past six months. This is why he tries to devote 20 minutes every morning to it before he leaves for work.
He introduced the idea of meditation to his Emergency Medicine interns during their orientation week, in what he characterized as a particularly intense period for them. Meditation, he says, can play an important role in a specialty like emergency medicine that has a high rate of burnout. Meditation programs, he says, have been used by the U.S. military for some Special Forces soldiers. “While they may have different aims, there are some similarities in the stresses shared by working in an ER and going into battle,” he says.
So, considering the extensive research supporting and promoting meditation and mindfulness as techniques to lessen stress and burnout, why are physicians resistant to embracing them?
That’s a question that is not easily answered.
“Why is it so hard to find few minutes to be with ourselves? To appreciate the moment, to be mindful of our feelings, to be empathic towards our tired and stressed self?” asks Dr. Troneci. “Could it be the invincibility we were trained to develop? Just as the times have changed, we must change. We need to change and embrace our humane, vulnerable and mindful I.”