Vital Signs: Summer 2013
Please join us for the 9th Annual Caring for the Caregivers Conference, “How Do We Reduce Physician Stress and Burnout?”, on Thursday, October 3, 2013, at MMS headquarters.
The conference opens with an overview of physician health by new PHS Director Dr. Steven Adelman and with an overview of the Massachusetts health care environment by MMS President Dr. Ronald Dunlap. The morning session features a set of dynamic speakers, each of whom explains below how he or she will focus on important ways to help caregivers and improve the health care work environment. After lunch, breakout groups hosted by the same faculty will dive deeper into each topic, focusing on identifying and overcoming obstacles that interfere with more widespread adoption and implementation of these approaches.
Following the small groups, the conference will reconvene to hold a robust discussion of our findings and recommendations with a panel of invited health care leaders that includes Jeanette Clough (Mount Auburn Hospital), Howard R. Grant, J.D., M.D. (Lahey Clinic), Gene Lindsey, M.D. (Atrius Health), Gerda Maissel, M.D. (Bay State Medical Center), and Kate Walsh (Boston Medical Center).
– PHS Director Steve Adelman, M.D.
Promoting Peer Support
Jo Shapiro, M.D., Center for Professionalism and Peer Support (CPPS) at Brigham and Women’s Hospital
Physicians encounter various stressors in their careers. One of the most demoralizing is personal involvement in an adverse event that harmed a patient. In most peer support programs, non-physicians support physicians and other clinicians. In our experience, physicians rarely access the support available from non-physicians. Reasons for this include the need for confidentiality, concern about reputation, and access issues. We have found that physicians involved in adverse incidents often prefer to get support from their peers.
The CPPS at Brigham and Women’s Hospital has trained over 60 physicians and nurses as peer supporters. Connecting with a peer supporter helps normalize the emotional distress the physician may be experiencing, and also allows the physician to feel supported, to talk openly about his or her feelings, and to move on to next steps.
My discussion will focus on the emotional impact and potential adverse consequences of adverse incidents, particularly where there has been an error. In addition, the negative impact of these emotions on disclosure and apology, as well as safety reporting, will be explored. Peer support is one mechanism that mitigates these negative consequences, while also helping to change the culture of how we respond to and prevent medical incidents. The fundamentals of our Peer Support Program will be outlined.
Building Caregiver Resiliency
Greg Fricchione, M.D., Benson-Henry Institute for Mind Body Medicine
Stress is pervasive. The prevention and treatment of the harmful effects of stress on health and well being is vital. We have innate qualities that confer on us a modicum of resiliency in the face of stress. The linkage of psychosocial stress to biological system stress will be explored, along with the interplay of heredity, environment, and physiological disease vulnerabilities. This is equally relevant in patient care, and in the self-care of the caregivers.
We hypothesize that the propensity to health is determined by a mind-body medicine equation. In this model, resiliency is characterized by the ability to reduce stress via the relaxation response. This may be achieved in a variety of ways: meditation; social support; pro-social altruistic, loving behavior; various cognitive restructuring strategies; enhancement of meaning and purpose; and, by true spiritual practice and belief.
Our programs are directed at enhancing resiliency through the integration of the relaxation response elicitation with cognitive restructuring, with positive psychology, with a patient’s existing beliefs and expectations (remembered wellness), and with exercise regimens, sleep hygiene and appropriate dietary changes.
Integrating Mindfulness into the Daily Routine of Physicians
Doug Ziedonis, M.D., Department of Psychiatry, University of Massachusetts Medical School
Mindfulness helps us to manage the stress of multitasking and operating on autopilot. It enhances attention and focus, allowing us to be more purposeful and less judgmental. Formal and informal mindfulness practices can benefit patient care, while fostering the quality of our personal lives at home and in the community. The practice of mindfulness is an effective self-care strategy that can improve clinical decision-making, along with our ability to form empathic connections with others.
Mindfulness will be discussed in the context of personal practice, organizational culture change, behavioral therapy development, and neuroimaging of fMRI brain changes. The Mindfulness-Based Stress Reduction model, developed at UMass, will be reviewed, to the ends of promoting personal mindfulness practice and creating a more mindful health care workplace for physicians, staff, and patients.
What is Compassion? Rediscovering the Human Connection in Health Care
Beth Lown, M.D., Schwartz Center for Compassionate Healthcare
Compassion is a universal response to the concerns, distress, and suffering of others. As such, compassionate care underlies the very purpose of medicine. Few would deny its importance, yet in our national survey of 800 recently hospitalized patients and 510 providers, only about half of the patients agreed that the U.S. health care system provided compassionate care.
This raises several questions: How can we best understand the nature of compassion? How do changes in the health care system influence our capacity to provide compassionate care? How can we foster and sustain our ability to experience compassion and to support our own and others’ capacity to provide compassionate care?
We’ll explore these questions and discuss a framework for understanding compassion and the Schwartz Center Rounds, a program that brings together interdisciplinary caregivers from more than 320 health care organizations across the United States to discuss the social and emotional issues they face in caring for patients and families.
Learn more about the upcoming Caring for the Caregivers conference by visiting www.massmed.org/caringforcaregivers_2013.
