Wednesday, April 11, 2018

Wellness for Physicians, & Why It Matters

As I've transitioned from primarily research & teaching back into the clinical realm, I've been looking for ways to bring my worlds together - so I'm excited to be a part of the Academic Life in Emergency Medicine's Wellness Think Tank this year.

Wellness has been getting a decent amount of attention within the healthcare field for the past few years, and for good reason. Burnout rates are high (with emergency medicine being the highest), and resident & physician depression and suicide are finally being talked about. The New York Times has published many articles on physician wellness, or our current lack thereof.

But what is wellness? It's gotten a lot of lip service lately...but what's actually been accomplished?

While it has been encouraging to see the increased attention to physician and resident wellness in recent years, there’s a lot of work to be done still – and the solution is not yet apparent. Creating educational programs for stress management and having wellness days is all well and good, but it’s essentially a bandaid – physicians aren’t burnt out because they don’t know how to take care of themselves or are lacking ice cream socials in their lives, they become unwell with the cumulative toll of daily micro-hits from the (often subconscious) emotional toll of managing difficult patients, time spent fighting with Electronic Medical Records, depletion of cognitive resources after a long shift, and looming worries of litigation.

The essential problem is that these aren’t things we can make go away (at least anytime soon and without significant nationwide systemic changes in healthcare) – so if we can’t take away the underlying source of un-wellness, we have to figure out how to help each other manage better. 

After building a research program of cognitive neuroscience centering around brain changes associated with stress, stress reduction interventions, and resilience, I began thinking about how this same line of work could benefit physicians in terms of wellness and managing symptoms of burnout. There’s a lot of potential for resilience training to be incorporated into residency education, using similar techniques (e.g. targeted mindfulness training) that the military has recently implemented. We need to start doing these things during residency, particularly for emergency medicine residents, to ensure career longevity (and this isn’t only for our well-being, it will have a direct impact on the quality of patient care we’re able to sustain over the course of our careers.)

So here's what I'm hoping to work on implementing:

First, I think a key step is to give people the information on why this should work - by going through what we've already shown about the neural and physiologic effects of mindfulness training (focus on emotional reactivity, non-judgment, and resilience aspects). From giving previous lectures to academic populations, showing science-minded people (e.g. our MDs) that you actually affect physiologic parameters by doing these things greatly increases buy-in.

The next step is to create a curriculum for resilience training exercises - similar to what exists in popular apps like Headspace & Calm, but specifically targeted to things that will help physicians the most – think non-reactivity, non-judgment, open monitoring. Ideally, we can also incorporate mental training techniques for enhancing situational awareness, which is key in a high-performance, critical care setting. Other keys: make this as easy and accessible as possible. Short and high-yield.

Finally, we want to know if it's working. An online form for evaluation, looking at effects (or lack thereof) on both perceived emotional wellness and job performance. What's the eventual dream? Being able to have a “smart” algorithm for advancing such a training program with further targeted exercises (to strengths, weaknesses, and goals) at the individual level.

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