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Restructuring Care vs Personal Resilience?

Tuesday, April 03, 2018

Van Gogh's painting of field and crows

Although not raised in the NEJM article, the conversation on the Family Medicine and Community Health departmental listserv soon swerved to contrasting efforts to promote personal resilience and wellness with “taking back our profession”. Below are some excerpts from the impassioned online discussion:

 “…The articles and lectures and conferences encouraging us and giving us ‘techniques’ to become more ‘resilient’ do not address the cause!  We are not the cause of burnout!  Burnout is a symptom of a problem!”

“…think about how at risk we all are of crashing, and what distracted doctoring we are doing with our current systems....”

“Resiliency is a Band-Aid.  We do need something very different.  I believe that we want to reclaim our control of our profession.”

Medicine boasts a “find it and fix it” (ideally as quickly and as painlessly as possible) mentality. However, changing and fixing systems is as, if not more, complicated than human beings and when things are going wrong, rarely is it one specific fix that can address all the issues. More often, a multi-pronged approach can lead to more sustainable change. In response to the litany of offerings on the list serve promoting systems change and maligning personal wellness, Professor Christine Runyan, one of our CIPC faculty members and Director of the Behavioral Health Fellowship, wrote:

“As a strong proponent of mindfulness in medicine and building resiliency skills through intentional practice, I also agree that the cause of burnout does not lie with the capacity of clinicians to tolerate stress. The causes are undeniably linked to the EMR, unnecessary and burdensome processes, paperwork, and prior authorizations, low staffing ratios, loss of control and autonomy, and even problematic leadership at times…. Mindfulness in Medicine is not going to eradicate burnout. I get it and I completely agree. Mindfulness in medicine can, however, help anyone feel more connection to themselves, their patients, and their family and friends, find deeper meaning in their practice and their life, and offer tools to reduce reactivity and personal stress… I think arguing against teachings and ways of being in practice (and in life) as the problem actually detracts from where the real energy needs to go … towards advocacy for the all the necessary regulatory, staffing, and EMR changes shared in this e-mail chain. And if that happens, perhaps we may agree that there is space for both.”

 We can all agree that physician (clinician) burnout is a very real concern.  We can all point to a myriad of bureaucratic causes.  Can physicians cede some of their traditional control to allow effective team-based care to flourish?  What role can Mindfulness in Medicine play in fostering better physical and mental health for all medical professionals?