Flip No. 18

Find more joy in your practice

Rely on proven techniques to avoid burnout and improve job satisfaction.

By Flip the Clinic

Burnout is common threat to the wellbeing of medical professionals. The main contributing factors—emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment—are commonly reported conditions among physicians, according to a review article published by the Journal of the American Medical Association. Patient interactions often suffer as a result. But improving the situation for health care providers means more than just reversing the condition. When the Flip the Clinic team consulted a group of health care innovators about their unmet needs, the physicians in the group labeled joy as a common deficiency. It isn’t enough to just get by; it’s about remembering the reasons you went into medicine in the first place.

Sure, less paperwork and more time would help the problem but waiting for an environmental change means change might never come.

Luckily, there are ways to guard against burnout that don’t require any modifications to one’s surroundings. Drawing from the work of Dr. Yang Yang, Dr. Rachel Remen, and the University of Wisconsin’s mindfulness in medicine work, here we present a range of self-directed techniques, broken into three categories, each with a proven track record of reversing the effects of burnout and improving job satisfaction.

Mindfulness Tools: Reflect/Move/Listen

Reflect

Keeping a simple log of good things that have happened every day can affect happiness over time. After a while, the practice can retrain physicians to notice gratifying moments as they occur instead of at the end of the day or not at all, according to Rachel Remen, a professor of clinical medicine at UCSF School of Medicine, who teaches a similar technique to her students. Here’s how to do it.

Step 1

Find a quiet, private place at the end of the day.

Step 2

Looking back on the day, identify anything that brought you joy or made you feel gratitude.

Step 3

Write them down.

Step 4

Do it again tomorrow.

Case Study

A study conducted by two university psychologists showed that when people write down things that they’re grateful for on a daily basis, they are more optimistic, exercise more, have more positive feelings about their lives, and have fewer doctor’s visits than those that record any daily events or those that record just negative ones.

Move

“Moving Qigong,” as demonstrated by Yang Yang, the founder of the Center for Taiji and Qigong Studies in New York City, is a classic exercise known for generating energy through deep breathing. It can be done on its own or in combination with other Qigong practices. During his decades of study, Yang has seen Moving Qigong help with fatigue, balance, range of motion and coordination.

Step 1

Stand with your feet a little wider than shoulder-width.

Step 2

Move your arms in a circular pattern.

Step 3

Starting from your core, raise your arms with your elbows bent upwards. As they reach the top of their trajectory, open your arms wide and bring them back down and together toward your core. Take a deep breath in as your arms go up, and exhale when your arms come down.

Step 4

Breathe. Smile. Repeat.

Note

As your arms go up, raise your body. As the arms go down, lower your body. Make sure to smile as you move. As you raise your body, open the chest, reaching through your arms. This movement should give a sense of calmness, openness, and power.

Case Study

During randomized controlled trials, Qigong and taiji have been shown to improve immune function, reduce chronic pain like arthritis and fibromyalgia, increase lower body strength, improve functional balance and reduce falls, improve cardiovascular health, and sleep quality.

Listen

Multi-tasking may be a necessary consequence of a busy practice, but studies show that quality of care suffers. Mindfulness, which includes techniques like meditation and journaling, can help physicians focus. Here’s an exercise that the University of Wisconsin’s Department of Family Medicine teaches its clinicians.

Pause:

Before you enter an exam room, stop and take a few breaths. On your out breath, think about releasing all of your mental clutter. Concentrate on your breathing to bring your next patient into focus.

Presence:

During the patient encounter, stay open and aware of what’s happening in the present moment. Take in the conversation without judgement, and resist the urge to compare your experience to the patient’s. Listen with the goal of understanding.

Proceed:

Create a health plan based on what you learned. The University of Wisconsin reminds providers to “respond skillfully, compassionately, and with positive intention to whatever needs attention in this moment.”

Case Study

A 2010 study that looked at 70 primary care physicians taking part in an eight-week mindfulness course followed by a 10-month maintenance course demonstrated both short-term and long-running gains in well-being and attitude about patient-centered care.

Comments

  • mdyke11

    I feel that everyone in healthcare could benefit from taking time to find more joy in their practice! I especially like the idea of reflecting on the day and what went right. Can’t we all benifit from being more optimistic, exercising more, and having more positive feelings about our lives? As a nurse, I think my unit could certainly benefit from having a more focused approach when having contact with patients and being more present in the moments with them.

  • Emily Ogden

    Being an ER nurse, I’ve witnessed “burnout” so many times. There are times, that I myself have begun to feel the pull in the burnout direction. I enjoy the tips that are given to decrease the risks of burnout and the ideas to improve mental health and concentration after a long day of busy work! I plan to discuss this with my fellow employees and direct them here for advice and more tips

  • Brian Dixon

    I too am an ED nurse and sometimes I feel burnout is all around us. I often times get concerned when I notice an employee is starting to just clock in and clock out. This tells me they are becoming more detached which can be an early sign of burnout. The examples given in the flip are not extreme, but instead small steps that we can take everyday to prevent this.

  • Sammie Pyle

    As an ICU nurse, I feel the burnout for sure. I made a vow to myself after I became a nurse 12 years ago to keep a journal of patients, stories, feelings, etc. It has been proven to be my go-to when needing a pick-me-up. I have found that I write after a 12, 14, 16-hr emotionally draining shift as this is where I find my humbleness in nursing. I love the simple techniques given in this flip as we can all benefit from stopping for just a few seconds to breath in & out.

  • Whitney Bowman-Zatzkin

    I’m curious, Sammie, Brian, Emily, and mdyke — have you encountered anything that offers you relief in “real time” during or shortly after the interaction with the patient before moving to the next? Brian, you mentioned noticing it in colleagues – do you then engage and offer support? Does your department?
    I visited a hospital down South recently and their vision of care was posted on a wall on the main floor. A bench was located across from it with some greenery (thus, standing out from the other benches!) and when I asked why they said they found many staff would stop in passing and spend a few moments staring and reflecting on it once in a while so they wanted to offer a bench. When the bench went in, they found they had a quiet way to intervene positively and thoughtfully with a clinician struggling with burnout by recognizing the frequent visitors.
    It made me realize this Flip offers great relief for those aware of the need but that we may need one around the intervention with a colleague.