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Mindful EM: Practicing Kindness is the Best Medicine

Hazan, Alberto, MD; Haber, Jordana, MD

doi: 10.1097/01.EEM.0000530451.90323.15
Mindful EM

Dr. Hazan is an emergency physician and the regional medical director of DMS-Envision in Las Vegas. He is the author of the medical thriller Dr. Vigilante and the urban fantasy series The League of Freaks. Find out more about his novels at http://amzn.to/2sshEUe. He is also a board member with www.GivingMore.org. Follow him on Twitter @Dr_Vigilante. Dr. Haber is an emergency physician and the director of clinical education at University Medical Center in Las Vegas. She has a master's degree in medical education. Follow her on Twitter @JoJoHaber. Read their past articles at http://bit.ly/EMN-MindfulEM.

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The statistics on physician burnout are staggering: The overall rate of physician burnout—a feeling of emotional exhaustion, a low sense of clinical accomplishment, or a lack of enthusiasm for work—is approximately 51 percent.

The highest rate of burnout was reported among physicians practicing emergency medicine (59%), higher than those in OB/GYN (56%), family medicine (55%), or internal medicine (55%); and the leading causes of burnout were having too many bureaucratic tasks, spending too many hours at work, and feeling like “a cog in a wheel.” (Medscape. Jan. 11, 2017.)

Concerns over the mental health of our medical providers are paramount because patient safety is dependent on having a high-functioning physician. Having a provider with compassion fatigue, no enthusiasm, or burnout will inevitably affect the clinical outcomes of patients being treated.

Physician burnout has become an epidemic. Increased demands from the hospital, government, and health insurance companies, coupled with higher volumes and acuity of patients and fewer resources with which to treat them, all lead to burnout.

Approaches to physician wellness, specifically those addressing aspects that enrich a physician's work-life balance and lead to increased happiness, health, productivity, engagement, and overall fulfillment, have therefore been at the forefront. (NJEM Catalyst. August 7, 2017; http://bit.ly/2ArQCwd.) We've discussed ways to minimize stress, prevent burnout, and avoid compassion fatigue before. (“Compassion Fatigue: PTSD's Wicked Sibling,” EMN 2016;38[5]:19; http://bit.ly/2AoOx3T.) These include cutting back shifts, eating healthy, exercising, getting adequate sleep, spending time outdoors, spending time with family and friends, taking on new projects, and practicing yoga and meditation. Carving out time for yourself and doing daily reflections and journaling are also very helpful.

But there is another approach to wellness that involves everyday interactions. If we want wellness for ourselves, we should be proactive about giving it to others. We should be lavish with our praise. We should be thankful for things done. We should go above and beyond to be kinder to our patients and helpful to our colleagues. The best way to get wellness is to give wellness.

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Just a Good Feeling

The Huffington Post published an article a few years ago titled, “6 Ways Being Nice to Others is Actually Good For You.” (Sept. 10, 2014; http://bit.ly/2Anq5Qy.) This article is one of several that highlight the selfish incentives to being a nice person. Our mood is instantaneously positive when we are kind. Dopamine, serotonin, oxytocin, and endorphins are all associated with generosity. The act of volunteering correlates with health benefits. Being kind is also associated with success in the workplace, an overall decrease in stress, and just a good feeling.

We are fortunate to work in a meaningful profession that allows us to interact with colleagues and care for patients daily. Bringing more kindness to our own work will undoubtedly prevent burnout, ward off lawsuits, and improve career longevity. Your own career morbidity and mortality, so to speak, depend on your wellness. Our work should energize us. We should look forward to going into a shift, the interactions we will have there, and the opportunities to serve and help others.

We should enjoy our work, not resent it. There is no question that our work has numerous stresses that contribute to burnout and work dissatisfaction, many of which are out of our control. We can, however, control our mood, our responses, and our actions. Practicing kindness may be the best remedy, so we developed five recommendations for a kinder practice:

Mood checks. Be mindful about what kind of mood you are in and why you are in this mood. If you are in a negative mood—or have thoughts that are counter-productive—have an escape strategy. Many people have a mantra that helps them return to their core values.

Sit down and be attentive. Take the time to be at eye level with your patient. One study found that sitting instead of standing had a significant impact on patient satisfaction. (Patient Educ Couns 2012;86[2]:166.) This is a simple way to be present with our patients and make the most of our encounter at the bedside.

Provide empathy. Clinical empathy is understanding what a patient is saying and feeling and expressing that back to him. It is extremely important that our patients know that we are listening to their stories and that we have understood them correctly. Not only will this make patients feel more satisfied, physician empathy has also been found to decrease patients' thoughts of litigation. (Emerg Med J 2016;33[8]:548.)

Have an attitude of gratitude. Work to cultivate a mindset of being thankful.

Be liberal with your praise. Take a moment to thank those around you for their work, even if they are every day, mundane tasks.

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