Mindfulness Matters: A Powerful Resource for Stressed Physician Leaders

The use of these techniques is growing in popularity and could help physician leaders gain better focus in the hectic health care world.

According to a 2013 study reported in the Annals of Family Medicine,1 physicians who said they used mindfulness techniques demonstrated higher numbers of satisfied patients and more frequently practiced patient-centered communication.

The topic of mindfulness has been increasingly studied of late, with particular emphasis on whether improving physician mindfulness can result in better patient outcomes and stronger physician leadership.

Gail Gazelle

Gail Gazelle, MD, FACP, FAAHPM, is a leadership development coach for physician leaders and physicians. As one component of leadership coaching, Gazelle helps clients incorporate straight-forward mindfulness techniques and has noticed the rising attention paid to the topic in the lay media.

"Mindfulness is not an esoteric other-worldly concept," Gazelle said. "Simply put, it's about a nonjudgmental, compassionate awareness of your life as it unfolds moment to moment." Mindfulness is one very important aspect of leadership and is being used by Google, Proctor & Gamble, General Mills, Comcast and many other Fortune 500 companies.

She said when physician leaders increase their awareness of what is going on real-time, they are "more present in every moment" of their work and more resourceful in meeting challenges. "Mindfulness may involve meditation practice but does not have to. With roots in Buddhist meditation and other traditions, mindfulness is a secular practice in the U.S., in large part through the pioneering work of Jon Kabat-Zinn at the University of Massachusetts Medical School, starting in the late 1970s."

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Why is mindfulness becoming more popular? Gazelle explained that society has become more complex, leading to "work increasingly spilling over into life. People are more and more distracted, pulled in many competing directions by the hold that technology has on them, and the expectation that they will be 'on' all the time. Mindfulness is a way to combat this sense that the mind is also always on, never still and at rest."

Mindfulness and meditation practices have been shown to assist patients dealing with pain, depression, hypertension and many other medical conditions. Multiple studies reveal salutary impact on the parasympathetic system, immune function and gray matter density.2-5

Gazelle noted that mindfulness is "being used in a wide variety of nonclinical domains. It is used by the military, in major league sports, for prisoner rehabilitation, in the business sector and in leadership training."

She also referenced studies in the Journal of the American Medical Association and the Annals of Family Medicine confirming that training in this area increases attentiveness to patient concerns and empathy, and increases physician satisfaction and quality of life, thus decreasing burnout.6,7

Burnout is an area of focus for Gazelle, who also coaches physicians and physician leaders to develop resiliency and regain a sense of calm; these skills naturally lead to better stress management and performance. She noted that most people have what she refers to as "scripts" in our heads, explaining these are methods for interpreting "situations or our actions, things we tell ourselves, assumptions we make about what we encounter."

"Mindfulness is not about shutting out thoughts," Gazelle said, "but more how can we alter our relationship to our thoughts, learning to question their veracity and learning to shift attention from our thoughts to our actual lived experience. When you can internalize these skills, you can impact every aspect of leadership, ultimately impacting the bottom line."

Overburdened physician leaders may be skeptical about mindfulness and wonder how they could possibly fit a formal training program into their schedules. Gazelle maintained that successful use of mindfulness techniques need not require hours devoted to meditation. She said the acronym RAIN by mindfulness teacher Tara Brach may resonate for physicians: recognize what is going on, allow the experience to be there, just as it is, investigate with kindness. Experience natural awareness that doesn't come from identifying with the experience, but simply noticing it instead. Gazelle described the following situation involving one of her clients, the CMO of a midsized hospital.

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She said the CMO suffered from peptic ulcer disease, thought largely due to stress. His anxiety was increasing, leading to sleepless nights; overreacting in meetings; irritability with co-workers, direct reports and family; and increased GI pain. He sought me out for coaching.

His coaching goals were clear: How can I perform at my highest level and avoid another GI bleed? How can I find some modicum of calm and avoid being overwhelmed while meeting all the demands I face?

After initial work gaining clarity on his leadership strengths, understanding his values and how they aligned (or didn't) with his workplace duties, shifting focus from failures to accomplishments, and picturing how he wanted to react in situations, we worked on three basic mindfulness techniques.

First, just as he prepared factual material for meetings and presentations, he practiced preparing mentally by stepping back from the fray and taking three slow deep breaths just prior to challenging situations.

Second, looking at what things were calming for him, he identified walks outdoors with his dogs. As a coach, I wanted him to be able to recall this calm state of mind so he could borrow from it during times of stress. Naming it "My Calm Dog Walks," his assignment was to practice accessing this state when he was working in high-stakes situations requiring intense focus. Gradually, he was able to conjure up this state and stay in it during times of stress.

Third, he began practicing the RAIN acronym, as a reminder whenever he noticed his anxiety kicking in. He began to gain mastery over his thoughts, reining them in. Using these skills, he gradually found that he could think more clearly, tune out distractions and focus more on the task in front of him. He would spend less time worrying about the inherent uncertainty of the future. As a result, he had more and more capacity to navigate complex and ambiguous challenges.

Rapid changes within health care create an increased need for physician leaders to develop new skills to remain at the top of their game. "We are in a VUCA environment, where Volatility, Uncertainty, Complexity, and Ambiguity are part and parcel of the health care landscape," Gazelle said.

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In addition to struggling with typical leadership issues, Gazelle recognized leaders increasingly face dilemmas their institutions do not have answers for, such as "inadequate and burgeoning technologies, security breaches, the growing physician shortage, decreasing reimbursement, the reduced autonomy and increased scrutiny facing their physician staff."

She noted there were many more challenges to come. She said the worry and stress felt by physician leaders doesn't translate to greater control over the outcome. Rather, it serves to increase anxiety, thereby contributing to frustration and burnout.

Mindfulness leads to a different relationship with circumstances — an actual divesting in the outcome. "It allows a leader to weather storms of change. The ripple effect a physician leader can have is significant. Modeling open awareness, calm and being less reactive can have a large impact on employee calm, satisfaction and productivity, which are all critical to the success of health care endeavors."

REFERENCES

1. Beach MC, Roter D, Korthuis PT and others. A Multicenter Study of Physician Mindfulness and Health Care Quality. Annals Family Medicine 11(5):421-8, Sep-Oct 2013.

2. Goyal M, Singh S, Sibinga EMS and others. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. JAMA Intern Med 174(3):357-68, Mar 2014.

3. Tang YY and others. Central and autonomic nervous system interaction is altered by short-term meditation. Proceedings of the National Academy of Science. 106(22):8865-70, 2007.

4. Kilpatrick A, and others. Impact of mindfulness-based stress reduction training on intrinsic brain connectivity. Neuroimage 56(1):290-8, May 1, 2011.

5. Holzel BK and others. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research 191(1):36-43, Jan 30, 2011.

6. Krasner M, and others. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians." JAMA 302(12):1284-93, Sep 23, 2009.

7. Fortney L, Luchterband C, Zakletskaia L, and others. abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med 11(5):412-20, Sep- Oct 2013.