PHILADELPHIA -- Physicians need to remember that self-care is a necessity, not just a luxury, Richard Wardrop III, MD, PhD, said here at the American College of Physicians (ACP) annual meeting.
"The way I think about this is -- you've got to put your mask on first," just like flight attendants tell you before an airplane flight, said Wardrop, who is vice-chair of medicine at the University of Mississippi in Jackson, and a member of the ACP Physician Wellness Task Force. "You've got to take care of yourself before you take care of somebody else."
He also decried the use of the term "work/life balance." "I think that's a horrible term; I don't like it. I like 'work/life integration' because as soon as you say 'balance,' you're insinuating one is worth keeping away from the other ... Work and life -- I want them to come together. I think that's really what we need to aim for."
Professionally, that means trying to find that "sweet spot" where you're doing something that you like, that you're good at, and that you can get paid for doing, said Wardrop. "Keep this in mind as you change jobs -- What are your personal and professional needs, and personal and professional values?"
And while you're trying to get to your ideal vision, "don't let perfect be the enemy of the good," said Wardrop. "Remember, just be kind to yourself. If this were easy, everybody would be doing it perfectly ... It's really about making progress."
Wardrop presented a number of suggestions aimed at preventing burnout and increasing resilience, including:
- Reading: "I like to read for the soul and not necessarily for the mind," Wardrop said, quoting the famous physician William Osler, who recommended that everyone spend the last 30 minutes of each day reading.
- Mindfulness: "Mindfulness is the practice of learning how to slow down and nurture calmness and self-acceptance; it's a form of meditation," Wardrop explained. "This alone is not sufficient to be well; this alone is not sufficient to produce a legion of non-burned-out physicians, but this is something that can be done to promote your own personal well-being." One study of 42 doctors found that mindfulness was associated with better heart rate control and more positive energy, he added.
- Practicing positive psychology: Whether learned through coaching or another program, "this is another way to promote well-being," said Wardrop. "Humans tend to remember the thing that went wrong -- 'I did everything right today except I didn't give that patient in the ICU enough fluids.' We think about that one thing over and over again, and keep bringing it up again days later." Instead, try to focus on what you did right, he said.
- Showing gratitude: "There's an app for that: Three Good Things," he said, explaining that the app reminds you to think about the three good things that happened that day. "I know it seems simple, and it may be too straightforward, but there actually is something to this taking a pause [to think about this] ... [Think about] 'What am I grateful for in my life? What is going well in my life? What is working well for me?' Do it for 7-14 days; get in a pattern. That's how good habits are established."
Wardrop also recommends that physicians work within their institutions to develop a culture of wellness, as discussed by the National Academy of Medicine. "One big step that needs to be done ... is we recognize as a profession that our own well-being is a professional competency," he said. "Also, [we should] recognize this national [burnout] epidemic is not a personal failure at all; this is something that's a systemic problem." Also, once burned-out people get help, "they need to be able to come back, so people aren't feeling like it's a one-way street out of the profession."
The AMA's Steps Forward program is designed to help with this, including topics on professional satisfaction and well-being in continuing education, having "meetings with meaning," not just about practice efficiency, and having social events, said Wardrop. "There's data for this. It's good to get together and have a meal ... but we have to find ways to do that so we're not taking time away from life, family, and things that don't involve work."
But not everyone was convinced by the "culture of wellness" idea. "This is nibbling at the edges," Greg Poland, MD, a vaccinologist at the Mayo Clinic, in Rochester, Minnesota, said during the audience participation part of the session. "I've seen far too many of you who suffer in unfathomable ways."
"No matter how much you give and how hard you work, the institution is never going to love you back," Poland said, turning the stand microphone around so he could face the audience. "That is not where you go for love and acceptance." He urged audience members to "learn to say No" to unreasonable demands made by practice administrators, and suggested that perhaps "that may [mean] -- I don't ever want to use the word 'union' [but] that may be that we have to collectively organize in some ways outside of these bureaucracies to develop boundaries that make their way into contracts and negotiations. Too many of you are suffering and I want to see that suffering end," he said to applause.
Wardrop responded, thanking Poland for his comments and adding that the ACP "does try to represent the collective good but at the same time [be] appropriately disruptive." He also discussed another potential area for reform: "right-sizing" the electronic health record (EHR). "You [the doctor] shouldn't be data-entry technicians for all parts of the patient visit," Wardrop said. "There is lots of work that we could do with [EHRs] and with vendors. They need to hear from us as far as what actually works and what doesn't." Physicians generally spend too much time on the [EHR], but "I think this is an area amenable to hygiene and coaching," he added.