Mindfulness and Healthcare: Combatting Caregiver Fatigue by Reconnecting with Self and PatientsDate Posted: Monday, February 11, 2019
The American Medical Association reports that at least 50% of doctors today say they’ve experienced some symptoms of burnout. This physician burnout has been increasing for years and is now considered by many experts to be a public health crisis. Tina Runyan, a Clinical Psychologist and Professor at UMASS Medical School, says it’s not just affecting doctors. “It’s nurses too as well as virtually all healthcare providers and caregivers.” She knows because she’s been there herself.
“I spent most of my professional career working in an integrated primary care clinic,” Tina explains. That means patients have same-day access to the mental health services they might need. “This is especially important to patients in crisis who, in a traditional setting, might need a referral from their physician and then wait for an appointment.”
The primary care clinic she worked for saw mostly an underserved population who struggled every day with poverty and a lack of resources. “We saw a lot of trauma, substance abuse and community violence,” she says. “After a while, when you are witnessing so much suffering, especially with trauma when the suffering results from the hands of other people, it does get to you.”
This was troubling to Tina because as a psychologist she feels one of the most valuable things she has to offer her patients is clinical empathy and compassion. “I can only do that if I’m able to stay fully present with people and their suffering,” she continues. “When I wasn’t able to do that to the degree I needed to, it was not only challenging for me to tap into my skillset and make a difference – I found that the effort left me completely empty at the end of the day.” Not good for her patients and not an option for a single mother of two.
Tina had been doing yoga and exploring meditation leading up to this moment, but she decided she needed to do something more. That’s when she signed up for a Mindfulness-Based Stress Reduction (MBSR) course with The Center for Mindfulness (CFM) at UMASS Medical School. She found what she learned so useful she continued on to Mindfulness-Based Cognitive Therapy (MBCT) training and started the requirements for becoming an MBSR teacher. “I took these courses initially for me, but I began to think that some of the skills I was learning to develop could help the people I work with.”
In addition to her practice, Tina also directs the post-doctoral fellowship in health psychology and primary care, working with psychologists who come to UMASS Medical School for a two-year training program in integrated primary care. She’s also responsible for the behavioral science curriculum for the Worcester Family Medicine residency. It is with these residents that she started to see a fairly rapid and marked increase in burnout.
“I saw these eager, bright, talented and compassionate residents coming into the program and within 15 months, they were very different people,” says Tina. And because she was teaching them about behavioral science, she says she became somewhat of a de facto counselor “They told me they felt exhausted and ineffective, that they weren’t able to really do what they’d hoped when they decided to become doctors – care for people.” So Tina decided to start teaching the residents based on the MBSR skills she had learned.
That was nearly five years ago, and since then she has been working to bring mindfulness into the everyday lives of doctors across disciplines and at all stages of their careers. To start, Tina oversees her department’s Wellness Committee, into which she has heavily infused her interest in mindfulness and the role of mindfulness in medicine. She holds formal workshops for her family medicine residents and also offers Mindful Practice training programs to physicians and anyone involved in healthcare – nurses, nurse practitioners, psychologists, clinical pharmacists and more.
Tina recently served as an instructor for a Mindful Physician Leadership Program, which was supported by a grant from the Physicians Foundation. Here she worked with two different groups of 30 physicians representing all specialties over the course of 10 months. The focus in regular sessions and two day-long retreats was to help participants identify stressors and pain points, and use mindfulness in their personal and work lives to better manage them.
In Tina’s experience, some people are more open to the concepts of mindfulness than others. “Physicians are not always the best at raising their hand and saying they need help,” she says. “They feel like they are supposed to have the answers.” Still, the response to her sessions has been both positive and interesting. “Many of the physicians I’ve worked with have become ambassadors for mindfulness, winning others over by putting the practice into action.”
For instance, Tina tells the story of one hospital pediatrician who started mindful rounding. Now, after every patient visit – he stops to do a brief but specific mindfulness exercise with residents. This creates space between one patient and the next and helps physicians connect with both patients and themselves in a different way than merely focusing on the task of finishing rounds. “I’ve started to see that spread in a very organic way,” she says. “I was recently contacted by an Internal Medicine hospitalist whose team wants to build this practice to their rounding.”
There’s a lot of technology in medicine today. A lot of it is good, but some of it has gotten in the way of human interaction. In fact, this is a common thread Tina has heard from her residents and seasoned physicians alike. There’s too much time in front of a computer and too little time spent interacting – either one-on-one with patients or in discussion and collaboration with colleagues.
“I see mindfulness as just another tool caregivers can have in their toolboxes to help bring back and maintain some of the humanity of medicine doctors say they are missing,” she says.
Her ultimate vision? For UMASS to train physicians and all staff to deliver Mindful Healthcare. “That means mindful attention to oneself, mindful communication with patients and tuning into what patients and their families need – our compassion and our presence as caregivers.”
 Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Pubic Health and Harvard Global Health Institute, Crisis in Health Care: A Call to Action on Physician Burnout (2019), Retrieved from http://www.massmed.org/News-and-Publications/MMS-News-Releases/A-Crisis-in-Health-Care--A-Call-to-Action-on--Physician-Burnout/#.XE9jHS2ZOnc