Download - Beyond coping & preventing burnout, to caregiver well-being & growth Stephen Liben MD PEI June 2014
Beyond coping & preventing burnout, to caregiver well-being & growth
Stephen Liben MD
PEI June 2014
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Problems in clinicians…
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The Problem
Reaction
1. Avoiding suffering
2. Conflicts with patients and staff
3. Feeling overwhelmed, cognitive traps.
4. Unhappy professionals
5. Burnout, Unacknowledged Grief , Depression
Outcome
1. Not listening
2. Lapses in professionalism
3. Bad Outcomes/Medical errors
4. Unhappy pts & parents.
5. Leaving practice…
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1.What is wrong with me? (Diagnosis)2.What is going to happen to me? (Prognosis)3.What can be done to help me? (Treatment)4.Can you/will you, BE with me?
Will you be there for me even when I feel things are hopeless?
What do patients want when they seek medical care?
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Questions that resonate•How do we sustain & grow in the face of so much suffering that we see?
•What drains us?– Compassion fatigue…
•What energizes us in our work?
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To Not Listen To Listen Mindfully
• Example of not listening – “Why did you have to keep asking me if I knew…?”
• A momentary pause – Listening with awareness to distress
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Challenged: Within & without
• We see others struggle & are affected – Can no more be in the presence of suffering and be unaffected than go
swimming and not get wet.
• We React or Respond – – Compassion– Anger– Non-acceptance
• Can we move from being reactive to being responsive?
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Challenged: Within & without
•Lost in reactive & unhelpful patterns- – Fixing instead of listening---coming to closure too
soon (e.g. kleenex)– Not able to be there for the child and family in front of
me = lack of presence (not being there)
•Reactivity – built in, conditioned, automatic•Responsiveness – a skill we can learn
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Primary Stability
Secondary Stability
Do you turn the motorcycle steering wheel to the right or left if you want to go around a right sided-turn?
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Between Stimulus & Response
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Mindful awareness is not ethically neutral
• Mindfulness cares.
• “Caring attention to the present moment.”
• Intention to not to harm and by the proactive intention to be kind, compassionate, and generous.
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Mindful awareness is simple, but not easy.
• Sometimes it’s easy, sometimes it’s not.
• Gets easier with practice, because you’re developing a habit.
• Mindfulness practice is like building a muscle in the brain: the mindfulness muscle.
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Mindful awareness practice is not just meditation
Mindful awareness exercises :
•Formal Practice– Body scan– Yoga– Mediation
•Informal Practice– Washing hands– Hand touching doorknob.
•In the moment - S.T.O.P.18
Mindful awareness is not synonymous with joy
• The present moment is not always a pleasant moment.
• “Giving up” is not the same as “acceptance” (e.g. unwanted rain)
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Mindful awareness is not passive.
• If you let go a little you will have a little peace; let go a lot you will have a lot of peace; let go completely…
• Caring attention also means that you know when to abandon observing your present moment experience & take action to prevent harm (e.g. abusive situations)
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Mindful awareness is both the means and the end
• Mindfulness, in and of itself, is the goal.
• Wisdom is also the goal.
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Mindful Practice
1. Willingness - Intention
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Mindful Practice
1. Willingness - Intention
2. Know How – Awareness Practices– Formal & Informal methods
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Mindful Practice
1. Willingness - Intention
2. Know How – Awareness practices
3. Effort towards building capacity• “How do you get to Carnegie Hall?”
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Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.
Design, Setting, and Participants Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians Michael S. Krasner, MD; Ronald M. Epstein, MD; Howard Beckman, MD; Anthony L. Suchman, MD, MA; Benjamin Chapman, PhD; Christopher J. Mooney, MA; Timothy E. Quill, MD
JAMA. 2009;302(12):1284-1293. doi:10.1001/jama.2009.1384.
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Main Outcome Measures: Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.
Conclusions: Participation was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care.
Levels of Knowing
1. Not knowing (ignorance)
2. Knowing = knowledge
3. Realizing – grounded in lived experience
4. Actualizing – bringing the knowing into moment to moment awareness
Example – Universality death27
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Beyond coping…
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3 questions to help dig for the reactive/unconscious subroutines
• Look at difference between intention and the result or outcome. = if there is a difference then reactivity is present. How to get curious about these reactive patterns?
• Ask these 3 questions ;– What do I not notice , – What do I not question, and – What am I not able to see some humor in…
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ClinicianPerson
Disease
Healing
Curing