UO > Feature > Happiness at Work

More and more there are programs to help physicians rekindle their happiness with their career choice. Wan is the chair of the physician well-being committee at St. John’s Pleasant Valley Hospital and St. John’s Regional Medical Center in Ventura County, California. One thing the hospitals are using to increase physician satisfaction is a “physician complaint line.” He says, “A doctor often has a valid reason for being upset, such as certain lab tests not being ready.” But if the doctor simply rants, it often makes the situation worse and becomes detrimental to patient care when the lab or nurse is afraid to call an easily-upset doctor. “When the complaint line gets a call, it’s triaged to the person who can get the problem fixed or find out why it can’t be done. Then, a supervisor is required to call the doctor and submit a written follow-up, so the physician knows there’s been some action.”

Robert Rufsvold, MD, is the director of the “Finding Meaning in Medicine” (FMM) program for physicians and med students that comes out of the Institute for Study of Health & Illness (ISHI) at Commonweal in Bolinas, California. (www.meaninginmedicine.org) “It helps them remember the core values of the healing profession: caring, compassion, reverence for life,” and others. Rufsvold says too often today those values are being replaced by what he calls “marketplace values,” for example, being rewarded for caring more about cost-efficiency than the patient.

According to Rufsvold, one of the sad things is how quickly young residents become disillusioned in ways they didn’t expect. Take the financial issue: Many older physicians have seen dramatic income cuts since managed care, but Rufsvold says today’s students grew up with that system. “If you have conversations with first-year students, they really want to serve, it’s what has drawn them into medicine. They know there are better ways to make money now.” So they’re going into medicine for the same reasons their elders did: to heal and provide care.

Yet six months into med school, he says, “They’re becoming more depressed and cynical” as they find a dissonance between their Hippocratic values for healing and what they’re truly allowed to do for patients.

Many doctors take FMM workshops and then go out and found their own groups. There are from 60 to 100 around the country, plus a “Healing Arts” program being given at medical schools. Others log onto the Web site where they can find all the resources for beginning, plus on-line discussions. (Rufsvold calls the FMM group process “simple and easily replicable” through the on-line resources.)

He emphasizes that group meetings are not gripe sessions about insurance problems or daily hassles. Instead, participants come to address a topic that’s been chosen—compassion, spirituality, joy, privacy, even fear. They bring stories from their own lives to convey their feelings on the topic in ways that connect with the deeper meaning of day-to-day doctoring experiences. Rufsvold says, “We lead far more meaningful lives than we often know...it just needs a little teasing to remember it. That can help strengthen the doctor’s commitment to service,” even when the work is tough and sacrifices great.

Several years ago Krasner started a similar stress reduction program. His is based on one developed by Jon Kabat-Zinn, PhD, at the University of Massachusetts’s Center for Mindfulness in Medicine, Health Care, and Society (www.umassmed.edu/cfm/). It’s still taught there and Krasner says it’s now used around the world. Krasner originally developed the program to help his patients, but more recently he has modified it for physicians. “It’s a six-week course with 22 CME credits.” In it doctors learn and practice together mindful meditation and learn to bring it into as many aspects of their life as possible. Many of the graduates have continued to meet colleagues every other month outside the seminar. In this forum, based partly on the FMM model, they combine meditation with discussing topics such as mistakes, loss, and compassion.

Hall took part in Krasner’s seminar. “It’s meditation, focused thoughts, centering yourself.” He admits it might have been easier for him to accept since he was already into Zen, but adds such sessions, “create a very safe environment in which to think about one’s personal values.”

Krasner highly recommends meditation, but if that’s not your thing, fine. “Exercise, find a hobby,” anything that clears your mind so that you can remember “why you went into medicine in the first place.” For the radiologist who dreads looking at one more mammogram, instead remember the miracle that gives you that film and how you can help someone’s life with it.

Church refers to a note from a grateful patient, the kind that she says, “wipes out 10 nasty things.” She also takes time to truly appreciate the stunning sunrises from her windows overlooking Lake Michigan.

Concludes LoPreiato, “Too many physicians focus on their trials and tribulations. You have to focus on the joy of a kid’s face when he sees you, the trust of your patients. That’s priceless.” g