Finding Balance in Work and

Life

Bill Elder PhD

Professor of Family and Community Medicine

Family Medicine Review Course

November 1 2010

Work-Life Balance

Broad concept closely related

to job satisfaction

Proper prioritizing between

work (career and ambition) on one hand and life (pleasure leisure family and spiritual development) on the other

Large individual componentndash Definitely not an ldquoequal distributionrdquo

ndash Not a one size fits all solution

ndash Meaning each individuals needs experiences and goals define the balance

Work-Life Balance

We take life so seriously that there is nothing

to fill our leisure hours during our working

years and when retirement comes we have

nothing to enjoy

CH Mayo 1935

Work-Life Balance

Engrossed late and soon in professional cares

you may so lay waste your powers that

you may find too late with hearts given

away that there is no place in your habit-

stricken souls for those gentler influences

which make your life worth living

Sir William Osler

Work-Life Balance

Difficulty balancing personal and

professional lives is a major contributor to

physician distress

Whippen Canellos Burnout syndrome in the practice of oncology results of a random

survey of 1000 oncologists J Clin Oncol 19919(10)1916-20

Ramirez Graham Richards et al Mental Health of hospital consultants the effects of

stress and satisfaction at work Lancet 1996347(9003)724-8

Kuerer Eberlein Pollock et al Career satisfaction practice patterns and burnout

among surgical oncologists report on the quality of life of members of the Society of

Surgical Oncology Ann Surg Oncol 200714(11)3043-53

Campbell Sonnad Eckhauser et al Burnout among American surgeons Surgery

2001130(4)696-702 discussion 702-5

Geurts Rutte Peeters Antecedents and consequences of work-home interference

among medical residents Soc Sci Med 199948(9)1135

Work-Life Balance New Challenges

Insurance and referral forms

Rapidly expanding body of medical

knowledge

Credentialing requirements

EMRs-15 more time

Shrinking of life Web-based care

Reimbursement for email based care

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance

Broad concept closely related

to job satisfaction

Proper prioritizing between

work (career and ambition) on one hand and life (pleasure leisure family and spiritual development) on the other

Large individual componentndash Definitely not an ldquoequal distributionrdquo

ndash Not a one size fits all solution

ndash Meaning each individuals needs experiences and goals define the balance

Work-Life Balance

We take life so seriously that there is nothing

to fill our leisure hours during our working

years and when retirement comes we have

nothing to enjoy

CH Mayo 1935

Work-Life Balance

Engrossed late and soon in professional cares

you may so lay waste your powers that

you may find too late with hearts given

away that there is no place in your habit-

stricken souls for those gentler influences

which make your life worth living

Sir William Osler

Work-Life Balance

Difficulty balancing personal and

professional lives is a major contributor to

physician distress

Whippen Canellos Burnout syndrome in the practice of oncology results of a random

survey of 1000 oncologists J Clin Oncol 19919(10)1916-20

Ramirez Graham Richards et al Mental Health of hospital consultants the effects of

stress and satisfaction at work Lancet 1996347(9003)724-8

Kuerer Eberlein Pollock et al Career satisfaction practice patterns and burnout

among surgical oncologists report on the quality of life of members of the Society of

Surgical Oncology Ann Surg Oncol 200714(11)3043-53

Campbell Sonnad Eckhauser et al Burnout among American surgeons Surgery

2001130(4)696-702 discussion 702-5

Geurts Rutte Peeters Antecedents and consequences of work-home interference

among medical residents Soc Sci Med 199948(9)1135

Work-Life Balance New Challenges

Insurance and referral forms

Rapidly expanding body of medical

knowledge

Credentialing requirements

EMRs-15 more time

Shrinking of life Web-based care

Reimbursement for email based care

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance

We take life so seriously that there is nothing

to fill our leisure hours during our working

years and when retirement comes we have

nothing to enjoy

CH Mayo 1935

Work-Life Balance

Engrossed late and soon in professional cares

you may so lay waste your powers that

you may find too late with hearts given

away that there is no place in your habit-

stricken souls for those gentler influences

which make your life worth living

Sir William Osler

Work-Life Balance

Difficulty balancing personal and

professional lives is a major contributor to

physician distress

Whippen Canellos Burnout syndrome in the practice of oncology results of a random

survey of 1000 oncologists J Clin Oncol 19919(10)1916-20

Ramirez Graham Richards et al Mental Health of hospital consultants the effects of

stress and satisfaction at work Lancet 1996347(9003)724-8

Kuerer Eberlein Pollock et al Career satisfaction practice patterns and burnout

among surgical oncologists report on the quality of life of members of the Society of

Surgical Oncology Ann Surg Oncol 200714(11)3043-53

Campbell Sonnad Eckhauser et al Burnout among American surgeons Surgery

2001130(4)696-702 discussion 702-5

Geurts Rutte Peeters Antecedents and consequences of work-home interference

among medical residents Soc Sci Med 199948(9)1135

Work-Life Balance New Challenges

Insurance and referral forms

Rapidly expanding body of medical

knowledge

Credentialing requirements

EMRs-15 more time

Shrinking of life Web-based care

Reimbursement for email based care

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance

Engrossed late and soon in professional cares

you may so lay waste your powers that

you may find too late with hearts given

away that there is no place in your habit-

stricken souls for those gentler influences

which make your life worth living

Sir William Osler

Work-Life Balance

Difficulty balancing personal and

professional lives is a major contributor to

physician distress

Whippen Canellos Burnout syndrome in the practice of oncology results of a random

survey of 1000 oncologists J Clin Oncol 19919(10)1916-20

Ramirez Graham Richards et al Mental Health of hospital consultants the effects of

stress and satisfaction at work Lancet 1996347(9003)724-8

Kuerer Eberlein Pollock et al Career satisfaction practice patterns and burnout

among surgical oncologists report on the quality of life of members of the Society of

Surgical Oncology Ann Surg Oncol 200714(11)3043-53

Campbell Sonnad Eckhauser et al Burnout among American surgeons Surgery

2001130(4)696-702 discussion 702-5

Geurts Rutte Peeters Antecedents and consequences of work-home interference

among medical residents Soc Sci Med 199948(9)1135

Work-Life Balance New Challenges

Insurance and referral forms

Rapidly expanding body of medical

knowledge

Credentialing requirements

EMRs-15 more time

Shrinking of life Web-based care

Reimbursement for email based care

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance

Difficulty balancing personal and

professional lives is a major contributor to

physician distress

Whippen Canellos Burnout syndrome in the practice of oncology results of a random

survey of 1000 oncologists J Clin Oncol 19919(10)1916-20

Ramirez Graham Richards et al Mental Health of hospital consultants the effects of

stress and satisfaction at work Lancet 1996347(9003)724-8

Kuerer Eberlein Pollock et al Career satisfaction practice patterns and burnout

among surgical oncologists report on the quality of life of members of the Society of

Surgical Oncology Ann Surg Oncol 200714(11)3043-53

Campbell Sonnad Eckhauser et al Burnout among American surgeons Surgery

2001130(4)696-702 discussion 702-5

Geurts Rutte Peeters Antecedents and consequences of work-home interference

among medical residents Soc Sci Med 199948(9)1135

Work-Life Balance New Challenges

Insurance and referral forms

Rapidly expanding body of medical

knowledge

Credentialing requirements

EMRs-15 more time

Shrinking of life Web-based care

Reimbursement for email based care

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance New Challenges

Insurance and referral forms

Rapidly expanding body of medical

knowledge

Credentialing requirements

EMRs-15 more time

Shrinking of life Web-based care

Reimbursement for email based care

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance

A large number of physicians now choose a

specialty based on how well it fits with their

personal life rather than on how well it

aligns with their professional interests or the

needs of society

Dorsey Jarjoura Rutecki Influence of controllable lifestyle on recent trends in specialty

choice byUS medical students JAMA 2003290(9)1173-8

Lind Cendan Two decades of student career choice at the University of Florida increasingly a

lifestyle decision Am Surg 2003(1)6953-5

Newton Grayson Thompson The variable influence of lifestyle and income on medical

studentsrsquo career specialty choices data from two US medical schools 1998-2004

Acad Med 200580(9)809

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Stress and the Practice of

Medicine

One third of physicians experience burnout at

any given point in time

Manifestations of physician distress include

anxiety burnout depression fatigue and

broken or strained relationships

Burnout and distress may have adverse effects

on quality of care patient satisfaction and

compliance and the frequency of medical

errors and malpractice claims

Shanafelt TD Sloan JA Habermann TM The well-being

of physicians Am J Med 2003114(6)513-7

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Workplace Stress and Burnout

bull Employee stress is recognized as a major drain

on corporate productivity and competitiveness

bull $300 billion $7500 per employee is spent

annually in the U S on stress related

compensation claims reduced productivity

absenteeism health insurance cost direct

medical expenses and employee turnover

bull Job burnout experienced by 25 to 40 of

workers in the US

bull Anxietydepression is the leading occupational

disease of the 21st Century responsible for more

days lost than any other single factor

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Provider Burnout

ndash 49 of female physicians reported high

stress levels

ndash 44 of female physicians felt mentally tired

ndash 17 of female physicians took

antidepressants

J Womens Health Gend Based Med 2000 9(2)185-90

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Provider Burnout

Internal Medicine Journal 2005 35(5)272-27828 experienced high levels of two or three aspects of

burnout (emotional exhaustion depersonalization low personal accomplishment)

Swiss Med Wkly 2005 Feb 19135(7-8)101-8 19 had a high score for emotional exhaustion 22 had

a high score for depersonalizationcynicism and 16 had a low score for professional accomplishment 32 had a high score on either the emotional exhaustion or the depersonalizationcynicism scale (moderate degree of burnout) and 4 had scores in the range of burnout in all three scales (high degree of burnout)

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Work-Life Balance

Common Stressors in Medical

Care

Frequently work nights weekends and holidays

Often must be available by pager

Too much contact with patients Lack of time outs

Inherent uncertainty involved in patient care

Dealing with life and death

Limited access to social-professional support systems

Limited time and place to share personal feelings with colleagues

Inadequate training for ldquodealing withrdquo people

Feeling indespensible

Drudgery-repetitive single tasks

High earnings

Chronic fatigue

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

MENTAL SIGNS OF DISTRESSDistressed worried upset tearful deflated feelings of helplessness amp hopelessness unable to cope anxious depressed

Impatient easily irritated angry hostile aggressive

Frustrated bored inadequate guilty neglected insecure vulnerable

Loss of interest in appearance health diet sex low self-esteem

Polyphasic (too many things at once) rushed

Failing to finish tasks

Difficulty thinking clearly concentrating making decisions forgetful lack of creativity irrational procrastinating

Hypercritical inflexible unreasonable over-reactive non-productive

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Compassion fatigue

A state experienced by those helping people in distress it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper

The helper in contrast to the person(s) being helped is traumatized or suffers through the helpers own efforts to empathize and be compassionate Often this leads to poor self care and extreme self sacrifice in the process of helping

Figley C Medscape 2005

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

What Is Stress

bull Process through which some stimulus or

change can result in long-term debilitation

bull Involves arousal response AKA ldquofight or

flightrdquo

bull The arousal response attempts to return

organism to equilibrium

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Stress is largely related to perceived threat

Perceived demand

- Perceived resources

= Perceived threat

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Stress Cycle

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Do clinicians have a different

personality

Resilience

Control

Competency

Challenge

Boredom the desire for desires

Leo Tolstoy

Boredom the desire for desires

Leo Tolstoy

Yerkes-Dodson Law

Arousal Performance Curve

H

Per

form

an

ce

L

L

H

ldquoUnmotivatedrdquo ldquoStress impairedrdquo

Zone of

maximum

performance

Balancing a Full Platter

Balance is experienced differently by everyone

and can be identified by some or all of the

following

bull Having time for life and work

bull Enjoying your family and social situations

bull Experiencing leisure

bull Peace of mind

bullOpportunity to grow

bullFinding satisfaction and sense of purpose in

your work

Importance of Sense of Purpose in

Life

Finding what you love to do the most living

with passion

About being in tune with who you really are

and living a life of meaning

Almost like a spiritual experience

Finding Purpose and Meaning in

Work and Life

For physicians helping and being of service

to others has particular meaning and leads

to a high level of personal satisfaction

Meaningful work is characterized by a sense

that the best within you is called upon each

day

Finding Purpose and Meaning in

Work and Life

Set aside four hours of uninterrupted time to

reflect

Indentify your five most important priorities

Rate how satisfying you find each priority

Indentify why these are satisfying Why are they

meaningful or important to you

Commit to spending more time with each priority

Time Management

Set boundaries between work and homendash Make your preferences clear

ndash Do not make your activities fit your time

ndash Negotiate product Do not evaluate your self on amount of time at work

Decide whether you are effective at time managementndash Reread Seven Habits of Highly Effective People by S Covey

bull Beginning with the end in mind

bull Sharpening the stone

bull Prioritizing demands

Balancing a Full Platter

Balance is experienced differently by everyone

and can be identified by some or all of the

following

bull Having time for life and work

bull Enjoying your family and social situations

bull Experiencing leisure

bull Peace of mind

bullOpportunity to grow

bullFinding satisfaction and sense of purpose in

your work

Importance of Sense of Purpose in

Life

Finding what you love to do the most living

with passion

About being in tune with who you really are

and living a life of meaning

Almost like a spiritual experience

Finding Purpose and Meaning in

Work and Life

For physicians helping and being of service

to others has particular meaning and leads

to a high level of personal satisfaction

Meaningful work is characterized by a sense

that the best within you is called upon each

day

Finding Purpose and Meaning in

Work and Life

Set aside four hours of uninterrupted time to

reflect

Indentify your five most important priorities

Rate how satisfying you find each priority

Indentify why these are satisfying Why are they

meaningful or important to you

Commit to spending more time with each priority

Time Management

Set boundaries between work and homendash Make your preferences clear

ndash Do not make your activities fit your time

ndash Negotiate product Do not evaluate your self on amount of time at work

Decide whether you are effective at time managementndash Reread Seven Habits of Highly Effective People by S Covey

bull Beginning with the end in mind

bull Sharpening the stone

bull Prioritizing demands

Importance of Sense of Purpose in

Life

Finding what you love to do the most living

with passion

About being in tune with who you really are

and living a life of meaning

Almost like a spiritual experience

Finding Purpose and Meaning in

Work and Life

For physicians helping and being of service

to others has particular meaning and leads

to a high level of personal satisfaction

Meaningful work is characterized by a sense

that the best within you is called upon each

day

Finding Purpose and Meaning in

Work and Life

Set aside four hours of uninterrupted time to

reflect

Indentify your five most important priorities

Rate how satisfying you find each priority

Indentify why these are satisfying Why are they

meaningful or important to you

Commit to spending more time with each priority

Time Management

Set boundaries between work and homendash Make your preferences clear

ndash Do not make your activities fit your time

ndash Negotiate product Do not evaluate your self on amount of time at work

Decide whether you are effective at time managementndash Reread Seven Habits of Highly Effective People by S Covey

bull Beginning with the end in mind

bull Sharpening the stone

bull Prioritizing demands

Finding Purpose and Meaning in

Work and Life

For physicians helping and being of service

to others has particular meaning and leads

to a high level of personal satisfaction

Meaningful work is characterized by a sense

that the best within you is called upon each

day

Finding Purpose and Meaning in

Work and Life

Set aside four hours of uninterrupted time to

reflect

Indentify your five most important priorities

Rate how satisfying you find each priority

Indentify why these are satisfying Why are they

meaningful or important to you

Commit to spending more time with each priority

Time Management

Set boundaries between work and homendash Make your preferences clear

ndash Do not make your activities fit your time

ndash Negotiate product Do not evaluate your self on amount of time at work

Decide whether you are effective at time managementndash Reread Seven Habits of Highly Effective People by S Covey

bull Beginning with the end in mind

bull Sharpening the stone

bull Prioritizing demands

Finding Purpose and Meaning in

Work and Life

Set aside four hours of uninterrupted time to

reflect

Indentify your five most important priorities

Rate how satisfying you find each priority

Indentify why these are satisfying Why are they

meaningful or important to you

Commit to spending more time with each priority

Time Management

Set boundaries between work and homendash Make your preferences clear

ndash Do not make your activities fit your time

ndash Negotiate product Do not evaluate your self on amount of time at work

Decide whether you are effective at time managementndash Reread Seven Habits of Highly Effective People by S Covey

bull Beginning with the end in mind

bull Sharpening the stone

bull Prioritizing demands

Time Management

Set boundaries between work and homendash Make your preferences clear

ndash Do not make your activities fit your time

ndash Negotiate product Do not evaluate your self on amount of time at work

Decide whether you are effective at time managementndash Reread Seven Habits of Highly Effective People by S Covey

bull Beginning with the end in mind

bull Sharpening the stone

bull Prioritizing demands

Organizational policies

The mission and policies of health care organizations may relate to physician satisfaction

ndash Opportunities for Professional Development

ndash Challenges Commensurate with Skills Interests and Resources

ndash A Culture that Values and Encourages Life Outside of Work

ndash A Culture that Cultivates Professionalism and Professional Satisfaction

Integrating work and home

Talk to your children about why you do

what you do

Bring them to work as soon as you can and

in developmentally appropriate ways

Avoid talking about the wrong things

The Medical Marriage

bullOne physician couple

traditional

bullOne physician couple

non traditional

bullThe two physician couple

bullThe retiring physician

Stress Management

Think Differently

bullAwareness is the key to managing stress

bullEveryone has their own unique

--Responses to stress

--Potential stressors

--Thoughts and subsequent feelings

associated with those stressors

--Symptoms that followEveryone thinks of changing the world but no one

thinks of changing himself

Leo Tolstoy

Integrating work and home

Talk to your children about why you do

what you do

Bring them to work as soon as you can and

in developmentally appropriate ways

Avoid talking about the wrong things

The Medical Marriage

bullOne physician couple

traditional

bullOne physician couple

non traditional

bullThe two physician couple

bullThe retiring physician

Stress Management

Think Differently

bullAwareness is the key to managing stress

bullEveryone has their own unique

--Responses to stress

--Potential stressors

--Thoughts and subsequent feelings

associated with those stressors

--Symptoms that followEveryone thinks of changing the world but no one

thinks of changing himself

Leo Tolstoy

The Medical Marriage

bullOne physician couple

traditional

bullOne physician couple

non traditional

bullThe two physician couple

bullThe retiring physician

Stress Management

Think Differently

bullAwareness is the key to managing stress

bullEveryone has their own unique

--Responses to stress

--Potential stressors

--Thoughts and subsequent feelings

associated with those stressors

--Symptoms that followEveryone thinks of changing the world but no one

thinks of changing himself

Leo Tolstoy

Stress Management

Think Differently

bullAwareness is the key to managing stress

bullEveryone has their own unique

--Responses to stress

--Potential stressors

--Thoughts and subsequent feelings

associated with those stressors

--Symptoms that followEveryone thinks of changing the world but no one

thinks of changing himself

Leo Tolstoy

Stress Management

The Here and Now

The Top Stress Reducer

bullStop feeling guilty about the past

bullStop worrying about the future

bullLive life in the Present

If you want to be happy be

Leo Tolstoy

Stress Management Mind-Body

Techniques

Relaxation

Generally shifts the sympathetic toward the

parasympathetic

ndash Heart rate blood pressure generally decrease

ndash Vaso-constriction to vaso-dilation

ndash Mechanisms appear mediated in part by shift to NO

production(1)

1 Zen Meditation increased serum NO ndash Prog Neuro-

Psychopharm Biol Psy 2005 29327-331

Primary goal elicitation of a psychophysiological state of

hypoarousal or relaxation

Mind-Body Techniques

Hypnosis

ndash Natural state of aroused attentive focal

concentration coupled with a relative suspension of

peripheral awareness

Biofeedback

ndash Devices that amplify physiological processes (eg

blood pressure muscle activity) that are ordinarily

difficult to perceive ndash electromyographic

biofeedback temperature biofeedback

Astin Shapiro Eisenberg Mind-Body Medicine

State of the Science Implications for Practice

JABFP 2002

Mind-Body Techniques

Guided imagery

ndash Generation of mental images ndash evoke a

psychophysiological state of relaxation

Meditation

ndash Intentional self-regulation of attention Systematic

mental focus on particular aspects of inner thoughts

Two most extensively researched transcendental

meditaion mindfulness meditation

Astin Shapiro Eisenberg Mind-Body Medicine

State of the Science Implications for Practice

JABFP 2002

Mind-Body Medicine State of the Science

Implications for Practice Clinical

condition

Evidence

level

Evidence Source Practice Implications

After myocardial

infarction

Strong Two positive meta-

analyses (12879)

Self-regulation skills such as

relaxation and the management

of anger hostility and general

stress reactivity

Cancer

symptoms

(disease and

treatment related)

Strong Two positive meta-

analyses (~6166)

Adjunctive therapy ndash efficacy in

improving mood quality of life

and coping with both the disease

and treatment-related side effects

Surgical

outcomes

Strong Two positive meta-

analyses (~6904)

Presurgical preparation

Headache Strong Two positive meta-

analyses (~3083)

Relaxation thermal biofeedback

recurrent migraine ndash relaxation

or muscle biofeedback

adjunctive or standalone

tension headache

Hypertension Moderate Positive results from 1

meta-analysis (1651) -

- contradictory findings

in 2 others

Multi-component ndash useful

adjuncts in the medical

management of hypertension

Mindfulness Practice

Characteristics

ndash Active observation of oneself

ndash Increased peripheral vision

ndash Presence-Being in the here and now

ndash Critical curiosity

ndash Courage to see the world as it is rather than as one perceives it to be

bull Adoption of a beginnerrsquos mind ndash continuing to see things as new

ndash Humility to tolerate onersquos areas of incompetence

ndash Compassion based on insight

Meditation Practice - Instructions

Sit comfortably

Pay attention to being centered

Eyes half closed or open ndash gently focus on object about 6 feet away

Mouth slightly open

Begin awareness of out breath (exhaling)

Note precise beginning of out breath stay with it as if riding the outgoing tide

Note gap at end of out breath just before inhaling

Let in-breath happen naturally ndash abdominal breathing ndash note the tummy rising

Repeat out breath practice

Any time practicing is worthwhile

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

Mind-Body Techniques

Hypnosis

ndash Natural state of aroused attentive focal

concentration coupled with a relative suspension of

peripheral awareness

Biofeedback

ndash Devices that amplify physiological processes (eg

blood pressure muscle activity) that are ordinarily

difficult to perceive ndash electromyographic

biofeedback temperature biofeedback

Astin Shapiro Eisenberg Mind-Body Medicine

State of the Science Implications for Practice

JABFP 2002

Mind-Body Techniques

Guided imagery

ndash Generation of mental images ndash evoke a

psychophysiological state of relaxation

Meditation

ndash Intentional self-regulation of attention Systematic

mental focus on particular aspects of inner thoughts

Two most extensively researched transcendental

meditaion mindfulness meditation

Astin Shapiro Eisenberg Mind-Body Medicine

State of the Science Implications for Practice

JABFP 2002

Mind-Body Medicine State of the Science

Implications for Practice Clinical

condition

Evidence

level

Evidence Source Practice Implications

After myocardial

infarction

Strong Two positive meta-

analyses (12879)

Self-regulation skills such as

relaxation and the management

of anger hostility and general

stress reactivity

Cancer

symptoms

(disease and

treatment related)

Strong Two positive meta-

analyses (~6166)

Adjunctive therapy ndash efficacy in

improving mood quality of life

and coping with both the disease

and treatment-related side effects

Surgical

outcomes

Strong Two positive meta-

analyses (~6904)

Presurgical preparation

Headache Strong Two positive meta-

analyses (~3083)

Relaxation thermal biofeedback

recurrent migraine ndash relaxation

or muscle biofeedback

adjunctive or standalone

tension headache

Hypertension Moderate Positive results from 1

meta-analysis (1651) -

- contradictory findings

in 2 others

Multi-component ndash useful

adjuncts in the medical

management of hypertension

Mindfulness Practice

Characteristics

ndash Active observation of oneself

ndash Increased peripheral vision

ndash Presence-Being in the here and now

ndash Critical curiosity

ndash Courage to see the world as it is rather than as one perceives it to be

bull Adoption of a beginnerrsquos mind ndash continuing to see things as new

ndash Humility to tolerate onersquos areas of incompetence

ndash Compassion based on insight

Meditation Practice - Instructions

Sit comfortably

Pay attention to being centered

Eyes half closed or open ndash gently focus on object about 6 feet away

Mouth slightly open

Begin awareness of out breath (exhaling)

Note precise beginning of out breath stay with it as if riding the outgoing tide

Note gap at end of out breath just before inhaling

Let in-breath happen naturally ndash abdominal breathing ndash note the tummy rising

Repeat out breath practice

Any time practicing is worthwhile

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

Mind-Body Techniques

Guided imagery

ndash Generation of mental images ndash evoke a

psychophysiological state of relaxation

Meditation

ndash Intentional self-regulation of attention Systematic

mental focus on particular aspects of inner thoughts

Two most extensively researched transcendental

meditaion mindfulness meditation

Astin Shapiro Eisenberg Mind-Body Medicine

State of the Science Implications for Practice

JABFP 2002

Mind-Body Medicine State of the Science

Implications for Practice Clinical

condition

Evidence

level

Evidence Source Practice Implications

After myocardial

infarction

Strong Two positive meta-

analyses (12879)

Self-regulation skills such as

relaxation and the management

of anger hostility and general

stress reactivity

Cancer

symptoms

(disease and

treatment related)

Strong Two positive meta-

analyses (~6166)

Adjunctive therapy ndash efficacy in

improving mood quality of life

and coping with both the disease

and treatment-related side effects

Surgical

outcomes

Strong Two positive meta-

analyses (~6904)

Presurgical preparation

Headache Strong Two positive meta-

analyses (~3083)

Relaxation thermal biofeedback

recurrent migraine ndash relaxation

or muscle biofeedback

adjunctive or standalone

tension headache

Hypertension Moderate Positive results from 1

meta-analysis (1651) -

- contradictory findings

in 2 others

Multi-component ndash useful

adjuncts in the medical

management of hypertension

Mindfulness Practice

Characteristics

ndash Active observation of oneself

ndash Increased peripheral vision

ndash Presence-Being in the here and now

ndash Critical curiosity

ndash Courage to see the world as it is rather than as one perceives it to be

bull Adoption of a beginnerrsquos mind ndash continuing to see things as new

ndash Humility to tolerate onersquos areas of incompetence

ndash Compassion based on insight

Meditation Practice - Instructions

Sit comfortably

Pay attention to being centered

Eyes half closed or open ndash gently focus on object about 6 feet away

Mouth slightly open

Begin awareness of out breath (exhaling)

Note precise beginning of out breath stay with it as if riding the outgoing tide

Note gap at end of out breath just before inhaling

Let in-breath happen naturally ndash abdominal breathing ndash note the tummy rising

Repeat out breath practice

Any time practicing is worthwhile

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

Mind-Body Medicine State of the Science

Implications for Practice Clinical

condition

Evidence

level

Evidence Source Practice Implications

After myocardial

infarction

Strong Two positive meta-

analyses (12879)

Self-regulation skills such as

relaxation and the management

of anger hostility and general

stress reactivity

Cancer

symptoms

(disease and

treatment related)

Strong Two positive meta-

analyses (~6166)

Adjunctive therapy ndash efficacy in

improving mood quality of life

and coping with both the disease

and treatment-related side effects

Surgical

outcomes

Strong Two positive meta-

analyses (~6904)

Presurgical preparation

Headache Strong Two positive meta-

analyses (~3083)

Relaxation thermal biofeedback

recurrent migraine ndash relaxation

or muscle biofeedback

adjunctive or standalone

tension headache

Hypertension Moderate Positive results from 1

meta-analysis (1651) -

- contradictory findings

in 2 others

Multi-component ndash useful

adjuncts in the medical

management of hypertension

Mindfulness Practice

Characteristics

ndash Active observation of oneself

ndash Increased peripheral vision

ndash Presence-Being in the here and now

ndash Critical curiosity

ndash Courage to see the world as it is rather than as one perceives it to be

bull Adoption of a beginnerrsquos mind ndash continuing to see things as new

ndash Humility to tolerate onersquos areas of incompetence

ndash Compassion based on insight

Meditation Practice - Instructions

Sit comfortably

Pay attention to being centered

Eyes half closed or open ndash gently focus on object about 6 feet away

Mouth slightly open

Begin awareness of out breath (exhaling)

Note precise beginning of out breath stay with it as if riding the outgoing tide

Note gap at end of out breath just before inhaling

Let in-breath happen naturally ndash abdominal breathing ndash note the tummy rising

Repeat out breath practice

Any time practicing is worthwhile

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

Mindfulness Practice

Characteristics

ndash Active observation of oneself

ndash Increased peripheral vision

ndash Presence-Being in the here and now

ndash Critical curiosity

ndash Courage to see the world as it is rather than as one perceives it to be

bull Adoption of a beginnerrsquos mind ndash continuing to see things as new

ndash Humility to tolerate onersquos areas of incompetence

ndash Compassion based on insight

Meditation Practice - Instructions

Sit comfortably

Pay attention to being centered

Eyes half closed or open ndash gently focus on object about 6 feet away

Mouth slightly open

Begin awareness of out breath (exhaling)

Note precise beginning of out breath stay with it as if riding the outgoing tide

Note gap at end of out breath just before inhaling

Let in-breath happen naturally ndash abdominal breathing ndash note the tummy rising

Repeat out breath practice

Any time practicing is worthwhile

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

Meditation Practice - Instructions

Sit comfortably

Pay attention to being centered

Eyes half closed or open ndash gently focus on object about 6 feet away

Mouth slightly open

Begin awareness of out breath (exhaling)

Note precise beginning of out breath stay with it as if riding the outgoing tide

Note gap at end of out breath just before inhaling

Let in-breath happen naturally ndash abdominal breathing ndash note the tummy rising

Repeat out breath practice

Any time practicing is worthwhile

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

Meditation Practice (cont)Thoughts will arise

When a thought is noted (you are distracted from your attention on the out breath) label the thought ldquothinkingrdquo and return to your out breath

Do not judge ndash there is no right or wrong way to practice

Accept the impermanent nature of thought

Come back to the out breath

Be gentle with yourself

Check you posture occasionally ndash sit upright

Come back to the out breath

Abide in peace

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

PrayerPick a focus word or short phrase thats firmly rooted in your belief system

Sit quietly in a comfortable position

Close your eyes

Relax your muscles

Breathe slowly and naturally and as you do repeat your focus word phrase or prayer silently to yourself as you exhale

Assume a passive attitude Dont worry about how well you re doing When other thoughts come to mind simply say to yourself Oh well and gently return to the repetition

Continue for ten to twenty minutes

Do not stand immediately Continue sitting quietly for a minute or so allowing other thoughts to return Then open your eyes and sit for another minute before rising

Practice this technique once or twice daily

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

References on Mind-Body

TechniquesJon Kabat-Zinn Full Catastrophe Living Dell Publishing 1990

Esch et al The therapeutic use of the relaxation response in stress-related disease Med Sci Monitor 2003 9(2)RA23-34

Chambers R Campbell I Anxiety and depression in general practitioners associations with type of practice fundholding gender and other personal characteristics Fam Pract 1996 Apr13(2)170-3

Stewart DE Ahmad F Cheung AM Bergman B Dell DL Women physicians and stress J Womens Health Gend Based Med 2000 Mar9(2)185-90

Sutherland VJ Cooper CLRelated Job stress satisfaction and mental health among general practitioners before and after introduction of new contract BMJ 1992 Jun 13304(6841)1545-8

Michels PJ Probst JC Godenick MT Palesch YRelated Anxiety and anger among family practice residents a South Carolina family practice research consortium study Acad Med 2003 Jan78(1)69-79

References

Infante JR Torres-Avisbal M Pinel P Vallejo JA Peran F Gonzalez F Contreras P Pacheco C Roldan A Latre JM Catecholamine levels in practitioners of the transcendental meditation techniquePhysiol Behav 2001 Jan72(1-2)141-6

Miller JJ Fletcher K Kabat-Zinn JRelated Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders Gen Hosp Psychiatry 1995 May17(3)192-200

Esch T Stefano GB Fricchione GL Benson H Links Stress-related diseases -- a potential role for nitric oxideMed Sci Monit 2002 Jun8(6)RA103-18 Review

Gross CR Kreitzer MJ Russas V Treesak C Frazier PA Hertz MIMindfulness meditation to reduce symptoms after organ transplant a pilot study Adv Mind Body Med 2004 Summer20(2)20-9

Waelde LC Thompson L Gallagher-Thompson D A pilot study of a yoga and meditation intervention for dementia caregiver stress J Clin Psychol 2004 Jun60(6)677-87

ndash

Positive Self-Talk

bull I am calm and relaxed

bull I feel peaceful and centered

bull My breathing is deep and regular

bull I have control over how I react to

stressful situations in my life

bull I am worthy and deserving of

happiness