Sunday, September 22, 2013

Mindful communication, physician burnout, and patient satisfaction

Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published this month in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful and nonjudgmental attentiveness to one's own experience, thoughts, and feelings," is being increasingly recognized as having a protective effect against clinical burnout. In the first study, an abbreviated mindfulness intervention in 30 primary care clinicians was associated with reduced burnout and improved measures of mental health 9 months later. In the second study, clinicians with higher self-rated mindfulness were found to engage in more patient-centered communication and have higher patient satisfaction scores.

These studies are particularly important to family physicians like me because other surveys have shown that we (and general internists and emergency physicians) are at much greater risk of experiencing early career burnout than other medical specialists. This isn't only a professional issue, it's a public health issue; since the U.S. primary care shortage is expected to worsen over the next decade due to low student interest, health insurance expansion, and population growth, we need "all hands on deck" now more than ever. (I'll tackle the issue of credentialing primary care nurse practitioners in a future post, but for now suffice to say that at best this is only part of the solution.)

Not long ago, to fulfill the requirements for a Master of Public Health degree, I reviewed the limited literature on interventions to reduce burnout and improve well-being in primary care physicians. The structured abstract is below, full paper available upon request.

Background: Burnout in primary care physicians may have negative effects on personal health and patient care.

Purpose: To review the prevalence of burnout in primary care in the U.S. and other Western countries; causes, determinants, and negative effects of burnout in primary care physicians; and interventions to reduce burnout.

Data Sources: Electronic searches of PubMed (2003-present) and hand searches of reference lists of key studies and reviews. The full text of 48 citations was reviewed for randomized controlled trials, cohort and cross-sectional studies, and descriptive studies relevant to one of the content areas. 17 studies were included: 4 on prevalence, 6 on causes, determinants, or negative effects, and 7 on interventions.

Data Synthesis: Burnout consists of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. The risk of burnout is higher in the presence of work overload and perceived lack of control over one’s workload. 46 percent of surveyed U.S. physicians reported at least one symptom of burnout; primary care physicians had among the highest rates. Family physicians from 12 European countries commonly reported emotional exhaustion (43%), depersonalization (35%), and reduced personal accomplishment (32%), with higher rates in younger and male physicians. Burnout was associated with a higher frequency of self-reported difficult patient encounters, but was not associated with medical errors, lower quality of care, or patient dissatisfaction.

Descriptive studies of physicians with reputations for “resilience” identified several themes that may prevent burnout. A multi-component intervention to improve physician control over work environment, staff efficiency, and patient care satisfaction was associated with a statistically significant reduction in emotional exhaustion. Limited evidence exists for the effectiveness of individual-level interventions to reduce burnout. A yearlong continuing medical education course in mindful communication was associated with decreases in all 3 burnout dimensions. Short-term cognitive behavioral interventions reduced emotional exhaustion and general psychological distress.