Abstract
The complex problem of clinician distress, a prevalent condition found across the spectrum of health professionals, has deleterious effects on quality of healthcare. Multiple factors contribute to this growing problem, including the increasingly complex nature of the management and organization of medical care delivery. This chapter describes Mindful Practice, an empirically studied educational program designed to enhance well-being, quality of care, and flourishing of physicians. A skills-based training program, Mindful Practice uses the technologies of one’s innate capacity for awareness, faculty to reflect on clinical experiences as narratives, and ability to learn one’s own capacities and strengths in the midst of the challenging dynamics experienced in the practice of medicine. Thus, the contemplative practices, narrative medicine, and appreciative inquiry that are woven into this educational experience energizes physicians and other health professionals through real-life relevance, an increased sense of meaning, and a growing capacity for health professionals to connect meaningfully across the divides that exist between individual clinicians and the organizations of health system delivery. Ultimately, clinician distress calls for an ethical mandate that requires courage and commitment, and eventual transformation, personally and collectively.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
All quotes not otherwise noted in references are from: Mead, J. September 30, 2019. Mindful Practice for Medical Clinicians. https://www.youtube.com/watch?v=MGliZssn-Ps&fbclid=IwAR3ns0U8bfdmjD5lt4MV1i10HEdINYLaD89XkJ3t06hUzUbXUexqKLhEgkQ
References
AAMC. (2018). 2018 update: The complexities of physician supply and demand: Projects from 2016-2030. Washington, DC: Association of American Medical Colleges.
Asuero, A. (2012). Effectiveness of an educational program on mindfulness to reduce burnout and improve empathy in primary care professionals. Barcelona, Spain: Universidad Autónoma de Barcelona.
Beach, M., Roter, D., Korthuis, P., Epstein, R., Sharp, V., Ratanawongsa, N., et al. (2013). A multicenter study of physician mindfulness and health care quality. Annals of Family Medicine, 11(5), 421–428.
Beckman, H., Wendland, M., Mooney, C., Krasner, M., Quill, T., Suchman, A., et al. (2012). The impact of a program in mindful communication on primary care physicians. Academic Medicine, 87(6), 815–819.
Bodenheimer, T. (2006). Primary care—Will it survive? New England Journal of Medicine, 355(9), 861–864.
Charon, R. (2001). Narrative medicine: form, function, and ethics. Annals of Internal Medicine, 134(1), 83–87.
Cooperider, D. (2005). Appreciative inquiry: A positive revolution in change. San Francisco, CA: Berrett-Koehler.
Crosskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78(8), 775–780.
Dewa, C., Loong, D., Bonato, S., & Trojanowski, L. (2016). The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open, 7(6), e015141.
Dierynck, B., Leroy, H., Savage, G., & Choi, E. (2017). The role of individual and collective mindfulness in promoting occupational safety in Health Care. Medical Care Research and Review, 74(1), 79–96.
Dunn, P., Arnetz, B., Christensen, J., & Homer, L. (2007). Meeting the imperative to improve physician wellbeing: assessment of an innovative program. Journal of General Internal Medicine, 22(11), 1544–1552.
Epstein, R. (1999). Mindful practice. Journal of the American Medical Association, 282, 833–839.
Epstein, R. (2014). What will it take for physicians to practice mindfully? Promoting quality of care, quality of caring, resilience, and well-being. In A. Le, C. Ngnoumen, & E. Langer (Eds.), The Wiley Blackwell handbook of mindfulness (1st edn). Hoboken, NJ: Wiley.
Epstein, R. (2017). Attending: Medicine, mindfulness, and humanity. New York: Scribner.
Epstein, R., & Krasner, M. (2017). Mindful practice workshop facilitator manual, 3rd edn. Rochester, NY: University of Rochester School of Medicine and Dentistry.
Freudenberger, H. (1975). The staff burnout syndrome in alternative institutions. Psychotherapy Theory Research and Practice, 12, 72–83.
Kabat-Zinn, J. (2014). Mindfulness and learning: An interdisciplinary symposium. Baltimore, MD: Johns Hopkins University.
Kleinman, A. (2017). The art of medicine: Presence. The Lancet, 2466–2467.
Krasner, M. S. (2016). Teaching health care professionals. In D. McCown, D. Reibel, & M. Micozzi (Eds.), Resources for teaching mindfulness: An international handbook (pp. 391–407). Cham: Springer.
Krasner, M., & Epstein, R. (2010). Mindful communication: Bringing intention, attention, and reflection to clinical practice: Curriculum Guide. Rochester, NY: University of Rochester School of Medicine and Dentistry.
Krasner, M., Epstein, R., Beckman, H., Suchman, A., Mooney, C., & Quill, T. (2009). Association of an educational program in mindful communication with burnout, empathy and attitudes among primary care physicians. Journal of the American Medical Association, 302(12), 1284–1293.
Linzer, M. (2018). Clinician burnout and the quality of care. JAMA Internal Medicine, 178(10), 1331–1332.
Ludwig, D., & Kabat-Zinn, J. (2008). Mindfulness in Medicine. Journal of the American Medical Association, 300(11), 1350–1352.
Maslach, C. (1976). Burned out. Human Behavior, 5, 16–22.
McHugh, M., Kutney-Lee, A., Cimiotti, J., & Sloane, D. A. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2), 202–210.
Montgomery, A. (2014). The inevitability of physician burnout: Implications for interventions. Burnout Research, 1, 50–56.
Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., et al. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. JAMA Internal Medicine, 178(10), 1317–1331.
Shanafelt, T. (2003). The well-being of physicians. American Journal of Medicine, 114(6), 513–519.
Shanafelt, T., & Noseworthy, J. (2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
Shanafelt, T., Boone, S., Tan, L., Dyrbye, L., Sotile, W., Satele, D., et al. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377–1385.
Shanafelt, T., Goh, J., & Sinsky, C. (2017). The business case for investing in physician well-being. JAMA Internal Medicine, 177(12), 1826–1832.
Shanafelt, T., Schein, E., Minor, L., Trockel, M., Schein, P., & Kirch, D. (2019). Healing the professional culture of medicine. Mayo Clinic Proceedings, 94, 81556–81566.
Sibinga, E., & Wu, A. (2010). Clinician mindfulness and patient safety. JAMA, 304(22), 2532-2533.
Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., et al. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753–760.
Sinsky, C., Dyrbye, L. N., West, C., Satele, D., Tutty, M., & Shanafelt, T. (2017). Professional satisfaction and the career plans of US physicians. Mayo Clinic Proceedings, 92(11), 1625–1635.
Tan, C.-M. (2012). Search inside yourself: The unexpected path to achieving success, happiness (and world peace). New York: HarperCollins.
Treadway, K. (2008). The future of primary care: Sustaining relationships. New England Journal of Medicine, 359(25), 2086.
Verghese, A. (2016, October). The importance of being. Health Affairs, 1924–1927.
Vogus, T., & Sutcliffe, K. (2007a). The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Medical Care, 45(10), 997–1002.
Vogus, T., & Sutcliffe, K. (2007b). The safety organizing scale: development and validation of a behavioral measure of safety culture in hospital nursing units. Medical Care, 45(1), 46–54.
West, C., Dyrbye, L. N., & Shanafelt, T. (2018). Physician burnout: contributors, consequences and solutions. Journal of Internal Medicine, 283, 515–529.
Williams, E., Conrad, T., Scheckler, W., Linzer, M., McMurray, J., & Schwartz, M. (2001). Understanding physicians’ intentions to withdraw from practice: The role of job satisfaction, stress, mental and physical health. Health Care Management Review, 26(1), 7–19.
Zuger, J. (2004). Dissatisfaction with medical practice. New England Journal of Medicine, 350(1), 69–75.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Krasner, M.S., Epstein, R. (2020). Mindful Practice: Organizational Change and Health Professional Flourishing Through Cultivating Presence and Courageous Conversations. In: Montgomery, A., van der Doef, M., Panagopoulou, E., Leiter, M.P. (eds) Connecting Healthcare Worker Well-Being, Patient Safety and Organisational Change. Aligning Perspectives on Health, Safety and Well-Being. Springer, Cham. https://doi.org/10.1007/978-3-030-60998-6_15
Download citation
DOI: https://doi.org/10.1007/978-3-030-60998-6_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-60997-9
Online ISBN: 978-3-030-60998-6
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)