Illustration Healing the Healers

Preventing Burnout: When Physicians Reap the Benefits of Mental Training

More than ever, doctors are faced with difficult working conditions that negatively affect their psychophysical balance and their motivation to practice their profession. To avoid succumbing to these difficulties, it has become essential to learn how to strengthen mental skills to better manage non-constructive thoughts, emotions and behaviors. This is the story of a pilot training course developed for the Local Health Unit of Tuscany.

A challenging social and health situation

We are at a time when the term “resilience” has begun to evoke an aversion among people experiencing difficulties in their working lives. The development of resilience is increasingly seen as a new attempt by organizations to shirk their responsibilities by transferring them to the adaptive capacity of individuals, while changes in work systems and cultures have become essential to enable people to continue to love their profession and to practice it under acceptable conditions.

Developing resilience does not mean accepting or submitting to a context of which we disapprove.

And yet, while this reaction may have some legitimacy, it is far more damaging to the individual than it appears, because being able to live better in the face of difficulties does not mean accepting or submitting to what we disapprove of – quite the opposite. Whether professional contexts evolve or not, by developing resilience, the individual gives himself the capacity to be less emotionally affected, thus protecting his professional capacities and his personal life, while maintaining a mind better able to make the right decisions in the face of problems to be solved.

A harmful and global emotional contagion that leads to a deterioration in the quality of human relations.

The pandemic years have exacerbated the poor service rendered to the healthcare sector in previous years (budget cuts, staff shortages, heavy bureaucracy and a general deterioration in working conditions), and today the sheer number of daily patients is putting more strain than ever on time management, human relations and the ability of health professionals to do their job properly. In addition, there is a kind of pernicious and global emotional contagion that leads to a marked deterioration in the quality of human relations, with widespread incivility in behavior and speech, even to the point of physical aggression.

We live in a society that increasingly fosters obsessive narcissism, the need for instant gratification, and the propensity to find external culprits when things don’t go as expected. We no longer take responsibility for our own frustration; it is necessarily the cause of others.

High levels of stress and fatigue have a major impact on the professional activities, personal lives and health of practitioners.

The medical and healthcare professions, as well as other key professions such as teachers, have lost the social respect they deserve and now find themselves competing with the knowledge of the Internet and social media, which are irrationally considered more reliable and make everyone believe that they are becoming professionals in everything they do.

These are all objective and serious factors that cause physicians to shun their profession and public service to an extent that cannot be ignored. In this context, the stigmatization of individual difficulties is certainly an approach that should not be followed. Nevertheless, the reality on the ground is inescapable: high levels of stress and fatigue have a major impact on the professional, personal, and health of physicians, with burnout being a particularly serious and unacceptable situation in the most severe cases.

Mental skills no longer to be neglected

Healthcare professionals are men and women who have chosen a noble and difficult commitment, but they are not invincible, because human beings, no matter how intelligent and sensible, have their limits. Those who care for others, like everyone else, need to learn to master and transform unconstructive mental attitudes and impulsive behaviors.

Learning to identify and manage the suffering caused by our thoughts and difficult emotions in a lucid and effective way.

This is why it has become essential to consider the many benefits that healthcare professionals can derive from specific mental training that complements the human qualities and skillset of each individual.

Unlike Chiron1In Greek mythology, Chiron is the wisest of the centaurs. Son of Cronos (in the form of a horse) and the oceanid Philyra, he is best known as the teacher of the gods and young heroes (including Achilles). He mastered the art of medicine, which he introduced to Asclepius, as well as the knowledge of herbs. Accidentally wounded by an arrow fired by Heracles, Chiron suffered excruciating pain from the wound, which could not be healed. Though immortal, he asked Zeus for death, which he granted after bequeathing his immortality to Prometheus. Zeus honored him by placing him in the sky as the constellation Centaurus., who in Greek mythology gave up his immortality in order to stop suffering from a poisoned wound, we can learn to identify and deal in a clear and effective way with the suffering caused by our thoughts and difficult emotions through mindfulness training based on knowledge and practices that have been widely validated and adapted to modern professional contexts.

It’s time to challenge the heroic cultural framework that demands a kind of vocation to social martyrdom from caregivers, and to offer them the opportunity to learn in a structured way how to train the mind to cultivate and maintain a good level of well-being, even in the face of the complexity and difficulty of professional life.

Specific training for doctors

In this context, at the suggestion and under the scientific direction of Dr. Paola Squilloni, the Local Health Unit of Tuscany decided to experiment with this possibility by asking us to develop a training course entitled “Prevention of Burnout: Focus on Mindfulness and Stress Management”, lasting 18 hours spread over 6 weeks and aimed at general practitioners. Despite the fact that this type of training is not yet widely available in the Italian medical world, the extreme speed with which all the places were booked demonstrated the real need for these tools.

Mental and emotional skills, although simple to understand, are not easy to acquire because they cannot be assimilated through simple intellectual understanding.

Over the weeks, participants gradually learned to stabilize their attention and cultivate awareness of the signals coming from their bodies, thoughts and emotions in order to better regulate them. Beginning with an analysis of the cultural and cognitive distortions that influence subjective well-being, the course began to lay the groundwork for identifying, reducing or eliminating toxic behaviors and mental attitudes, while cultivating and strengthening those that are healthy and constructive. Methods for increasing awareness of emotional responses were also covered, as well as a wide range of strategies for coping with stress and anxiety. The meditative practices shared not only reduce mental rumination and empathic exhaustion, but also strengthen inner resources by replacing the tendency toward perfectionism with self-kindness, fully savoring positive experiences, and reconnecting with values and aspirations.

However, the mental and emotional skills discussed in this course, while simple to understand, are not easy to acquire because they cannot be assimilated through simple intellectual understanding. While a knowledge base is important, the ability to appreciate its most authentic effects necessarily involves personal mental and physical experience. To explain this difficulty, we can use the analogy of someone who has tasted an extraordinary dish and would like to recount the experience. Even if it is described in the finest prose, no one in the audience will be able to approximate the experience. It’s the same with mental training: it’s impossible to grasp the benefits without personal commitment and practice from session to session.

100% of people satisfied and very satisfied

For us, it was in many ways a particularly stimulating and enjoyable course, which turned some initial (healthy) skepticism among participants into an extremely high level of satisfaction (88.2% very satisfied and 11.8% satisfied in the final evaluation questionnaire). This encourages us to maintain the motivation, commitment and richness of the content we have developed and shared.

Everyone who participated in the training was curious and open to understand and experience something new. As the weeks went by, we observed more serenity, more good humor, and a growing interest in learning, reflecting, and experimenting.

The exchanges during the sessions were extremely rich and beneficial, as they allowed everyone to understand that certain difficulties are not only personal, and that in the variety of content offered by the training, everyone could find what they needed.

There’s nothing more satisfying for us than to know that our efforts have been worthwhile. The sympathy, thanks and testimonials we’ve received have strengthened our confidence in the choices we’ve made in designing the course and in the spirit with which we offer it.

The need for a long-term commitment

Of course, this kind of training is only the beginning. It’s an opening, a momentum that needs to be sustained over time to make sense and take root in daily habits. As many participants have expressed this need, it will be a pleasure to develop further training and support opportunities for individual practice. Evaluating the impact of the training over time will be even more interesting.

After this first experience, we look forward to the September edition.

We would like to thank all the physicians who participated in this pilot training for their willingness to experiment with new tools to make their professional and personal lives more serene and balanced.

We wish you all a pleasant summer.

Valentina et Laurent

Modified image. Original image credit: Phillip Dvorak

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