We welcome guest blogger Dr. Vijay Pattni, a Clinical Education Fellow who is developing an emerging social initiative to address the issues associated with burnout and improving wellbeing amongst doctors within his trust.
Let’s look at treating doctors with mindfulness because we’re busy, in fact really busy; and stressed.
Focusing on the present moment can seem difficult, even with the best intentions.
As our desire to become involved in everything for everyone, eventually, something’s got to give. We’ve lost touch with being focused on the now and not being distracted and distant in thought.
Here’s how we can define mindfulness:
“Mindfulness is a practice which allows participants to focus attention on the present moment and promotes acceptance of thoughts and feelings without judgement”
‘The benefits of being present: mindfulness and its role in psychological well-being.’ Journal of Personality and Social Psychology.”
We’re often in a psychological position whereby trying to be present and ‘in the moment’ lasts only momentarily before our mind wanders and thoughts begin to penetrate our concentration.
Mindfulness to Treat Patients
Clinically, the National Institute for Health and Care Excellence (NICE) recommends mindfulness-based cognitive therapy (MBCT) for patients as a psychological intervention for prevention of depression.
Mindfulness for the improved health of junior doctors and subsequent impact on patient care is supported by minimal evidence; however, stress experienced by NHS staff on an ongoing basis is at an overwhelming unprecedented level.
Its knock-on effects, down to the quality of patient care and costs to the NHS (for sick leave) is alarming, and at a financial cost of around £2.4bn, it’s something we must address immediately.
How are Junior Doctors Suffering?
Assessing the symptoms of overworked and highly stressed junior doctors is something I take an interest in, as I watch my fellow friends experience what it’s like on the front line in the NHS. It should come as no surprise that the debilitating anti-social hours and the daily grind of pushing through this high-pressure environment are really taking its toll.
For me, it seemed paradoxical that doctors, highly trained in treating and saving the lives of others, were neglecting their very own wellbeing.
There seems to be a culture within medicine where as a doctor you are expected to carry on stoically in the face of such adversities, with the consequence that one’s wellbeing played 2nd fiddle to work.
Clearly, this is not a new dilemma, but this undercurrent of dissatisfaction resurfaced after the junior doctors’ contract negotiations. It simply cannot go on with how things are.
Mindfulness in Medicine
Some of my friends and family had recently completed mindfulness and were very positive about its impact it had on them and on their work-life balance. On first impression, mindfulness seemed to be “another fad” which was going to inevitably fade away in a few years.
Some doctors I speak to when I mention mindfulness are naturally sceptical. However, in light of worsening morale, there had to be a more sustainable solution to this issue, rather than the traditional approach of seeking last-minute help through an educational supervisor or through the deanery.
A Course in Mindfulness
In my quest to go deeper, I approached my Foundation Programme Director and we proposed that using mindfulness in junior doctors could be a novel approach to tackling such issues.
Although we had a small educational budget, we had a team of enthusiastic doctors and mindfulness practitioners to help deliver an 8-week course in mindfulness where we aimed to assess staff well-being.
Mindfulness sessions were carried out in our trust between June – July 2016 and the sessions were delivered by Ridgeway Mindful Psychology (RMP).
The cost of the course was fully subsidised by RMP and the Department for Postgraduate Medical Education for 8 participants.
8 two-hour sessions were delivered over 8 weeks
The sessions were structured to cover:
- The theory,
- The Science,
- The practice of mindfulness,
- Group discussions about experiences of stress, and
- A silent one-day retreat.
Did the mindfulness sessions have a positive impact? Pre and post measures were used to determine whether mindfulness had a positive impact on staff wellbeing. The data collected from the 8-week course suggests that in a small group of doctors, mindfulness can offer a novel approach to improving doctor wellbeing.
On a practical level, it was ironic that many busy junior doctors could not commit to all 8 weeks due to on-call commitments, the very people we wanted to target for the course. Conversely, the course was selective to more senior doctors and those not on the on-call rota so this may have skewed these data.
Looking at this project from a Trust perspective raised some interesting questions.
The possibility of creating a positive working environment is in the interests of a NHS Trust, with a view to retaining core staff and reducing sickness rates, saving those extra pounds.
The million dollar question remains whether mindfulness can not only improve the wellbeing of doctors but whether this can then translate into improved clinical outcomes? So are we going to see more mindful practice in the NHS? Let’s hope so.
There appears to be a growing appetite for mindfulness with other Trusts now interested in this work and keen to pursue this exciting venture.
It’s certainly changed my perspective on medicine and well-being and I am optimistic that this movement will no doubt grow in future and improve other doctors’ personal and professional lives. If you are interested in introducing mindfulness at your trust for doctors, it would be great to hear from you.
We hope to develop a collaborative on this initiative across different trusts so please get in touch if you are interested.