Pediatric Population Health Forum Preview: Preventing Burnout

We are delighted to welcome Dr. Cora Breuner as one of the presenters at our fourth Pediatric Population Health Forum on June 8, 2019. Dr. Breuner will lead a breakout session on Tending the garden: recognizing and preventing provider burnout. One tool that everyone can use to prevent burnout is cultivating a practice of mindfulness, which Dr. Breuner describes below.  

Recognizing and preventing pediatrician burnout:
Sustaining your practice using mindfulness as an everyday tool

Cora Collette Breuner, MD, MPH, FAAP
Professor Department of Pediatrics  – Adolescent Medicine Division
Chair Committee on Adolescence – American Academy of Pediatrics
Seattle Children’s Hospital/University of Washington

I have spent a good portion of the weekend trying to write an article on mindfulness.  I am thinking about my audience – peers, colleagues, interested pediatricians, and health care providers.  My problem – I have written a few articles on this and have read many more. What more can I say about this that would make potential readers not turn away and say “I know I should be doing the but I don’t have time…” or  “This is way too woo woo for me …” or  “Honestly I would rather exercise, or read, or be with my kids than sit and just breathe…” or  maybe “My job is too stressful because the system/EMR/RVU/productivity demands make it this way. I miss the good old days when being a doctor was fun…” Or “What good old days are you talking about??? …I was never told it would be this challenging. I was not prepared. It is hopeless.”

So how does one recognize and prevent burnout? Does being mindful really sustain you and your practice? Are having compassion and empathy possible with stressful jobs? Can stress,  instead of exploding compassion and empathy, actually foster more?

Here is one question to ask yourself on a daily basis: Does what you are doing make you happy and are you happy with what you are doing? If the answer is no, there are three ways to address this – as an individual, as a member of a community and as part of a system. Mindfulness in all three areas can affect change.

Research has shown that the mind is prepared and generally ready to be compassionate, loving, and  kind.  Our systems and culture don’t give us many opportunities to develop this yet when given the opportunity positive emotion is something we can train and develop. Loving-kindness refers to the altruistic wish that yourself and others be happy and well. No strings attached, no arguments about whether it’s realistic, no thoughts of who does or doesn’t deserve to be happier. Loving-kindness pivots on the idea that all human beings want and deserve happiness.

Suffering and stress can not be avoided. Recognizing the inevitability of suffering and stress and knowing that we have the capacity to turn towards that suffering and stress with the kind eyes of loving-kindness. Research has shown that people who meet difficulty with compassion tend not to be burned out or burdened by it. (Raevuori A. Health effects of mindfulness – what should the doctor know? Duodecim. 2016;132(20):1890-7; Declan Aherne, Katie Farrant, Louise Hickey, Emma Hickey, Lisa McGrath, and Deirdre McGrath Mindfulness based stress reduction for medical students: optimising student satisfaction and engagement. BMC Med Educ. 2016; 16: 209.)

What is Mindfulness?
Mindfulness is being aware of where you are, to pay attention of what is going on around you.  When you train your brain to be mindful, you’re actually remodeling the physical structure of your brain.

Here is a basic technique for you to get started:
1. Find a quiet and comfortable place. Sit in a chair or on the floor with your head, neck, and back straight but not stiff.
2. Try to put aside all thoughts of the past and the future and stay in the present.
3. Become aware of your breath, focusing on the sensation of air moving in and out of your body as you breathe. Feel your belly rise and fall, and the air enter your nostrils and leave your mouth. Pay attention to the way each breath changes and is different.
4. Watch every thought come and go, whether it be a worry, fear, anxiety or hope. When thoughts come up in your mind, don’t ignore or suppress them but simply note them, remain calm and use your breathing as an anchor.
5. If you find yourself getting carried away in your thoughts, observe where your mind went off to, without judging, and simply return to your breathing. Remember not to be hard on yourself if this happens.
6. As the time comes to a close, sit for a minute or two, becoming aware of where you are. Get up gradually.

Learn more or register for the Pediatric Population Health forum today – free for WCAAP members and P-TCPi clinics!