News

Physician Self-Care Practices

August 16, 2017

By Tom Janisse, MD

Introduction

What do physicians do to most satisfy their patients? And how do they maintain a state of well-being in their clinical practice? The answers to these questions and others have unfolded over several years in a series of confidential interviews I’ve done with physicians who rate highest on the post-visit patient satisfaction survey.

The area of physician well-being was an important component of my research interest, and some of the following has been previously published in The Permanente Journal.* I believe these verbatim statements speak for themselves.

The fifth post in a series
This article continues a series of five articles detailing, through verbatim Northwest Permanente physician voices, how physicians value and experience patient interactions as part of their medical practice.

This note presents the fifth of five realms of well-being that these high-satisfying Northwest Permanente physicians identified in the confidential research interviews. The five installments are:

  1. What physicians derive from patient interactions
  2. Physician awareness of their state of well-being
  3. Physician personal and professional sense of self
  4. The effect of physician well-being on patient interactions
  5. Physician self-care practices.

The actual question posed to the physicians was:

Do you feel that your sense of well-being as a doctor is related to how you practice medicine with your patients?

All physicians agreed that how they practice medicine with their patients is related to, and improves, their own sense of well-being.

Physician self-care practices
“I like to take care of myself and make sure I’m feeling strong. However, it’s been one of the biggest challenges for me to learn how to comfort myself and not be overwhelmed by stuff. That’s the hardest part of maintaining my well-being. The physical well-being—being healthy and all that—I try to be healthy, but the emotional well-being—it’s been hard. We’re not really encouraged to reach out to other people. If you want relevance and you want connection, then you have to feel the wounds too. You can’t get both. You can’t have doctors feel very connected with their patients and then get wounded and not have any way to heal that.” (Oncologist)

“I don’t think, ‘Well, this is my eight hours here in the clinic, and I put on my doctor hat while I’m here, and when I’m home I just don’t deal with medicine.’ For colleagues that I’ve worked with who have had problems with patient relationships, there has always been an undertone of resentment—either resentment for the patient or resentment for their inability to fix the problem. They take it very personally that they aren’t able to fix that person. None of us may be able to. Or, they resent somebody making a demand on them that they perceive as out of their routine, or their schedule. It’s just how we choose to live that reality. Nothing ever really changes; it’s just our perception of it. I do take a few minutes every day to just remind myself that if it’s busy and I’m feeling overwhelmed and I tap into that, recognize it, I’ll meditate. When things are most out of control is when I’m most likely to take two or three minutes, just close the door, and chill, get things in perspective, and then get back at it. Just putting in perspective how good things are for me, I’m really blessed. Rarely is there anything here that’s worth getting stressed out over or burned out over.” (Urologist)

“The relentlessness of the pace is something I struggle with. The only way I can continue to do this business, and to give what I need to give to my patients, and want to give to my patients, is if I take care of myself in a way that allows me space, balance, to be reenergized—to eat well, sleep well, exercise, do my art, cook, garden, and things that completely use a different part of my brain. Obviously, a lot about the work itself is energizing.” (Infectious Disease)

Because it can be hard to continually engage patients, especially given the technical and time-constrained environment, physicians take care of themselves, and care for themselves, in a variety of ways and
practices, such as: taking a moment and a deep
breath, meditation, being with their families, reflecting on their life, writing poetry. They describe these practices as necessary to maintain or return to a state of well-being. Creation of well-being is part of the psychological-physiological mechanism to maintain human homeostasis.

*Janisse, T. Relationship of a physician’s well-being to interactions with patients: practices of the highest performing physicians on the Art of Medicine patient survey, Perm J 2008 Fall:12(4):70-6. DOI: http://dx.doi.org/10.7812/TPP/08-041.

Tom Janisse, MD, is editor and publisher of The Permanente Journal and The Permanente Press.

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