SURGEON GENERAL’S RX FOR STRESS IN AMERICA

The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.

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PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS

The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training....

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ALLOWING AWE IN MEDICINE

Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace.

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young children. Moments of awe can easily pass us by. We adults need to learn to ‘stop and smell the roses’ anywhere, anytime.


Cultivating Awe

When given the opportunity to reflect on the experience of awe in medical training, most medical students can easily give examples. Though their resident or attending physician rarely reports sharing their experience, students talk about the deeply moving experience of first hearing fetal heart sounds, delivering their first baby, assisting in major surgery or being with the dying.


These experiences of awe are not typically validated and reinforced by the culture of medical training. Medical electives, and occasionally required courses, seek to correct this deficiency in the training of the physician as a whole person. The Healer’s Art–Remembering the Heart in Medicine is an elective taught to students and residents at over 100 medical schools (including UK for the last 15 years). Mindful Practice is an elective created for students and residents at the U of Rochester.


These courses cultivate the qualities of exemplary clinicians that transcend a purely biomedical model. They enhance the self-awareness, wellbeing, and resilience of health professionals. They help medical learners prevent burnout by improving relationships with patients, colleagues, their own family and themselves. These courses help us create the conditions for experiencing moments of awe that we might otherwise miss. They can also give us tools with which to maximize our experience when we find ourselves captured by moments of awe.


Some skills taught in these courses include- ‘double vision,’ emotional intelligence and mindfulness.


Double Vision

To develop our exemplary physicianhood and humanity, we need to develop a kind of ‘double vision.’ We must focus on the biological, physiological and pathological in the conventional medical scientific care of our patients. And we must simultaneously focus on the unique human being we are treating- especially being respectful, amazed and in awe of their ability to navigate the health care system and the many barriers and obstacles of disease, trauma, mental illness, family upheaval, financial stress, aging and the approach of death itself.


The developers of Mindfulness-Based Cognitive Therapy refer to this double vision as our doing mode and our being mode. As so many physicians can attest, we can learn from our patients how we ourselves might dwell more in our being mode, making the experience of awe more available and finding joy amidst our own suffering and even our own healing when curing is not possible.


Emotional Intelligence (EQ)

In explaining our diagnostic processes and decision-trees, we usually rely on ‘clinical judgment,’ which is part linear/ cognitive and part non-linear/intuitive. Most clinicians can recall a diagnostic workup that involved an intuitive hunch, a feeling that ‘something’s just not right here.’ For me, it was the diagnosis of a leaking abdominal aortic aneurysm in a walk-in patient who complained of a cough and ‘having the flu.’ He had emergency surgery within 3 hours and lived.


The future of medicine is bright, in part due to the growing emphasis on the training of emotionally mature and aware physicians and health team members. Those in health care leadership and administration can also maximize their effectiveness, communication, career satisfaction and the satisfaction of their workforce by the intentional fostering of EQ through emotional awareness, fluency and flexibility.


Our entire societal education system is recognizing the importance of preparing learners of all ages to maximize their inborn skill of emotional intelligence-learning to feel their emotions without self-judgment and blame or wondering if it is ok to feel their emotions. We need to be prepared for the tears shed by patients and colleagues and feel ok if we shed our own-even in the presence of others- avoiding the dehumanizing effect of thinking that emotional expression is unprofessional.


Mindfulness

Moments of awe may be fleeting. We can train ourselves to be ready for them. If we look closely, awe is as close as your own remarkable human physiology. The wisdom of your body is truly awe-inspiring. We must be able to pay attention to truly be present to that sunrise, sunset, music, newborn baby, child’s laughter or the good humor and devotion of the homeless woman caring for her child at the shelter. While some moments of awe demand our attention, we can also create the conditions for awe by intentionally practicing mindfulness by being present to this moment- with intentional openness and curiosity- anywhere, anytime.


The growing research applications of mindfulness include promoting resilience, managing stress, preventing burnout, cultivating compassion, growing our sense of gratitude, joy in medicine and the potentially life-saving experience of awe.


Resources


Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace. And the more we learn about the physiological effects of the physician-patient relationship, the more we seek to harness the power of the placebo effect in the way we use words and communicate non-verbally with our patients.


This humanistic trend in physician/ physician relationships and physician/ patient relationships can be nurtured without traversing the potentially hazardous terrain of conflicting religious or spiritual beliefs. An encouraging sign of this maturing transpersonal humanism in medicine is the respect and serious study being given to awe as worthy of our professional attention.


What is Awe?

Most physicians never heard the word ‘awe’ mentioned in medical training as something worth taking precious time away from more ‘serious’ study. Yet, some of our greatest medical and scientific minds (the ‘father of modern medicine’ William Osler, current director of NIH and the Human Genome Project Francis Collins, physicist/ pacifist Albert Einstein, astronomer/ cosmologist Carl Sagan) have spoken about awe as a primary motivation for medical and scientific inquiry.

BY JOHN A. PATTERSON MD, MSPH, FAAFP

Though awe is a transcendent, often reverential, experience filled with wonder that needs no logical rationalization, it is not necessarily rooted in one’s religion or spirituality, though these may be involved for some people. Researchers view awe as perhaps a uniquely motivating driver of the scientific search for truth and a hopeful environmental future as nature-based experiences of awe connect us to all of creation.


Awe is an emotional experience–not an idea, thought, opinion, fact or cognition. It is often beyond words. It is the experience of being in the presence of something larger than ourselves–something vast and unexplainable. In your own life experience, recall the ways you have been moved, touched and inspired by the depth of love, loyalty and commitment you have witnessed or experienced. Recall your response to the courage and the will to live you have seen in a family member or patient.


Spending time with pre-school children can provide a window into awe as a normal, natural, almost ubiquitous human experience. Seeing the world through eyes that have not yet been blinded by acculturation and educational competition can be deeply rewarding to adults. This is one reason for the traditional Ayurvedic medicine recommendation that adults spend time with

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org