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.
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-
Of all the sciences, medicine uniquely combines all domains of the human condition-
Medicine has always attracted the best and the brightest. Most applicants to medical school are also inspired by a desire to be of genuine service and express their deepest human values through their professional lives. This ethic of altruism, compassion, meaning and service distinguishes medical students from most other professional students.
This new patient was a desperate, mid-
Modern life is taking its toll on our nation’s mental and physical health. Physicians and their patients both suffer from stress-
Former Surgeon General Vivek Murthy MD has sounded the alarm regarding our country’s epidemic of stress.(1) He calls for a serious national effort to mitigate the corrosive effect of chronic stress on every organ system. He calls for a nationwide campaign to spread a preventive, behavioral lifestyle prescription of healthy eating, physical activity and genuine social support (other than social media). Based on solid peer-
Behavioral medicine research confirms the value of mind-
Relationships are at the very heart of medicine. I recently saw one of my favorite patients whom I had not seen in 10 years. I have thought of her often since the hospital took over my Estill County practice in Irvine and I moved to Lexington. Wanda always lifted my spirits. She always asked me how I was doing because she cared about me. We joked and laughed while managing her chronic medical conditions. She was good medicine for me.
Defining resilience: The American Psychological Association (APA) describes resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress, such as family and relationship problems, serious health problems or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” APA further describes resilience as “ordinary, not extraordinary. People commonly demonstrate resilience.
Wayne Jonas MD is clinical professor of family medicine, Georgetown University, retired Lt. Colonel United States Army Medical Corps and a complementary medicine researcher. He previously served as Director of the Office of Alternative Medicine at NIH, which is now called the National Center for Complementary and Integrative Health. He has recently proposed the HOPE note (Healing Oriented Practices and Environments) as a clinical tool to help physicians….
Anxiety, depression, loneliness and suicide are increasing-
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solitary, independent, rugged individualist collapses under the weight of evidence that loneliness can kill. Physicians are also affected. My lab partner in medical school committed suicide as an intern. One of my favorite physicians, to whom I referred for 25 years, committed suicide. My physician next door neighbor committed suicide.
Physician Burnout– A Public Health Crisis
Multiple internal and external stressors can lead to physicians’ compassion fatigue, substance misuse, family discord, burnout, leaving medicine and suicide (6). Harvard Medical School and the Massachusetts Medical Society recently declared physician burnout a public health crisis (7). Our continuing education as physicians has historically focused on cognitive and technical CME as the cornerstone for professional development. But personal development of the whole person of the physician is receiving increasing emphasis.
AMA STEPS Forward Program (8) aims to improve practice efficiency and help you achieve the Quadruple Aim of improving patient experience, improving population health and lowering overall costs while also increasing your professional satisfaction. AAFP Physician Health First (9) prioritizes physician health and well-
Doctor as Drug
Balint popularized the phrase “doctor as drug” in his 1957 medical classic The Doctor, His Patient and the Illness, emphasizing the impact of physician communication and behavior on the patient’s clinical course. Cardiologist Bernard Lown, formerly at Harvard School of Public Health and original developer of the defibrillator, spoke eloquently about “the healing power of words” and “the lethal power of words” in his introduction to Norman Cousins’ 1983 The Healing Heart-
A recent RCT (11) showed that a one-
Patients Can Be Good Medicine
Much has been written about the emotional cost of patient care–the vicarious trauma and compassion fatigue suffered by physicians. Less widely discussed is the vicarious healing and inspiration we receive by walking alongside those exceptional beings we call patients. As I interview physicians for a companion Profile in Compassion column in this magazine, I am struck by a recurring theme. In addition to describing their personal story of stress and burnout, physicians consistently report the personal benefits they receive from their relationships with patients. It is uplifting and healing to us as physicians to be in relationship with our patients’ strength, resilience, hope, courage, faith, determination, acceptance, humor, wisdom, forgiveness, compassion, generosity, optimism and gratitude.
May you be blessed with healing relationships in your practice of medicine-
Relationships are at the very heart of medicine
I recently saw one of my favorite patients whom I had not seen in 10 years. I have thought of her often since the hospital took over my Estill County practice in Irvine and I moved to Lexington. Wanda always lifted my spirits. She always asked me how I was doing because she cared about me. We joked and laughed while managing her chronic medical conditions. She was good medicine for me. Seeing her again got me thinking about relationships in medicine.
Consumer choice in the medical marketplace and mandated patient satisfaction surveys highlight the clinical and financial importance of positive relationships. As physicians, we work in relationships with our patients, colleagues, staff, organizations and community. Importantly, we also work in relationship with ourselves–physically, mentally, emotionally and, some would add, spiritually.
Relationships Can Heal
RCC underscores the importance of promoting resilience, managing stress, preventing burnout and cultivating compassion–for physicians and all those with whom we are in relationship.
Epidemic of Stress
Former Surgeon General Vivek Murthy actively campaigns to address the epidemic of stress in America (2). He includes social support and relationships, including co-
A survey by Cigna documents the erosion of supportive relationships and the epidemic of loneliness in our society (3). The CDC reports that nearly 45,000 lives were lost to suicide in 2016 and that life expectancy (a snapshot of national health) declined twice between 2014 and 2017, driven by suicide, drug overdoses and alcohol-
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-