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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as well as prayerful talking to a higher being. She also had a more personal meditation practice involving spending time with a thought or a word. Simply spending time with a higher power was always a part of her life. She maintained close relations with friends from her Orthodox Christian community. She also felt tremendous support speaking regularly by Skype with her long-time surgical mentor in India (a Muslim). It has only been recently that she has realized how much these formal and informal practices have been protective of her physical and mental health and well being sustaining her joy in life and her joy in medical practice.


Losing Hope and Losing her Husband

Life became more complicated after moving to Lexington and beginning work in an RVU-based compensation and productivity model. She began to feel like she was drowning. She was beginning to lose hope of regaining her life’s balance. She was losing the sense of freedom and autonomy she had taken for granted in North Dakota. She was heading toward burnout and considered resigning her position. Instead, she made several patient care changes with the help of the clinic director, streamlined some of her charting practices and made adjustments in her weekend time management. She also discussed her needs with the department chair who agreed to reduce her time to four days a week with a three day weekend. These changes have helped tremendously.


This improvement in her quality of life could not have been better timed. Not long after making these practice changes and recovering some sense of coping and control, her husband had a sudden cardiac arrest. He was on life support and had no advanced directives. She and her two sons had to make the decision to withdraw life support after attempts to revive him proved futile. She credits a single casual family conversation about end-of-life wishes with guiding their decision-making. They all knew that he did not want to be kept alive without any reasonable hope of recovery. She was also guided by her own management of patients who lived in long-term care with little or no conscious awareness.


Coming Home to Self Care

That was September 2016. Her New Year’s resolution this January was to re-commit to more regular observance of her longterm self-care rituals, combining prayer, meditation and exercise. She now claims 30-40 minutes each morning as her time for caring for herself. She walks on the treadmill for 10-15 minutes to a target heart rate, sits down cross-legged on her yoga mat and pauses with a quiet mind until her breathing returns to normal.


Next comes heart-centered meditation, beginning with an intention to welcome and grow the following qualities of the heart limitless compassion (with both hands placed on her heart), innate harmony (a sense of calm in the eye of the storm), healing presence, unconditional love, reverence for the way things are and a feeling of ‘Wow’. Throughout her day, she can simply say to herself ‘innate harmony–calm in the midst,’ anytime she needs to calm and quiet her mind and body.


This meditation is followed by chanting out loud a liturgical prayer from her childhood and lifelong Christian tradition, ending with the Lord’s Prayer recited in her mother tongue. She sometimes adds a healing touch practice to her feet and a brief energy practice followed by 4 deep breaths using alternate nostril breathing. This 30-40 minute morning routine ends with hatha yoga postures.


Healthy Lifestyle and Work-style Tips

She tries to weave the following tips for healthy living and healthy working into her own life and her counseling to residents and patients:


Neena Thomas-Eapen, MD is a family practice physician in the UK Department of Family and Community Medicine. She has completed the University of Arizona’s fellowship in integrative medicine and brings that broader perspective to the department’s faculty, staff and residents. Growing up in India, she liked biology and always thought she would be a teacher. She had seen the poor conditions in Indian government hospitals and didn’t initially consider medicine as a career. Nevertheless, she tentatively went to medical school at age 18, saw the modern and clean basic science laboratories and was surprised how much she liked it. Influenced largely by a supportive mentorship relationship with a senior surgery professor, she did three years of general surgical training and research after medical school. Having always felt an altruistic impulse to serve needy people, she served for a year in a Christian mission facility before marrying and moving to the US with her new husband who had permanent US residency.


From India to North Dakota

In the mission hospital she saw a different kind of medicine from medical school, surgical training and research–a type of medicine that addressed the whole person, not just the biomedical, anatomical or surgical perspective. After passing her US licensing exam and having two young children, she wondered how to train and practice in the US. She decided that practicing surgery in the US was not an attractive option for a woman with young children. At that time, in the 1990s, family medicine included a lot of procedures and would permit her to use her surgical training. She completed a family practice residency in

BY JOHN A. PATTERSON MD, MSPH, FAAFP

North Dakota after which she was employed by the local hospital. She was able to practice the whole person medicine she had loved so much in her mission work.


Discovering Integrative Medicine

She emphasized lifestyle medicine, behavioral approaches, the importance of social connections and spirituality in patient care in her small-town North Dakota practice. She also felt a strong desire to advance her training but was not sure what training to pursue. After reading a book by Andrew Weil, MD, she applied and was accepted to his Integrative Medicine Fellowship in Tucson Arizona in 2005. After spending 2 years in the sunny and warm Southwest for the fellowship, she went back to snowy and cold North Dakota and joined her former residency as faculty for 7 years. She offered the 200 hour Integrative Medicine in Residency program as an elective for residents. She then moved to Lexington when her son was accepted for the BS/MD program at UK.


Taking Self Care for Granted

Despite the responsibilities of training and practice and feeling like a single parent for many years due to her husband’s travel demands, she never really felt severe stress or burnout. She practiced daily liturgical prayer from her Christian tradition

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