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.
Neena Thomas-
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….
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In Seligman’s model, optimists and pessimists differ dramatically in their ‘explanatory styles’, which he defines as “the manner in which you habitually explain to yourself why events happen” (Learned Optimism. Seligman, M., 2006). Optimists and pessimists differ in the stories they tell themselves to make sense of events in their lives. Simply put, an optimist’s cup is half full and a pessimist’s cup is half empty? The difference can mean living a long life or dying young.
A pessimist is more likely to be self-
Cultivating optimism with mindfulness
The Center for Mindfulness at the University of Massachusetts Medical Center is the home of mindfulness-
The Mindful Practice Program at the University of Rochester School of Medicine includes MBSR in its curriculum for medical students, residents and physicians. (https://www.urmc.rochester.edu/family-
Mindfulness training helps physicians improve communication, promote resilience, manage stress, prevent burnout, and improve the quality of care and the quality of caring by cultivating optimism and compassion. Below are several foundational skills for living mindfully and becoming more optimistic and resilient.
Here’s a suggestion. Take an open-
1. Slow down.
The pace of our hurrying and worrying modern lifestyles is a form of self-
2) Truly pay attention.
Pay attention rather than multi-
3. Practice being fully present.
Be present rather than our common habit of thinking about the past or the future. Bringing your attention to your present experience (physically, mentally and emotionally) is a simple, but not so easy, way to widen your vision to a 3-
4. Listen deeply.
Listen as others speak rather than being distracted by planning your response. The greatest gift you have for someone at home or work may be your genuine interest in what they have to say. Relationship-
5. Feel your emotions.
Feel your emotions without wondering if it is ok to feel them. Though emotional intelligence (EQ) may not have been part of your medical training, it plays a huge role in both professional and personal life. Emotional journaling is a simple tool for raising your EQ. Whether pleasant or unpleasant, happy or sad, positive or negative-
6. Cultivate gratitude.
Gratitude is the personality trait that some consider the #1 promoter of life satisfaction and emotional wellbeing. Consider keeping a daily journal of What went well and why, listing 3 things that happened this day that went well and anything you did that helped. Paying attention to the small things that went well is actually more effective as we learn to carry the attentiveness of things going well throughout our daily routine. See A Simple Exercise to Increase Well-
7. Allow awe into your life.
It is increasingly recognized as good medicine. Hit the pause button and pull the car to the side of the road the next time you see a beautiful sunset or moonrise. Spend unhurried time in nature, with children and pets. Be in awe of the wisdom of your own body’s function, the growth of your children and your good fortune to have friends or a life partner. Replenish your cup of awe regularly. See The art and science of awe – https://ggsc.berkeley.edu/what_we_do/event/the_art_and_science_of_awe .
8. Trust your intuition, your 6th sense, your gut instinct.
The more we learn about the ‘brain in the gut’ the more scientifically credible this deeply human sense becomes. At a minimum, don’t discount your ‘hunches’ about a patient’s diagnosis or the subjective experience of your own health and your family’s needs. See The science behind intuition – https://www.psychologytoday.com/blog/radical-
9. Make and keep friends.
This is an increasingly recognized crucial ingredient in wellbeing, happiness and even longevity. The impact of social support on physical and emotional health is compelling. As our society ages, this protective factor is becoming increasingly appreciated and cultivated. Being with positive people who help you laugh (and cry) is powerful medicine. See Enrich your life and improve your health – https://www.mayoclinic.org/healthy-
10. Practice forgiveness.
Forgive, not to condone a past injustice, but to take the heavy burden of resentment off your heart and mind. One of my favorite teachers describes holding a grudge as taking poison and expecting the other person to get sick. Thankfully, forgiveness is beginning to receive long-
11. Be kind and friendly to yourself and to everyone else.
Sadly, this is one of the most challenging tasks I encounter in my classes. So many of us are able to be kind to others but not ourselves. Self-
As we strive to keep alive the idealism, altruism and compassion that led us to choose medicine as a life’s calling, let us remember that our own well being is crucial to the well being of our patients, colleagues, staff, family and community. Taking good care of others demands that we take good care of ourselves. Living mindfully and cultivating optimism can help us listen deeply, speak kindly, build resilience, manage stress, prevent burnout, cultivate compassion, promote health and even save lives-
May these thoughts, suggestions and resources serve you well.
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-
Yet most physicians are glad they chose medicine as a career and would recommend it to their children (AMA survey https:// www.ama-
Why do some physicians suffer, leave medicine or die prematurely while others thrive? Resilience is a crucial protective factor against stress, job dissatisfaction, marital discord, the stress of parenting, substance misuse, burnout and suicide.
What is resilience?
The APA defines 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.” The APA points out that “research has
PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS
WINTER 2018
BY JOHN A. PATTERSON MD, MSPH, FAAFP
shown that resilience is ordinary, not extraordinary. Being resilient does not mean that a person doesn't experience difficulty or distress. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone. (The road to resilience, http://www.apa.org/helpcenter/road-
The CEO of a resilience training company says “More than education, more than experience, more than training, a person’s level of resilience will determine who succeeds and who fails. That’s true in the cancer ward, it’s true in the Olympics, and it’s true in the boardroom.” (Harvard Business Review https://hbr.org/2002/05/ how-
Optimism promotes resilience
Martin Seligman PhD is the director of the Positive Psychology Center at the University of Pennsylvania. His research suggests that optimists are more resilient than pessimists and more predictably bounce back from failures, divorce, job loss, financial insecurity and disability. Optimists are more likely to succeed in relationships, business, personal health, sports and academics. Pessimists tend to feel overwhelmed, anxious, depressed and give up rather than bouncing back.
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-
