Last week I had the opportunity to go to an early morning presentation titled: “Self Care For the Caregiver.”

I chose not to go.  I’ve been underwhelmed by similarly titled presentations that I’ve attended recently, and I decided that it would be better self-care to get the extra 30 minutes of sleep, and start the day with some reading and meditation.

My colleague, who went, tells me I made the right choice.  He said that the presenter spent the entire time talking about various causes of burnout, and zero time talking about solutions.  My colleague said: “We already know about the problems. In fact, I have a few more I could add to his list.  What we need are solutions.”

Let’s talk about possible solutions for the burnout problem.

1.  Mindfulness Practice. 

I’ve quoted elsewhere my Mindfulness teacher’s brilliant equation: S = P x R.  The letters stand for Suffering = Pain x Resistance.  In the case of burnout, “pain” can be physical discomfort like fatigue, muscle tension, and other physical ailments that might arise.  “Pain” can also be emotional discomforts such as anxiety, frustration, sadness, irritation, disgust, and anger.  With mindfulness we first become AWARE that we’re having these discomforts, and then, as best we’re able, we let go of RESISTANCE.  We stop fighting ourselves.  We don’t burn up our stores of physical, mental, and emotional energy so fast.  We can better apply that energy towards our work, and towards finding creative solutions.

What’s the “Minimum Effective Dose” of formal mindfulness practice to notice a significant benefit?  Opinions vary, but Sharon Salzberg and several other excellent mindfulness teachers I respect say: 20 minutes a day.  Shinzen Young says it’s possible to notice significant benefits with just 10 minutes of high-intensity mindfulness practice daily.

2.  Shorter hours. 

Mindfulness is great.  As I wrote above, it helps free up energy for productive work and creative solutions.  Even so, by the end of the work-day afternoon, I’m pretty spent.  If I schedule my patient care hours to end prior to the time I need to leave the office I can often finish all my documentation at the office.   This is way better than bringing work home.  However, if I’m really mentally exhausted it’s better to head home, get some R&R, and finish up non-critical tasks either later in the evening or the next day.

3.  Fewer patients per hour.

Taking care of people takes time.  Time for introductions and establishing rapport, time for taking a good medical history, time to perform appropriate physical exam, time for reviewing tests and data, and time to THINK.  Fewer patients per hour allows more time for these components of good medical care, as well as for completing required documentation.

As an interlude, I realize that Solution 2: Shorter hours, and Solution 3: Fewer patients per hour, may seem incompatible with running a profitable health-care organization.  I understand completely.  However, if the physicians burn out and quit, then you have zero patients per hour and zero hours.  A couple of years ago I provided some mindfulness training for physicians at a well-respected area hospital.  The department head who contracted me for the training was doing an amazing job for his physicians to help prevent burnout.  In addition to providing mindfulness training, for them, the program director met with hospital administration requesting exactly the above- fewer patient care hours, and fewer patients per hour.  Instead, the administration offered the following solution:

4. More Money

This is a “palliative.”  It’s something that doesn’t eliminate the causes of burnout, but I will admit it does help ameliorate it, up to a point. 

5. Better Schedule Management, i.e. more physician input/control regarding scheduling.

An OB-GYN colleague of mine told me that at her previous office, Tuesdays were the day allocated for Women’s health screening.  The medical assistants set up each office with the equipment needed, and the staff quickly got into the groove, able to see the patients more efficiently and effectively than if screening exams were sporadically scheduled throughout the day.  A family practice colleague of mine who is one of the most dynamic and capable docs I know, tries to schedule nothing but procedures for his Wednesday office hours.  Because of the increased paperwork requirements, I ask that pre-operative consultation/exams be scheduled in the morning office hours so I can have a cushion to finish the notes which will need to be faxed to the surgeon by the end of the day.

It’s well established that providing CONTROL to those who have the RESPONSIBILITY is paramount for decreasing stress and burnout.  The above example is just one of countless possible interventions.

I titled this essay Part 1, because the solutions I propose are broad, general, and simple (although not necessarily easy!)  There are other important fundamentals to staving off burnout like purpose, social connections, healthy diet, exercise, sleep.  If it’s useful I may write more about these fundamentals in the future, as well as taking on specifics.