Leading by example

Patricia Lindholm, M.D.
2010-2011
MMA president

I was recently alerted to a new Gallup study that looked at the health and health behaviors of physicians compared to nurses and to other employed adults. The results were also controlled for income and education. How did we physicians do? Perhaps the title will give it away: “U.S. Physicians Set Good Health Example.”

Overall, physicians are in better health compared to the employed adult population.  The study also lists comparative prevalences of chronic diseases among physicians, nurses and employed U.S. adults. 

Our health behaviors are similar to other highly educated individuals with the exception of smoking. Only 4 percent of physicians smoke, compared to 15 percent of nurses and 20 percent of other workers.

It would be interesting to see if the findings hold true at each of our clinics and hospitals. Like all rankings, it can be a motivator for some of us to do better.

Here is a link to the study: http://www.gallup.com/poll/157859/physicians-set-good-health-example.aspx

 It’s great to see that we appear to be listening to our own advice.

 

Remembering friends and looking ahead

Patricia Lindholm, MD
Immediate Past MMA President

I want to take some time to honor the passing of two physicians whose careers were dedicated to the promotion of physician well-being. 

Remembering our colleagues

Jud Reaney, MD was a developmental pediatrician at Park Nicollet and a most valued member of the MMA Physician Well-being Task Force in 2010-2011.  He worked through the Park Nicollet Foundation to promote physician wellness by coordinating and facilitating physician retreats among other activities.  He offered to facilitate a retreat for the task force based on the work of Parker Palmer.  We attended this Courage and Renewal Retreat as a group and I personally found the weekend to be a growth experience and an opportunity to enjoy nature and the companionship of colleagues.  During the past year we followed Jud’s journey with pancreatic cancer on his Caring Bridge web site.  Jud was one of those people who seemed to me to have a special aura of deep joy and sincere caring for people.  The many tributes to him on the Caring Bridge site made evident that many lives were touched by his and made better for having known him.

Lee Lipsenthal, MD was introduced to some of you last year in my President’s Blog.  He wrote a book and founded an organization both called “Finding Balance in a Medical Life.”  His presentations, conferences and writings have been enthusiastically received over the years by our colleagues around the country.  I recommend his work to you.  He also wrote a book during the last period of his life when he knew his time was limited by cancer.  The book is called “Enjoy Every Sandwich.”  It is in my library and a reminder of the importance of gratitude and mindfulness throughout our lives.  You can watch a brief video of him discussing his book at www.youtube.com/watch?v=3UIFbOfWwYE.  

Physician well-being symposium

Minnesota physicians have an opportunity this spring to attend a special event offered by the Health Partners Institute for Continuing Education.  On June 7 there will be a physician well-being symposium, “Enhancing Physician Resilience” at the Burnsville Performing Arts Center.  This will be followed by several performances at the Guthrie Theater of a play written by William Thomas, MD, “Play What’s Not There.”  The play portrays five physicians at various points in their careers and the stresses and efforts to achieve work-life balance.  It will be followed by a facilitated discussion.  For more information and to register, please go to http://www.physicianwell-being.com/. 

I will try not to be absent so long from the blog in the future.  I look forward to writing again soon!

Mindfulness

Patricia Lindholm, MD,
Immediate Past MMA President

Often I arrive at the end of a week, a month or a year wondering, “Where did all the time go?”  This sense of time moving more quickly is common as we age.  As a child I felt that a year was an eternity.  Now that we have entered a new year, it seems that last January was only a couple of months ago.  Am I failing to fully realize each moment in the present?  Probably.

Mindfulness is a practice of being present in the here and now, fully aware of the moment in which we live.  This concept is at least as old as Buddhism which teaches among other things that we should be awake while we live. 

Essentially I usually live in my head.  My thoughts come and go and take me away as if on a train.  While I am on the thought-train reality is present all around me and I am not aware of it.  I may be driving to work and not even noticing the landscape around me, rather I am in my own imaginary world.  When I spend time living in my thoughts the passage of time is not noticed until I awaken to it. 

I am pleased to see that psychology and other mental health disciplines have been using mindfulness practice in the treatment of anxiety, depression and other affective disorders.  Being mindful of the present is a therapeutic alternative to preoccupation with worries and negative thoughts.  Even suicidal thinking can be derailed by a purposeful attention to my breath in the present moment.  Rather than ruminate on a vicious cycle of self-criticism, I can choose to acknowledge that in this present moment I am alive and can appreciate the song of a bird or the beauty of a sunset.  I can feel the air enter and leave my lungs, smell the fragrance of clean laundry. 

During the day in my clinic I have learned to treasure the moments that I am with each patient.  If I am mindful during these encounters I can realize the joy in my work.  I am learning to be present for a greater proportion of my day.  I frequently find myself pausing deliberately to take a slow conscious breath and remember that I live only in the present moment.  I am striving to increase my mindfulness practice and capture as many of my moments as possible.

If you are interested in mindfulness practice I recommend the books of Thich Nhat Hanh, Jon Kabat-Zinn, Pema Chodron, and others who have been teaching mindfulness for many years.  I would also recommend enrolling in a Mindfulness Based Stress Reduction (MBSR) course such as offered by the University of Minnesota Center for Spirituality and Healing.   

Wellness Challenge Yields Results for Mayo Residents and Fellows

Patricia Lindholm, MD,
Immediate Past MMA President

I recently had a conversation with Noel So, M.D., (pronounced like Noelle) a resident in physical medicine and rehabilitation at Mayo, who wanted me to share information about a unique wellness activity, she and Mark Steffen, M.D., preventive medicine resident, are co-chairing-- the Mayo Fellows Association (MFA) Wellness Challenge.


The event that commences December 1 builds on the success of the previous MFA Wellness Challenge, which was a 12-week program, chaired by Christopher Weight, M.D. A total of 630 residents and fellows, or about half of those at Mayo, participated in the first Wellness Survey, and about 230 went on to enrolled in the MFA Wellness Exam at a cost of $5 per person. The exam measured fitness parameters including body mass index (BMI), percent body fat, and VO2 max. 46 teams of five people competed for the grand prize, which was a trip to the Olympics. The teams earned points for activities such as time at the gym, number of steps walked (measured by pedometers), participation in pre- and post- activity surveys and wellness exams. Another innovative activity was “Climb the Clinic” that involved walking up and down the stairs in five Mayo buildings. ID badges given to each participant were scanned at the bottom and top of each stairwell to record completion times. Dr. So tells me that the presence of the 46 competing teams fostered positive peer pressure that yielded the greatest amount of physical activity. The points earned by each team equaled the number of raffle entries each team received for the grand prize Olympics trip.


Other prizes were awarded for:

• The biggest loser of fat (without being underweight)

• The fittest female/fittest male (the best VO2 max)

Challenge Results
Some statistics from first wellness challenge:

• Collectively the participants walked 171,008,824 steps which is equivalent to 3.4 times around the Earth at the equator;

• Over 10,000 trips to the gym; and 

• 189 completed wellness evaluations.


After the event, a survey was sent to all Mayo residents and fellows about burnout and emotional health. The Wellness Challenge participants as a group reported less burnout, better sleep and better nutrition. The coordinating committee for the Wellness Challenge is clearly a research-oriented group.  It was noted that after the event was over there was decreased gym attendance, although it is possible that people were exercising more outdoors in milder weather, since the challenge started January 1st.  One question that was raised is how to maintain the motivation of participants to maintain fitness after the formal monitoring period.  

Social Media

The 2nd Annual Wellness Challenge will be extended to 16 weeks.  Dr. So, Dr. Steffen, and the committee will be studying the impact of social media on participation in the challenge. The challenge already has a page on Facebook, which is a social medium that I'm familiar with, but I was educated by Dr. So about Yammer, which is a workplace-based social medium using work e-mail addresses.
The MFA Athletic Committee has also introduced the concept of “walking meetings” instead of sitting around a table, so that exercise is integrated into the meeting. They are hoping to incorporate it into the Mayo culture.  

Following in their Footsteps

This challenge is a very ambitious undertaking and may seem daunting to some of us, but consider what we can do in our own workplaces and communities.  I think any of us can use the concept of monitoring with pedometers as a competitive activity, and perhaps find other parameters that are easily measured.  I am going to challenge my local partners who are fitness enthusiasts to design a fun incentivizing wellness program for our group.
If anyone is looking to do research more broadly on the effects of physical fitness on the mental, emotional and physical health of physicians, I think we can round up quite a few physician subjects across Minnesota.  I hope someone will take me up on this challenge!

Care for the Caregivers

Patricia Lindholm, MD,
Immediate Past MMA President

I have just returned from two inspiring events in the past week.  First the MMA held a summit meeting on Sharing Solutions to Combat Burnout.  The conference was conceived as a session to share and learn from people working on physician wellness in their organizations.  There were a variety of presentations highlighting diverse and unique approaches to addressing wellness in physicians as well as studying the effectiveness of interventions or programs.  The audience was also asked to share their ideas on how the MMA can help facilitate the development of wellness strategies for physicians.  It was gratifying to see the interest in the topic and I believe we could easily have spent twice the time in order to answer audience questions and even to lengthen the presentations.  In the near future the presentations will be made available on the MMA web site with our other wellness resources.

I also attended the second biennial Canadian Conference on Physician Health.  The theme for the meeting was “Healthy Physicians = Healthy Communities”.  I have long admired the Canadian Medical Association’s international leadership in physician wellbeing.  After having an informal discussion with two Canadian family physicians at breakfast the first morning, it occurred to me why the Canadians have worked on the issue for so long.  These physicians were from different provinces and each in solo practice.  Each was in practice for about 25 years (like myself) and female (like myself).  For the most part, Canadian physicians tend to own their businesses and are facing increasing overhead expenses and decreasing payment as are the U.S. physicians.  More of their physicians are in extremely remote areas where there is little collegial or technological support.  These two physicians each shared that some years ago they had taken a two-year leave of absence from the practice of medicine due to burnout.  They do not have colleagues to cover their practices, and often cannot obtain locums coverage.  If ill or on vacation they have to close their offices.  Furthermore there is no paid vacation since they are self-employed and they continue to pay the overhead. 

I attended a breakout session regarding the stress of litigation on physicians.  There was a video scenario of a young rural physician who had been staffing an ER where she saw a patient with a painful swollen leg.  She felt it was cellulitis, but of course it turned out to be a deep vein thrombosis and the patient died of pulmonary embolus.  Of course the clinical diagnosis of DVT is not straightforward, which is why we have tests like d-dimer and ultrasounds.  This doctor would have had to send the patient fifty miles to get an ultrasound!  That is quite a decision for a remote solo doctor to make.  I reality-checked the scenario with an OB-GYN physician who had practiced in a remote area and she confirmed that lack of resources is a fact of rural practice. 

There was an interesting “debate” about the issue of limiting physicians’ work hours (or resident work hours).  Two physician leaders spoke in favor of mandatory work hour limits and two spoke against.  To my surprise both sides had compelling arguments.  I believe they were randomly assigned a position to present and of course each had data to support their arguments.  The ending plenary speaker was Dr. Roberta Bondar who was the first neurologist to take part in a space shuttle mission.  One of her themes was to maintain our curiosity and continue learning throughout our lives. 

Workshops on “music and medicine”, mindfulness meditation, nutrition, caring for physicians as patients, combating the stigma against mental illness and psychiatry, supporting medical students and residents were presented, among other topics.  Time was set aside for exercise (run/walk) or mindfulness meditation. 

Having witnessed the strong interest in addressing physician wellbeing among Minnesota physicians, I believe that we should be able to develop a more comprehensive conference in the future.  We had some visitors from the Dakotas and also several physicians who came for their own personal edification rather than from an organizational perspective.  I am very proud of the good work that is happening in Minnesota and we have much to offer to our colleagues around the country. 

I am also encouraged that the AMA President-elect, Dr. Jeremy Lazarus, plans to make physician wellbeing the emphasis of his upcoming term.  It is time to care for the caregivers.

Welcome to Well Physician

Patricia Lindholm, MD,
Immediate Past MMA President

I am back!! No longer the MMA president, my blog has moved to a nearby address.  The work of promoting physician well-being continues to be a priority for the MMA and for me. 

For those of you who have been thinking about bringing some physician wellness resources to your community, we are here to help.  On October 27, 2011 the MMA is convening a conference to share ideas from a number of leaders in the medical community who have implemented or who are developing resources to promote an environment supportive of the health of physicians.  We will hear some great presentations and also learn from each other.  If you have ideas please come to share with the rest of us and network with like-minded colleagues throughout Minnesota and the surrounding area.  Sharing Solutions to Promote Physician Well-being Conference is free for MMA members and only $35 for nonmembers. There is CME credit (4 hours). 

Some time ago I shared that I will be attending the 2011 Canadian Conference on Physician Health.  It will be held in Toronto on October 28-29, 2011.  The title is “Healthy Doctors = Healthy Communities.”  There is still time to register. 

For those of you who have not recently checked the MMA physician well-being page we have added an excellent webinar that AMA presented on physician suicide.  Two more webinars will be presented in the near future on issues challenging medical students, residents and other physicians. 

Finally, in this new incarnation of the Well Physician Blog, I am considering inviting guest bloggers to appear from time to time.  I have some folks in mind and would also love to hear from any volunteers.  I look forward to continuing the conversation with you all.

To Err is Human



Patricia Lindholm, MD,
2010-2011 MMA President


Orginally Posted September 7, 2011

I believe that we all recognize the above title as a timeless adage, but also the title of the Institute of Medicine report that brought to public scrutiny the problem of medical errors in hospitals and the prevalence of harm that patients experience during their hospitalizations.  The report jump-started a nascent patient safety movement that now appropriately applies to outpatient care as well. 

An excellent article appeared this week in AMA News about physicians who have publicly acknowledged their medical errors.  They are using such disclosure as teaching opportunities for themselves and other health care professionals, and to highlight that systems improvement is the key to preventing errors.  The “I’m Sorry” legislation that has been discussed in various states reflects the need to provide transparency to patients and to make amends when they are harmed by medical procedures and decisions. 

The most interesting part of the article for me is a discussion of how to support physicians who have harmed patients through diagnostic or treatment errors.  I trained in the era of “shame and blame” when one person was assigned total responsibility for an error.  This led to a tendency to hide our errors from patients, hospitals and our colleagues.  Physicians judge themselves quite harshly and question their general competence or even their personal worth when faced with an error. 

In Boston at the Brigham and Women’s Hospital, a Center for Professionalism and Peer Support was created to reach out to physicians who are in the painful and lonely position of having acknowledged a medical error.  A number of physician peer advisors are available to reach out to their colleagues and ask about their wellbeing and offer support.  Similar programs have developed at medical centers around the country.  A compassionate and human approach to such colleagues can save careers as well as the lives of the physicians who are supported. 

Several years ago when I served on the board of MMIC (the professional liability company started by MMA some years back) we started the Physician Litigation Support Program.   Each physician facing a claim is personally contacted by a psychiatrist whose only purpose is to provide support and education to the insured.  We have received many thanks from recipients of this caring program.

If your training program or health care organization does not have a mechanism to support colleagues who have made errors or who face litigation, what can you do to get such a program started?  I suggest that the first step is speaking up and insisting that collegial support programs be proactive, supported and expected.  You should expect to hear from colleagues who want to work with you to make good work happen.  I suspect you will have richer friendships and happier patients as a result.