Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians

Abstract

RIMARY CARE PHYSICIANS REport alarming levels of professional and personal distress. Up to 60% of practicing physicians report symptoms of burnout, 1-4 defined as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment. Physician burnout has been linked to poorer quality of care, including patient dissatisfaction, increased medical errors, and lawsuits and decreased ability to express empathy. 2,[5][6][7] Substance abuse, automobile accidents, stress-related health problems, and marital and family discord are among the personal consequences reported. 4,[8][9][10] Burnout can occur early in the medical educational process. Nearly half of all third-year medical students report burnout 2,11 and there are strong associations between medical student burnout and suicidal ideation. 12 The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the sta-For editorial comment see p 1338. CME available online at www.jamaarchivescme.com and questions on p 1374.Context Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients. Design, Setting, and ParticipantsBefore-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Main Outcome MeasuresMindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. Results Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [⌬], 8.

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