Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study

Mindfulness or not, what practices, and how much?

In effort to learn about and address physician burnout, particularly in primary care where increasing workload, decreased medical student interest, attrition, institutional costs, and detriment to patient care outcomes are significant areas of concern, we set out to focus on one area of intervention that focused directly on helping physicians develop skills that have shown promise (Krasner et al JAMA 2009). We recognize that there are other factors that contribute to professional burnout, including strain on personal health, family, finances, and others. However, no matter the type of intervention or what aspect of burnout one chooses to address, it is sensible to start with a skill set that is inherent in all dimensions of burnout. In this instance, we elected to train busy physicians in basic mindfulness practices. In doing this, it is imperative to understand what mindfulness is and is not. Mindfulness is defined as paying attention, on purpose, in the present moment, without judgment. But this definition is elusive and although it is a simple concept, mindfulness is something that requires practice like any other skill. Furthermore, it should be noted that mindfulness is an inherent human capacity, like reason, that can be honed and developed through practice. Most students of mindfulness report that one of the most difficult aspects to grasp is that mindfulness is not simply another thing or something one just reads about for proficiency. It is rather a fluid, non-reactive framework of perception that encompasses an easeful acceptance of whatever is happening in the present moment. Each moment brings an experience that includes emotional feelings, mental thoughts, and physical sensations that have either a neutral, pleasant, or unpleasant quality to them. Every experience changes moment by moment. While we cannot necessarily control the content of which experiences or life events present themselves, we can learn to approach them differently, in a more thoughtful and responsive manner. We suggest that these mindfulness skills, therefore, are inherent and important in any form of burnout prevention, whether it is one on one with a psychologist, in a Balint group, participating in an online chat group, or other various approaches. So no matter what the intervention, mindfulness skills--listening, compassion, staying present, non-reactivity --are paramount to its success. Mindfulness is about cultivating awareness that helps us respond more thoughtfully to whatever arises in our day to day life.

While there are some aspects of mindfulness that can be grasped through reading and lecture, there are others that are discovered through practice, like any other skill. While we agree that exploration of the various dimensions of teaching and learning mindfulness should be pursued, we acknowledge that some degree of practice, guidance, and interaction with other students and a skilled instructor are needed. Although the debate on how much practice is needed to have a meaningful impact on burnout, it should also be acknowledged that, like any other skill, there is a dose response to proficiency that cannot be ignored.

Being conscious of the ever-growing number of demands and time constraints pressing upon physicians, we went further to adapt typical 8 week courses into a weekend immersion training, using a non-typical CME format that provided time for shared practice. Interventions that are adapted to the needs of particular groups such as this one are a logical response to meeting the various needs of different people coming from different situations with different constraints and needs. In this study, we ultimately found similar lasting results on measures of burnout using a tailored mindfulness intervention that better addressed the needs of this particular group in an efficient and meaningful way. Our hope is to stimulate further investigation and we look forward to the evolution of other participant-adapted interventions that continue to explore the gray zone of meaningful proficiency and educational efficiency in mindfulness.

Competing interests: None declared

In the article "Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study" Doctor Fortney et. al. place the substantial topic of clinician well-being in the cross-hairs of the burgeoning intervention of mindfulness. This study provides novel insight to a mindfulness intervention that is compressed from the oft-studied standard eight-week mindfulness stress reduction course. The study's favorable results on well -being for primary care providers adds to the chorus of research demonstrating the multitude of benefits resulting from a mindfulness intervention and practice. Additionally, positive effects of an "abbreviated" intervention hints toward the consideration that training the brain with mindfulness may be similar to training the body with physical activity, in that any amount of intervention is better then none!

Competing interests: ?? None declared