Physicians, nurses, and clinicians given tools for self-healing
Physicians, nurses, and clinicians given tools for self-healing
Stress management program gives tired caregivers a fresh start
It’s 4 p.m. The waiting room is crammed to the rafters. Labs are delayed. Patients are impatient, and emergencies are cropping up like dandelions in spring lawns. What for many people might be the end of a long and exhausting day has only begun for many health care professionals. Sure, no one ever promised you a rose garden when you entered the chaotic world of medicine, but few health care professionals anticipate the stress that goes with the turf of working in a hospital, clinic, or even in private practice.
Does that mean you have to live with it? "Not at all," says Lee Lipsenthal, MD, the Sausalito, CA-based founder of the lecture series, "Physician, Heal Thyself," and a collaborator in HeartMath, a Boulder Creek, CA-based company that offers coping courses to a broader spectrum of the health care community and its patients. "The practice and delivery of medical services is in severe disarray," he says. "The community has high expectations of their health systems’ ability to deliver services, but those health systems are unable to meet the demands of the community, and many have even become financially disabled."
The new reality of high-stress jobs with long hours and low pay has dissuaded the next generation of health care professionals. "In short, the system is falling apart," says Lipsenthal, who also is medical director of Lifestyle Advantages, a Dean Ornish-inspired clinic in Sausalito, CA, and Pittsburgh.
"I was so unbalanced in my life that I didn’t even know how far out of whack I was until I went to a HeartMath program," says Diane Ball, RN, a professional associate at Delnor Community Hospital in St. Charles, IL. By 1999, Ball had worked in cardiac rehabilitation for 13 years and managed the hospital’s program for seven years when she heard about the programs that help recognize and contain stress. "I thought I was going out there for four days to learn how to help my patients manage stress better in their lives," she says. "Instead I found answers to what was wrong in my life — at home and at work — and got some very concrete tools to deal with problems as they emerged and in the long term."
Ball was so enthralled with what she had learned that she persuaded members of Delnor’s administrative staff to attend the program. From there it was a cinch to get them to offer stress reduction training to all staff members who wanted it. Ball says she found her mission in life and is now a one-on-one trainer, using many of the techniques she learned in HeartMath to train fellow staff members in eight-hour versions of HeartMath and to reach patients through community outreach programs.
It worked: Delnor’s turnover rate, 44% annually before the program began, dropped to 19%. Only 13% report they are exhausted, compared to 39% before the program. Now 61% report feeling peaceful in the workplace compared to 35% pre-program. Customer satisfaction has skyrocketed from 73% to 94%. Employee satisfaction is over 70% — the second highest ranking by Sperduto and Associates, an Atlanta-based psychological assessment firm, Ball says.
Lipsenthal points with pride to Delnor and a flurry of other facilities and individuals in private practice making giant leaps in staff and patient satisfaction — and improved health outcomes — through the programs he helped develop. At the heart of his programs are two techniques called Freeze Frame and Heart Lock-in. Lipsenthal calls Freeze Frame "a hypercondensed mindfulness meditation," used to instantly shift emotions from chaotic and scattered input to "a more centered focus" in seconds. "It’s designed to address moments of overwhelm, as a timeout, that can be practiced in any setting — even when you’re walking down the hall."
Ball calls Freeze Frame a one-minute de-stressor that teaches practitioners not to overreact and helps them move to a more neutral state when stress threatens to prompt overreaction. Physiological benefits of Freeze Frame also are measurable. Intense emotions affect heart rate variability, Ball explains, and when signals of intense emotion are transmitted by the vagus nerve to the brain, perceptions actually shut down. Ball recalls a time when she felt frustrated — rushing to complete a report on deadline and she couldn’t find her stapler. A brief pause practicing Freeze Frame allowed her to see that the stapler was right on her desk where it always was. "My brain had shut down to the point where I actually could not see the stapler," she says. The practice works to neutralize heart rate variability and literally re-open the brain receptors, she says.
Freeze Frame also helps balance the autonomic nervous system and reduces catecholamine levels, Lipsenthal adds, as well as decreasing the production and release of sugar in the liver. His experience shows changes in DHEA, IgA, cortisol, blood pressure, lipid levels, and diabetic control, too.
The second technique, Heart Lock-in, requires more time and produces longer lasting results, says Lipsenthal. This sit-down, 20-minute daily practice helps the practitioner focus on what is needed at that precise moment for a better quality of life. Unlike meditation, Lipsenthal says, Lock-in is encouraged when stress is building.
In his longer programs, Lipsenthal also teaches goal-setting techniques called Mind Map and Heart Map, which provide skills to accomplish specific tasks through nonlinear thinking. Participants create "puzzle pieces" of the project and then assemble them in a logical order. "This is the hardware of making a plan," says Lipsenthal. The "software," is another Lipsenthal technique called Heart Map, which takes the same task and offers an opportunity to look at the human aspects of the project and how a team might be assembled, if that is appropriate to the task, and harmony produced.
In the physicians’ component of his programs, Lipsenthal encourages coherent communication between clinicians and patients by using an innate sense of medical intuition — particularly in listening to the patient. Surveys have shown that doctors interrupt their patients approximately 20 seconds after the beginning of the litany of symptoms. Lipsenthal suggests that improved communication would probably make diagnoses more accurate if health care professionals are "present" with the patient and use intuitive listening to get some clues to the underlying causes of the patient’s complaint.
"Physicians who partner with patients get better outcomes. If a patient doesn’t feel heard, he feels dissatisfied," says Lipsenthal. Doctors and other health care professionals need to see patients as individuals, even when giving full attention to a minor ailment for the 10th time in a day becomes a crashing bore and produces frustration. Automaton diagnoses and dispensation of pills is an area where the medical structure begins to go wrong, says Lipsenthal. "By assuming that this patient’s complaint is the same as the last patient’s, we set ourselves up to make mistakes. We need to listen fully to each patient and see each one as an individual," he adds.
Becoming emotionally present for patients makes a world of difference and may even bring health care professionals back to the primary concern that brought most of them to medicine: the desire to help people, says Lipsenthal.
Finally, Lipsenthal teaches health care professionals that they have the power to say, "No." "You can decide where you want to be across the spectrum of how many patients you will see in a day," he tells doctors. "Yes, there is a financial cost in seeing fewer patients, but there may be an emotional benefit far beyond what you might have imagined. At the same time, he tells doctors, if they choose to continue practicing in the same way they are currently practicing, seeing the same number of patients they are now seeing, they are giving up the stressor of blame: "You decided to stay where you are. You’re no longer a victim."
Adam Duhan, MD, an internist in Berkeley, CA, took Lipsenthal’s message very seriously when he took the course earlier this year. Now he’s only in his office one day a week, as opposed to six and even seven days a week a couple of years ago. "I decided to heal myself by doing creative things with my time and energy," says Duhan, who now is fulfilling a lifelong dream of becoming a writer. He still keeps his hand in medicine with a new business with an old twist: He’s a doc with a black bag who makes house calls on a very limited basis and to a very limited clientele — celebrities who visit his area.
His advice to fellow health care professionals on the edge of burnout: "Don’t stretch yourself farther than you are comfortable. Take time for yourself and remain a whole human being. And most of all, don’t let yourself be under the gun of managed care. I left that gun behind years ago, even before I took Lee’s program because I knew how destructive it would be," says Duhan.
[For more information, contact: Lee Lipsenthal, MD, Sausalito, CA. Telephone: (415) 482-9529.]
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