When someone asks you what you do for a living, don’t you find that people react with a lot of interest? Often with a degree of longing for our career as they always wanted to be a vet or nurse. The general assumption is that we are living the dream, career-wise. There’s a long queue of disappointed A-level students desperate to get onto the course. And yet there’s a surprisingly long queue (42 percent of us) wanting out of the profession.
Why aren’t we more fulfilled?
Few careers provide the opportunity to have such a profound effect on the lives of others and to derive meaning from work. To experience the joy of facilitating healing, and to help support those patients who can manage a good quality of life despite their medical diagnoses is a pleasure that often passes us by.
Often, we disregard our clinical successes and are driven immediately to problem solving the next case. We would never get through the ops list if we spent our time basking in the glory of one case that went beautifully. But this isn’t mindful working. The avoidance of pausing to take a moment to observe what is good at work for fear that we might waste time is prevalent among vets and nurses.
Putting mindful working into practice
Taking a minute, or even 30 seconds, to appreciate a case that is going well, however minor a case it may be, might contribute to better time management for the next few hours. When we are stressed, or even just mildly overwhelmed or flustered, we are less focused on the individual patient.
We have a responsibility to ourselves, to our colleagues and most importantly to our patients and their owners to manage the stressors unique to our career path, to determine the optimal balance of noticing the successes while being driven to treat the next patient with focused concentration, and to nurture our personal wellness.
Morbidity and mortality reviews of surgical errors show that one of the main reasons cited for gross errors is that the vet was not focused. They were thinking of something else which was apparently more urgent; they were not being mindful. Mindfulness is not a luxury that vets with short ops lists partake in at their leisure. Mindful working is paramount if we are to perform to the best of our ability and thus avoid many of the errors that would drive us to join the queue to leave the profession.
A study in the Journal of the American College of Surgeons by Carter Lebares last year looked at burnout and stress among US surgery residents. It rings true for many healthcare professionals and, I believe, very much so for vets. The author noted the connection between the mental health of the practitioner and how it affects patient outcomes. She examined burnout and the psychological characteristics that can contribute to burnout vulnerability and resilience in a group of surgical trainees.
Burnout was assessed with an abbreviated Maslach Burnout Inventory. Stress, anxiety, depression, resilience, mindfulness and alcohol use were assessed and analysed for prevalence. Truthfully, how many of these appear in your life? Among the 566 surgical residents who participated in the survey, burnout was a whopping 69 percent, equally driven by emotional exhaustion and depersonalisation. Depersonalisation involves a persistent or recurring feeling of being detached from one’s body or mental processes. To some of us, it may feel like going through the motions, purposefully feeling as little as possible in order to get through the day. Depression, suicidal ideation and anxiety were notably high across training levels, but improved with greater experience.
Odds ratios (ORs) were used to determine the magnitude of presumed risk and resilience factors. I include the OR in brackets just to stress the differences between burnout and mindful working. Higher burnout was associated with high stress (78), depression (48) and suicidal ideation (57). However, on a more optimistic note, she also found that dispositional mindfulness was associated with lower risk of stress (0.15), depression (0.26) and suicidal ideation (0.25). These figures are vastly different.
The case for mindfulness is strong. For it not to be promoted as part of the workplace culture is to miss a real opportunity to optimise patient care by promoting clinician self-care. This study supports the potential of mindfulness training to promote resilience, decrease exhaustion and burnout and to improve the standard of care we provide to our patients. Being proactive is better than reacting to burnout after it has damaged one’s professional life or personal wellness.
To promote mindfulness training in practice, why not have a mindfulness CPD day with a qualified mindfulness practitioner? This counts as RCVS CPD and is tax deductible. Set up a mindfulness hub in your practice and employ the mindfulness practitioner to teach staff how to use it for mini meditations.
