When Coaching Physicians with Wellness, Don’t Always Lead with Mindfulness

They were right!

In my work with physicians and physician leaders in academic medicine, I quickly learned that physicians are highly self-reflective and are aware of the pressures and demands that they face. However, physicians are frequently the last to ask for help, if they do at all, and the first to deprioritize their own self-care. This has led to high suicide rates in the overall physician population.

For coaches partnering with this population to explore burnout, balance, and well-being, leading with mindfulness as a first practice could cause an adverse reaction. This happened to me when a colleague and I held a workshop on physician wellness and began the session with mindfulness. Several people left the room and a few others spoke up immediately, indicating that what they needed as help was not mindfulness, but solutions for inefficient processes and help with increased demands from their medical coding departments. We did not make that mistake again!

These professionals are overwhelmed and in a state of raw coping, rather than thriving, and are far away from any tools to support ongoing resilience. They are just trying to get through the day and meet their goals. Oh, and take care of their patients. Leading with mindfulness as a first solution can be seen as “another thing to do” in an already packed schedule or can make physicians feel angry, or ‘wrong” or “guilty” for not already trying something that seems so simple. It can also cause the physician to close down to exploring other solutions.

Of course, we know that mindfulness is a powerful tool, and can help physicians be more self-aware and navigate physical and emotional reactions to stressors, but timing and context is key. How can we partner with them to understand the issues they face, and help them frame and reframe a path forward?

As coaches, we have tools that can help. First, we must create a sense of trust and safety with the physician so that they understand we are there to help them find their own path forward. This seems like an obvious statement given that Building Trust and Safety is one of coaching’s core competencies, but physicians, if they are provided coaching through the organization may suspect that this is an offering provided to help make them more productive. Once we have established trust, and the physician can verbalize and frame their personal set of stressors, there are other tools to help them categorize and prioritize a way forward.

The Maslach Burnout Inventory (MBI), a psychological inventory and proven war horse, is one tool we can employ to help the physician prioritize their experiences and the negative outcomes those stressors create. The report is categorized into five dimensions: Emotional Exhaustion, Depersonalization, Cynicism, Personal Accomplishment, and Professional Efficacy. In this framework Emotional Exhaustion, Cynicism, and Depersonalization contribute to burnout, while Personal Accomplishment and Professional Efficacy reduce burnout. The individual report provides physicians some action steps and prioritization to help them understand where to focus and where they have power to make change toward thriving. The MBI also has group and team assessments and reports for work with intact teams or groups of physicians.

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