Page numbers printed in boldface type refer to tables and figures.
Accreditation Council for Graduate Medical Education (ACGME),7, 37, 110, 138
ACGME.
See Accreditation Council for Graduate Medical Education
Alcohol abusecase example of,155–156
signs and symptoms in the workplace,158,
159Alcoholics Anonymous,71–72
American Academy of Pediatrics,110
American Foundation for Suicide Prevention,72
American Medical Association, ethics codes,156, 158
American Psychiatric Association, ethics codes,156, 159
American Psychological AssociationAdvisory Committee on Colleague Assistance,72
Center for Organizational Excellence,121
Colleague Assistance and Wellness Survey,72
ethical principles and code of conduct,158–159
Americans with Disabilities Act,111
American Time Use Survey,20
Aoun, Hacib,9
Ayurveda medicine,5
Behavior.
See also Mindfulness
emotional toll of burnout,131
goals for changes in,210
healthy,13
mental and emotional well-being,179–180
nutrition and physical activity and,208–210
sleep and,227
Bipolar disorder,93–94
Body scans, mindfulness and,199–200
Breathing, mindfulness and,200
British Columbia Medical Association,211
“Bullying culture,” in medicine,87
Burnout.
See also Well-being; Wellness
antecedents and causes of,66–70
individual factors,66–68
organizational and environmental contributions,68–69
societal and systemic explanations,69–70
symptom overlap between early-stage burnout and clinical depression,68,
69avoidance of,12
case examples of,59–61, 67–68
challenges to prevention and treatment of,70
combating burnout and enhancing compassion with mindfulness,194–195
components of burnout syndrome,11,
12costs of clinician burnout,13–14, 63–66
clinician well-being,63
organizational losses,63, 66
patient care,63
threats to health care reform,66
definition of,57
depression and vulnerability to,15
description of,11–13, 57, 103–104,
107environment as predictor of,68–69
gender and,20–21
ICD-11 classification of,11, 58
identification and measurement of,61–63
measurement of,142–143
models of,58–61
dimensions of,57,
59prevalence of,58–59
negative consequences of workplace distress and sources of professional burnout,124positive practices in identification of early signs of,75–76
prevention of,29–30
relationship of gender differences and caregiving roles with,20–21
vignette,21
sense of calling in relation to physician burnout,262,
263stress and,18–20
student meaning of,107–
108susceptibility to,59–61
symptoms of,20
untreated burnout and mental illness,70–75
depression,71
issues in medical training,73–75
overview,70–71
substance abuse,71–72
suicide,72–73
in younger clinicians,39
Case examples.
See also Vignettes
of alcohol abuse in the workplace,155–156
of burnout,59–61, 67–68
of clinician-patients,89–96, 113–116
of clinicians-in-training,113–116
of cognitive impairment,159–160
of culture of living well,253
of depression,95–96
of legal/ethical issues,155–156, 159–160
of mindfulness,198
of nutrition and physical activity,209–210
of opportunity for connectedness,237–238
of Parkinson’s disease,162
of sleep deprivation,224–225
CBI.
See Copenhagen Burnout Inventory
CBT.
See Cognitive-behavioral therapy
Chinese medicine,5
Circadian rhythms, sleep and,223
Clinician-patients.
See also Clinicians; Mental health care; Professional development
accommodations for,88–89
alternatives to therapy,249–252
finding or creating the right consultation for your needs,250–
251vignette,249, 251
barriers to care,246–247
benefits of seeking care,247–248
boundaries of,90care,84–86,
87,
90case examples of,89–96
common humanity among,85
communication among,89–90
confidentiality among,87, 88, 93
core beliefs of,256–258
culture of living well,252–253
case example of,253
improvement in access to care,87–88
informal consultation with,88
overview,245
personality traits of clinician,86
positive practices,96–97, 254–255
selection of a therapist,248–249
separation of,85
stigma of,85, 88,
91treating clinician of,84
treatment recommendations,91–
92vignettes,83, 85
Clinicians.
See also Clinician-patients; Legal/ethical issues
certification of,141
challenges and opportunities in clinician wellness,132clinician involvement in initiatives for wellness,136–137
compensation structures,138–139
confidentiality during training of,73
costs of burnout,63–66
clinician well-being,63
organizational losses,63, 66
patient care,63
factors affecting willingness to intervene or report potentially impaired colleague,157importance of wellness,10
licensing of,141
measurement of clinician engagement,23
mindfulness for,193–194
physician wellness programs,135–136
selection of,248–249
self-care habits of,xii, 3, 23
as superhumans,11, 24
Clinicians-in-trainingachievement-oriented character traits of,102–103
future for,111–116
case examples of,113–116
communication to trainees,113reframing unhelpful thinking,113as healers,109overview,101–102,
102personal stressors for,106, 109–110
student meaning of stress, burnout, coping, and resilience among,107–
108positive practices,116–117
preexisting mental health challenges among,110–111
professional stressors for,104, 106
prevalence of harassment and discrimination among,105vignette,104
risk of mental health issues for,103–104
successful trainees,103
Clinician Well-Being Knowledge Hub,125
Cognition, maladaptive,239
Cognitive-behavioral therapy (CBT),192
for insomnia,223–224
Cognitive impairmentcase example of,159–160
signs and symptoms of clinician in the workplace,160,
161Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS),140
Communicationclinician-patients,89–90
for clinicians-in-training,113medical jargon,89,
91COMPASS.
See Colleagues Meeting to Promote and Sustain Satisfaction
Compassionenhancing with mindfulness,194–195
self-compassion,213
Confidentialityamong clinician-patients,87, 88, 93
of clinician-patients,247, 251
during clinician training,73
Continuous positive airway pressure (CPAP),224
Copenhagen Burnout Inventory (CBI),62
Copingdescription of,105student meaning of,107CPAP.
See Continuous positive airway pressure
Culture.
See also Race
bullying and,87
of living well,252–253
of medicine,87, 102–103, 143
of well-being,195
of wellness,86
Death.
See also Grief
of a patient,106
Depersonalization,20, 62
Depressioncase example of,95–96
in physicians-in-training,19symptom overlap between early-stage burnout and clinical depression,68,
69untreated burnout and,71
vignette of clinician-patient,85
vulnerability to burnout and,15
Diet.
See also Nutrition
mindfulness and,200–201
self-care and,177
Discriminationamong clinicians-in-training,105in wellness programming,22
“Doctor’s doctor,”83.
See also Clinician-patients
Early careerbenefits of mentorship,41positive practices during,43professional development during,38–42
stressors,39–40
vignette,39
wellness growth opportunity,40–42
Eating disorders,206.
See also Nutrition
EHRs.
See Electronic health records
Electronic health records (EHRs)burnout and,124, 138
sleep and,221–222
Empathy,17–18
Energy, management of,183–184
Environment.
See also Nature, connecting with; Workplace
as factor affecting willingness to intervene or report potentially impaired colleague,156,
157nature and mindfulness and,196,
197, 201
negative consequences of workplace distress and sources of professional burnout,124noticing surroundings,201
as predictor of burnout,68–69
Ethical issues.
See Legal/ethical issues
Federation of State Physician Health Programs (FSPHP),158
Fellowship.
See also Clinicians-in-training
positive practices during,36stressors,35, 37–38
vignette,37–38
wellness growth opportunity during,38
Financescosts of clinician burnout,13–14, 63–66
costs of medical school,109–110
resilience and,180–181
Friendship,235.
See also Relationships
connection with,239
FSPHP.
See Federation of State Physician Health Programs
Genderbalance of demands of family life and work,30
burnout and,20–21
depression and,71
discrimination,105suicide and,72–73
Gratitude,184–185
Grief.
See also Death
case example of,67–68
description of,50
Harassment, among clinicians-in-training,105Health care systems.
See also Resilience
physician wellness programs,135–136
preventive health carebarriers to self-care,171–172
overcoming,172–173,
174change and flexibility across the professional life span,173–175
vignettes,175
overview,169–170
positive self-care and resilience practices,170–171
self-care strategies for,181–182
well-being continuum,170,
171House of God, The,74
ICD-11, classification of burnout,11, 58
Identity development, of early-career professional,39–40
Imposter syndrome,40
Ingelfinger, Franz,7–8
Institutions.
See Organizations
Internshippositive practices during,36stressors,35, 37–38
vignette,37–38
wellness growth opportunity during,38
Job descriptions,131
Job satisfaction,69
Kabat-Zinn, Jon,191, 193
Late careerpartial retirement during,48
positive practices during,47practitioner policy,163
professional development during,46–48
stressors,46
wellness growth opportunity,47–48
Leadershipconscious leaders and mindfulness,195
organizational support for,141
participatory management style and,137
for resilience of mental health professionals,124–125
roles during mid career,44
Legal/ethical issuesgovernance of,153
obligations,153–164
case examples of,155–156, 159–160, 162–164
factors affecting willingness to intervene or report potentially impaired colleague,157overlapping issues related to clinician impairment,154signs and symptoms of alcohol dependence in the workplace,158,
159signs and symptoms of cognitive impairment in the workplace,160,
161overview,153
positive practices,164–165
reporting,153–154
well-being and,14
Liaison Committee on Medical Education,34
Listen-Act-Develop model,137
Loneliness.
See also Relationships
avoidance of,238–239
consequences of,232–233,
234lack of social connectivity and,232
scale,234Maslach Burnout Inventory (MBI),61–62
Match Day,34
Mayo ClinicListen-Act-Develop model for well-being,137
program on physician well-being,135
MBI.
See Maslach Burnout Inventory
MBIs.
See Mindfulness-based interventions
MBSR.
See Mindfulness-based stress reduction
Medical school.
See also Clinicians-in-training
abuse in,75
black-and-white thinking,112
career progression in academic medicine,31costs of,109–110
demands of,82
discrimination in,75
harassment in,75
health insurance in,9–10
health issues during,73–74
positive practices during,33professional development during,30–35
stressors,32
vignette,32, 34
Medications, as sleep aid,222
Mental health care.
See also Clinician-patients
access to,84–88,
87,
90among professionals,16–18
physician motivation,17vignette,17–18
among students and trainees,18–20
depression and suicidal ideation,19barriers to,246–247
benefits of strong social connections,236benefits of seeking,247–248
costs of clinician burnout in health care reform,66, 129
description of,3–4
mindfulness for clinicians,193–194
preexisting mental health challenges among clinicians-in-training,110–111
risk of mental health issues for clinicians-in-training,103–104
staff turnover and,129
stigma of,88
Mental illness, untreated burnout and,70–75
Mentors.
See also Peers
benefits of,41description of,40
institutional support for,41–42
versus isolation,15
meaningful professional contributions and,268–269
mosaic,41, 134
peer mentoring,42, 61, 93
vignette,234–235
Mid careercase examples of,95–96, 253
culture of living well,253
leadership roles during,44
positive practices during,45professional development during,42–46
stressors,44
wellness growth opportunity,44, 46
Mindfulness,10
body scans and,199–200
breathing and,200
combating burnout and enhancing compassion with,194–195
daily work task for,272
description of,191–192
“fringe” therapeutic approach,191
interventions for,191–192
for mental health clinicians,193–194
mindful systems,195
nature and,196,
197positive practices,199–201
role of religion and spirituality with,195–196
self-care and,196–199
wellness and,192–193
Mindfulness-based cognitive therapy,249
Mindfulness-based interventions (MBIs),191–192
Mindfulness-based stress reduction (MBSR),191–192
Mindful practice,10
Modelsof burnout,58–61
dimensions of,59prevalence of,58–59
of care,127–128
of physician wellness programs,135–136
tiered primary prevention as model for system-level intervention,131–133,
133Mosaic mentoring,41, 134
National Alliance on Mental Illness,21
National Sleep Foundation,219
Nature, connecting with,196.
See also Environment
inside,197outside,201
NCDs.
See Neurocognitive disorders
Neurocognitive disorders (NCDs),160–162,
161Nutrition.
See also Diet; Self-care
healthy eating pattern,207
mindfulness and,200–201
physical activity andbehaviors among physicians,208–210
case example of,209–210
examples of activities by intensity level,208institutional support,211
overview,205
positive impact on well-being,207–208
self-monitoring,215
support,215
positive practices,211–212
fallback plan,214
food log,214
sleep and,206
Obesity, stigma of,206–207
Organizationsclinician compensation structures,138–139
contributions to causes of burnout,68–69
costs of medical errors,129–130
financial losses of clinician burnout,63, 66
impact of systems issues for wellness interventions,130–131
implementation of support measures,138–141
need for system-level change,141
resources for self-care,172–173
risk of burnout in low-resource settings,126–128
vignette,127–128
support for leadership,141
support for nutrition and physical activity,211
tiered primary prevention as model for system-level intervention,131–133,
133Parenting, wellness and,20
Parkinson’s disease,162
Patientscosts of clinician burnout and patient care,63
death of,106
difficult,104, 106
well-being outcomes of,5
wellness activities for,23
Peers.
See also Mentors
consultation groups,249, 251
evaluation of older workers,46
mentoring,42, 61, 93
Perfectionism,18
Personal developmentstressors,48–49
vignette,48–49
wellness growth opportunity,49
PFI.
See Professional Fulfillment Index; Stanford Professional Fulfillment Index
PHPs.
See Physician health programs
Physical activity.
See also Nutrition, physical activity and
psychological benefits of,207–208
World Health Organization’s emphasis on health care across the life span,176–177
Physical health, resilience and,176–177
Physician health programs (PHPs),158, 164
Positive reframing,179
Postdocpositive practices during,36stressors,35, 37–38
vignette,37–38
wellness growth opportunity during,38
Professional development.
See also Clinician-patients; Quality of life
acknowledgment of contributions,265–266
career progression in academic medicine,31choosing meaning,266–267
connecting work with,267vignettes,267–268
during early career,38–42
benefits of mentorship,41mental health care and,246
positive practices,43stressors,39–40
vignette,39
wellness growth opportunity,40–42
inspiration and,270
job satisfaction,69
lack of personal accomplishment,262
during late career,46–48
positive practices,47stressors,46
wellness growth opportunity,47–48
meaningful professional contribution,180
during medical school,30–35
positive practices,33stressors,32
vignette,32, 34
during mid career,42–46
positive practices,45stressors,44
wellness growth opportunity,44, 46
overview,29–30
personality and,271
positive practices,269–270
professional activities and,271–272
professional effectiveness and work satisfaction,262–264
during residency, internship, fellowship, and postdoc,35–38
positive practices for advanced trainees,36stressors,35, 37–38
vignette,37–38
wellness growth opportunity,38
sense of calling in relation to physician burnout,262,
263sense of meaning in work,265,
266types of contributions,264–265
wellness growth opportunity,34–35
writing,272–273
Professional effectivenessdefinition of,262–263
self-care and,51
Professional Fulfillment Index (PFI),12–13
Psychological empowerment,137
Quality of life,182, 252–253.
See also Professional development
Race.
See Culture
discrimination,105suicide and,72
Rapid eye movement (REM) sleep,222
Relationshipsbenefits of strong social connections,233–235
health-promoting factors and,236chronic problems with,16
lack of social connectivity and loneliness,232
consequences of,232–233,
234loneliness scale,234vignette,234–235
maintenance of,242
opportunity for connectedness,237–238
case example of,237–238
overview,231–232
positive practices,238–240
quality of,178
resilience and,177–179
Religionmindfulness and,195–196
spiritual connection and,196
REM.
See Rapid eye movement sleep
Residency.
See also Clinicians-in-training
positive practices during,36stressors,35, 37–38
vignettes,37–38, 122–123
wellness growth opportunity during,38
Resilience.
See also Health care systems
components of,175–181
financial health,180–181
meaningful professional contribution,180
mental and emotional well-being,179–180
physical health,176–177
social relationships,177–179
descriptions of,108, 169
enhancing,183–185
flourishing and mental health,170
leadership and,124–125
positive practices for,170–171
recharging one’s batteries,175,
176relationships and,177–179
student meaning of,107–
108teaching and development of,112
Roosevelt, Theodore,261
Safe Work Australia,128
Saint-Exupéry, Antoine de,245
Self-care,30.
See also Diet; Nutrition; Physical activity; Sleep
barriers to,171–172
overcoming,172–173,
174compromising,271
during major life events,49
mindfulness and,196–199
organizational resources for,172–173
positive practices for,170–171, 182–183
for professional effectiveness,51
quality of life and,182
strategies for preventive health care,181–182
Self-compassion,11, 194–195, 213, 249
Self-reflection,185, 240–241
Shem, Samuel,74
Sleepbenefits of,220–221
calculation of sleep time,226
deprivation,37, 221–222
case example of,224–225
medications and,222
mindfulness and waking up,199
nutrition and,206
positive practices,225–226
regulation of circadian rhythms and,223
self-care and,177
sleep hygiene,224strategies for optimizing,222–225
vignette,220–221
Sleep apnea,224
SMART.
See Stress Management and Resilience Training
Social relationships.
See also Relationships
resilience and,177–179
Spiritual connection, definition of,196
Spirituality, mindfulness and,195–196
Stanford Emergency Medicine Department,211
Stanford Professional Fulfillment Index (PFI),63,
64–
65, 75
Steinbeck, John,219
Stigmaof clinician-patients,9, 85,
91of mental health care,88
of obesity,206–207
Stressburnout and,18–20
description of,107monitoring,130, 133
student meaning of,107–
108Stress Management and Resilience Training (SMART),172–173
Stressorsof clinicians-in-trainingpersonal,106, 109–110
student meaning of stress, burnout, coping, and resilience among,107–
108professional,104, 106
prevalence of harassment and discrimination among,105vignette,104
during early career,38–42
during late career,46
during medical school,32
during mid career,44
personal development and,48–49
during residency, internship, fellowship, and postdoc,35–38
Substance abuse, untreated burnout and,71–72
Suicideattempt of a colleague,xi
gender and,72–73
interpersonal theory of,235race and,72
suicidal ideation in physicians-in-training,19untreated burnout and,72–73
Timewith friends and family for well-being,179
“must-haves,”183
sleep and,226
Vignettes.
See also Case examples
of burnout,21
of clinician-patients,83, 85, 249, 251
of clinicians-in-training,104
of elevated clinician burnout,125–126
of lack of social connectivity and loneliness,234–235
of meaningful professional contributions,267–268
of mental health care among professionals,17–18
of mentors,234–235
of personal development,48–49
of preventive health care,175
of professional developmentduring medical school,32, 34
during residency, internship, fellowship, and postdoc,37–38
of sleep deprivation,220–221
of volunteering,268
of writing,267
Volunteering,239–240
vignette,268
Walk With Your Doc Initiative,211
Weight, stigma of,22, 206–207
Well-being.
See also Burnout; Wellness
business case for clinician well-being,128–130,
132compromised,13–14
continuum,170,
171costs of clinician burnout,63–66
definition of,4–5
discussion questions for colleagues and mentors,24
ethics and,14
individual and system-level interventions,14–15
key drivers of physician wellness,6Mayo Clinic’s program on physician well-being,135
mental and emotional,179–180
patient outcomes and,5
positive impact of nutrition and physical nutrition of,207–208
system-level responsibility for,8–9, 24
time with friends and family for,179
Wellness.
See also Burnout; Well-being
challenges and opportunities in clinician wellness,132changing cultures of,86
clinician involvement in initiatives for,136–137
consensus definition for physician wellness,4
criticism of programs for,21–23
description of,29
discriminatory programs for,21–22
growth opportunity for personal development,49
growth opportunity for professional development,34–35
during early career,40–42
during late career,47–48
during medical school,34–35
during mid career,44, 46
during residency, internship, fellowship, and postdoc,38
historical roots of wellness for physicians,5–11
key drivers of physician wellness,6suicidal ideation among American surgeons,8versus illness,5, 7
importance of physician wellness,10
mindfulness and,192–193
models of physician wellness programs,135–136
parenting and,20
physician wellness programs,135–136
positive practicesclinician engagement,23
for clinician-patients,96–97, 254–255
for clinicians-in-training,116–117
of culture of living well,254–255
during early career,43for meaningful professional contributions,269–270
in identification of early signs of burnout,75–76
during late career,47legal/ethical issues and,164–165
during medical school,33during mid career,45mindfulness and,199–201
of nutrition and physical activity,211–212
for optimizing sleep,225–226
for organizations,143–144
during residency, internship, fellowship, and postdoc,36of self-care,182–183
of strong social connections,238–240
professional,122–126
advancing the science of,142–143
impact of systems issues for interventions,130–131
negative consequences of workplace distress and sources of professional burnout,124vignettes,122–123, 125–126
programs for physicians,135–136
structures for support of,133–135
Womendepression and,71
job pressure on,125–126
maternity leave,110, 128
Workplace.
See also Environment
appreciation and acknowledgment for good work,266
mentorship programs,269
negative consequences of workplace distress and sources of professional burnout,124reasonable demands in,133–134
self-care in,178
signs and symptoms of alcohol abuse in,158,
159technology-based solutions for well-being,139–140
World Health Organizationclassification of burnout,11, 58
emphasis on physical activity in health care across the life span,176–177
Writing,270, 272–273
vignette,267
