Equanimity in Medicine Cassie C. Ferguson, MD Associate Professor - - PDF document

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Equanimity in Medicine

Cassie C. Ferguson, MD

Associate Professor of Pediatrics, Section of Emergency Medicine Director of the Student Pillar, The Kern Institute for the Transformation

• f Medical Education

Objectives

• 1. Explore the concept of equanimity as it

applies to our well-being as physicians.

• 2. Explain how recognizing and managing our

emotions as physicians play a significant role in

• ur well-being.
• 3. Describe how vulnerability is key to

experiencing our emotions in a healthy way.

• 4. Practice three specific techniques for

improving our individual well-being.

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Disclosures

• I have no relevant financial relationships with

commercial interests to disclose

“One of the great mysteries of illness is that no one can be healed by anyone whose emptiness is greater than their

• wn.”

Mark Nepo

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August 2009

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“We were taught,” he said, “that only the patients’ emotions should matter.”

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“Physicians are prone to all the same human emotions of pride and guilt and shame that distort

• ur reason, but we are just

trained to believe that we can surmount them.”

In Shock, Awdish

Aequanimitas

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Is there a better way?

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Physician Responses to Grief

–Altered treatment decisions –Mental distraction –Emotional and physician withdrawal from patients –Burnout

Granek, et al. Arch Intern Med (2012)

% reporting burnout: 2011: 45.5% 2015: 54.4% % OB-GYN physicians reporting burnout: 2011: 48% 2015: 53%

Shanafelt T, et al. Mayo Clin Proc (2015)

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48.4% 28.4%

Shanafelt T, et al. Mayo Clin Proc (2015)

Burnout…

…is specific to the workplace and is typically caused by system bureaucracy or dysfunction that interferes with what you know you could do to help and to heal …is the result of the accumulated impact of thousands of everyday “micro” traumas

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We were called to this work.

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“Nothing ever goes away until it has taught us what we need to know…it just keeps returning with new names, forms, manifestations until we learn whatever it has to teach us about…how we are closing down instead of allowing ourselves to experience fully whatever we encounter, without hesitating or retreating into ourselves.”

Pema Chodron

“Vulnerability…

…is not winning or losing; it’s having the courage to show up and be seen when we have no control

• ver the outcome.”

Brene Brown

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Have I missed an important diagnosis? Is surgery the right option for this patient? For this family? Do the benefits of this medication

• utweigh the risks?

Is it safe to send this patient home? Did I save this patient for a good life?

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“We often cause pain rather than feeling it.”

• B. Brown

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Recognize Acknowledge Investigate Natural awareness

Pay attention to what you’re saying to yourself and take some responsibility for that voice.

Jill Bolte Taylor

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A shift from the belief that we can control what we feel to the understanding that the only thing we can control is how we respond

Where are my feet?

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“…is not to try and throw

• urselves away and become

something better. It’s about befriending who we are already.”

Pema Chodron

“Mindfulness means paying attention in a particular way:

On purpose In the present moment Non-judgmentally

Jon Kabat-Zinn

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Self-compassion is the seed of well-being and the basis of compassion for all others 3 Elements of Self-Compassion

• 1. Self-kindness vs self-judgement
• 2. Common humanity vs isolation
• 3. Mindfulness vs over-identification

www.self-compassion.org

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• ne for me & one for you

“The secret of transformation is in how we handle this very moment.”

Thich Nhat Hanh

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It is the strong back that supports the soft front of compassion

Roshi Joan Halifax

Thank you.

Cassie Ferguson, MD cferguson@mcw.edu Twitter: @mcwquips