Program aims to counter physician burnout, prevent related lapses in patient care quality
Dr. Jennifer Rench certainly felt called to a career in medicine. Her original plans to follow in her father's footsteps and become an engineer were transformed, while she was in college, through a deeply spiritual encounter she experienced while volunteering at a small hospital in the Dominican Republic. Her steadfast belief that through medicine she could best serve both God and people sustained her through many challenging years of medical school.
And yet even Rench, committed and inspired though she was, felt deeply disillusioned by the time she'd finished her residency.
"It's soulless," the young family medicine doctor said of her medical training. "You become a machine, and you lose sight of the humanity.
"Then I was a new physician, and I felt pressure to increase my numbers and see more patients. And there was the paperwork — the long hours in front of the computer — and the short time I had with the people."
A program offered by her employer, Columbia St. Mary's, helped Rench rediscover her original passion for patient care, she said.
She's not alone. Over the past two years more than 40 physicians at the Milwaukee-based health system have completed the "Medicine in Search of Meaning" program. Through it, Rench said, she found other dedicated physicians who shared her mission to heal but also her frustration with modern medical practice.
The contemporary version of this weekend workshop has its roots in the early 1990s, when Bill Bazan, a spiritual counselor
who worked extensively with medical professionals in Milwaukee, cofounded a program of the same name at Columbia St. Mary's Hospital. Bazan, who conducted retreats at several hospitals around Wisconsin in the 1990s, said the program was in demand because physicians were then — as they are now — becoming burned out by overwhelming changes in their profession, from practice consolidation to risk management to increasing financial complexity.
"I began to sense burnout happening at an age you wouldn't expect it. Young physicians in their 30s and 40s, just getting burned out, and that began to lead to an increased inability to express empathy," Bazan recalled. "Meaning and purpose in why they chose to be a caregiver was being sapped because of external forces."
Columbia St. Mary's and the other hospitals eventually stopped offering the program and Bazan went on to a career in advocacy with the Wisconsin Hospital Association. Medicine in Search of Meaning was revived at Columbia St. Mary's two years ago, said Paul Westrick, the health system's vice president of mission integration and advocacy. Bazan, who retired last year from the state association, is leading the retreats.
Bazan's semiannual two-day retreats use case studies and discussions to examine the challenges and benefits of practice, explore individual spirituality and encourage collegiality, Westrick said. Bazan has been invited to lead a physician retreat in April at Providence Hospital in Mobile, Ala. Providence and Columbia St. Mary's both are members of Ascension Health.
Breakfast club
Last year, in an effort to capitalize on the enthusiasm generated by the program at Columbia St. Mary's, Westrick and others developed a yearlong program of monthly, physician-led breakfast meetings to provide a forum for continued discussion about meaning, purpose and value in medicine.
Along with helping the doctors, Westrick said, these meetings serve the system's physician alignment strategy, "building relationships between physicians that otherwise wouldn't be happening at that level if we weren't doing something like this, setting a different context for physicians to engage with each other as human beings."
Mark Repenshek, a health care ethicist at Columbia St. Mary's, said such opportunities for physicians to discuss nonclinical subjects, especially deeply personal issues like spirituality and burnout, are rare in the current hospital climate.
"The whole system and structure of medicine has changed," Repenshek said, and added that many of Columbia St. Mary's primary care physicians don't come to the hospital anymore. Their hospitalized patients are cared for by specialists in hospital care. The primary care doctors "just see patient after patient after patient, while the hospitalists or intensivists have very little time to develop a rapport with the family and the patient. And physician collegiality . . . has gone by the wayside."
Boosting physicians' spirits relates directly to quality and safety measures, Repenshek said, referring to literature that shows that physicians who are overwhelmed with their work are more inclined to medical errors and lower patient satisfaction. "There is a strong correlation between physician burnout and quality," he said. "It's not just about patient satisfaction but about having the true healing presence."
Mindful medicine, meaningful contact
Repenshek said many physicians who have participated in Medicine in Search of Meaning have followed Bazan's advice and have developed personal practices that help them stay "mindful" in the midst of a hectic schedule. "It might be something very ordinary. Maybe it's just, as they grab the handle to the door, taking five seconds to breathe deeply and let go of the patient they just saw, and prepare for the next patient."
For Dr. Antonio Salud II, an enthusiastic supporter of Medicine in Search of Meaning, a tactic for staying engaged with patients involves making sure he sits, and listens.
"It's not so much a routine or ritual, but it is how I relate with other people. It's more subtle. For me, it is sitting down, trying to connect and get to know someone, giving the other person a chance to say something or to share a particular thought or feeling," he said. "That's how I maintain the reflective approach — that it's not about me."
For Rench, Medicine in Search of Meaning "is still keeping me alive." She said the weekend retreat gave her a "jump start" and she finds the monthly breakfasts are important to maintain her relationships with other physicians.
"The face of medicine is changing, but we need to be reminded that the spirituality of medicine hasn't changed. It is still here," she said. "Once a month, I'm going to sit with people because I need to be reminded, this is why I did this. This is why I need to continue to do this, and do it well."
To help reinforce her sense of meaning and purpose, Rench volunteers at the free clinic operated by Columbia St. Mary's, providing health care to the uninsured.
"It's refreshing. I feel like I'm really doing something good. These are people who don't have insurance, or any state aid. They've waited in line for hours to be heard. I am as present as I can make myself.
"I find that medicine is always challenging," Rench said. "But when it is really your passion, and maybe your mission, it's not so hard."