Medicine

Meditation: A Surefire Approach to Mitigate the Consequences of Burnout Among Health Practitioners

Abstract

The cases of occupational stress (commonly referred to as burnout) experienced in healthcare facilities have augmented exponentially. This paper amalgamated a series of studies, all of which evaluate the consequences and implications of burnout in said facilities, laying the groundwork required to fully answer the question of whether the implementation of meditation sessions in healthcare facilities can reduce occupational stress and burnout levels among health practitioners. Minimized cerebral gray matter volume, a lack of functional connectivity within certain areas of the practitioner’s brain, and dereliction of patient care originating from a stressed healthcare worker’s inability to fully engage during the job, are found to be complications arising from a stressful environment. The remainder of the article is centered around the topic of how meditation successfully renews previously lost brain volume and functional connectivity within the brain structures among these medics, and ameliorates doctor-patient relationships. Counterarguments to the aforementioned notion based on instances of psychosis among meditators were discussed, and limited solutions were addressed.

INTRODUCTION

Since the initial conceptualization of burnout, a term introduced in 1974, cognizance of how occupational stress influences healthcare personnel performance in the 21st century has expanded (Reith[1], 2018). Levels of stress are prevalent in America among college graduates predominantly, prompting further international and global critical evaluation of occupational stress (Kahneman[2] & Deaton[3], 2010, 17). Regarding the preliminary inspection of this pressing matter, exacerbating stress levels must be urgently addressed by providing a means to help healthcare workers balance daily tasks, and maintain a sense of transcendental gratification (spiritual satisfaction). Meditation has been classified as a method of coping with stress in 19th century American literature. Literary characters, such as Mrs. Mallard in “The Story of an Hour” by Kate Chopin[4], have been depicted to cope with stressors while engaging in a meditative state; said meditative practices have evolved to become modern methods of reducing stress (1894, 42). Such brings us to the inquiry: Can the implementation of meditation sessions in healthcare facilities reduce occupational stress and burnout levels among health practitioners? Through the evaluation of the scientific and sociocultural lens, it becomes apparent that meditation can address the anatomical and biological changes burdening stressed health professionals, while serving as a means to ameliorate the gradual diminution of doctor-patient relationships and patient well-being that stem from escalating burnout levels.

DISCUSSION

Figure 1. Blix, Eva, Aleksander Perski, Hans Berglund, and Ivanka Savic, Reductions in GM Volumes in Stressed Subjects. 2013. Long-term Occupational Stress is Associated with Regional Reductions in Brain Tissue Volumes. PLoS One 8, no. 6. Minimized gray matter volumes (as shown is red), are apparent among stressed subjects.

With the demands and professional imperatives working in the field of medicine entails, interpersonal and cognitive productivity is a must for health professionals. Eva Blix[5], and co-authors, conducted a study directed toward measuring the scope of cortex volume reductions when correlating such to occupational stress, relying on the usage of Positron Emission Tomographies[6], or PET scans (2013). Significant decreases in “gray matter, basal ganglia volumes” were monitored throughout the brains of participants experiencing occupational stress (2013, 5). Minimized volume in the brain regions mentioned was associated with impaired cognitive and autonomic responses, both of which are critical abilities that health workers must possess. Though this study had minimal participant variability, it measured the scope of cortex volume reductions when correlating such to occupational stress systematically, as was noted in research that followed. For instance, said information was similarly established in a 2014 study by Srmita Golkar[7] and co-authors, as “functional connectivity within the anterior cingulate cortex, associated with the ability to down-regulate negative emotion,” was found to be hindered by occupational stress (Golkar et al., 2014, 1). Negative affectivity[8] is minimally suppressed, and as biological impediments emerge from high demands, health practitioners fail to incorporate their knowledge fully in a situation that requires initiative, critical thinking, and emotional intelligence. Thus, patient dissatisfaction and an inability to develop solution frameworks when working in a designated patient’s case can start to become highly probable scenarios.

Occupational stress often forms the roots of poor doctor-patient relationships, which can cause further dereliction of patient care and patient well being cross-culturally. Exigent professional demands across American employment sites have resulted in a report that is salient among the rest, stating that Americans seem to experience “staggering levels of stress, being fifth among 151 countries” (Kahneman & Deaton, 2010, 17). With health practitioners comprising a significant segment of American workers, analysis of how burnout is prevalent in the United States leads to further assessment concerning the levels of stress within medic populations in other regions. In fact, through a cross-sectional study conducted in Western Greece, similar to the study mentioned previously, Fotios Anagnostopoulos[9] and co-authors advanced the notion that “burnout can lead to medical negligence and malpractice litigation,” with the inclusion of patient care that is nothing more than substandard, as well as suboptimal patient attitudes (2012, 402). Even though satisfaction variances are noted predominantly among patients in this study rather than among physicians, associations between physician well-being and patient care are fully exhibited through those means. Patients are often discharged to make the service at hand seem feasible for the healthcare workers and are therefore not provided proper diagnoses or satisfactory answers to their inquiries. Communication between healthcare workers and patients throughout Europe appear to be severely hindered as well, as the reality of occupational stress and burnout has begun to infiltrate the grounds of medical facilities within countries such as Portugal and Spain (Travado[10], Grassi[11], Gil[12], Ventura[13], & Martins[14], 2005). With reduced confidence and emotional intelligence suppressed due to what seems to be the biological consequences of external circumstances, health practitioners often find themselves incapable of effectively imparting the critical advice patients desperately need.

When regarding the aforementioned research compounding evidence of the baneful implications associated with occupational stress, the notion that meditation is an efficient approach to address those factors becomes evident. This rationale is particularly veritable granted that meditation is consequential to the study of neuroscience, serving as a means to rectify the mentioned physiological complications that occupational stress may generate. The interrelation surveyed between cortical thickness around the prefrontal cortex and meditation is clear. Joseph Loizzo[15] discussed the matter as he conducted an informative assessment of how contemplative meditators are known to display augmented levels of prefrontal cortex thickness (Loizzo, 2014). In accordance with Loizzo’s argument, post-doctoral scholar Do-Hyung Kang[16], and contributing authors expanded on the notion that increased cortical thickness is observed in the temporal and frontal lobes, as well as in the “bilateral ventromedial PFC,” a cerebral region critical to decision making (Kang et al., 2013, 27). Conversely, cortical thickness in the inferior parietal cortex, also known as the posterior cingulate cortex, is significantly lower among meditators of Brain Wave Vibration[17] meditation (Kang et al., 2013). When in the inferior sector of the parietal cortex, cortical thickness reduction can improve cognition, the ability to engage in self-assessment with competence, and inclusively regulate positive emotions with efficacy. Even though this study implemented a cross-sectional design, therefore making the results slightly tentative, it emphasizes on findings already proven to be veritable by researchers like Loizzo.

Increased gray matter in the “right inferior fronto‐insular cortex,” and functional alterations in the dorsolateral and dorsomedial prefrontal cortex, the dACC,” is observed among meditators, leading Alessandra Dodich[18] and contributing researchers to suggest that Sahaja Yoga[19] meditation enhances goal‐directed behavior and attention (Dodich et al., 2019, 1). In essence, the brain changes described are correlated with an increased level of emotional well-being, a point that was assessed through a series of questionnaires. Though the surveys did not fit the description of the more validated forms, they substantiated the notion that a relationship is present between subjective well-being, mental health, and functional modifications in the brain. Deviating slightly from the subject matter of how meditating gives way to the advent of restorative cortical thickness alterations among medics, “increased connectivity of the anterior cingulate cortex” is also proven to transpire throughout the population of meditators (Loizzo, 2014, 45). Therefore, brain regions encompassing “social responsiveness, empathy, positive affect, and internal reward,” are stimulated during meditation. Reliance on meditation as an approach to mitigate the stressors concurrent with a profession in the health sector, will lead to the minimization of cognitive and neurological decline, considering that mental acuity is an obligatory prerequisite for working as a health practitioner.

The underlying argument put forth by critics, however, seems to be that meditation, to an extent, can lead those who practice it to experience acute psychological trauma. A case of “polymorphic symptomatology[20] precipitated by intense meditation,” observed in a 24-year old Caucasian male, advanced the notion (Kuijpers[21], van der Heijden[22], Tuinier[23], & Verhoeven[24], 2007, 462). The young adult was subject to an “acute sensation of being mentally split during a Hindustan type meditation” (Kuijpers, van der Heijden, Tuinier, & Verhoeven, 2007, 462). The fact that periods of unguided or immoderate levels of meditation caused the above mentioned psychotic sensations to arise must be clarified. The 14th Dalai Lama propounded that balance, whether it includes in “thinking about God, compassion” or when applied in other contexts, is crucial, in an excerpt from The Book of Joy: Lasting Happiness in a Changing World (Bstan-ʼdzin-rgya-mtsho[25] & Tutu[26], 2016, 52). Logically, anything pursued in excess can have damaging effects on one’s well-being; therefore, excessive involvement in meditative sessions aimed at alleviating occupational stress is not advisable to those already receiving treatment for a psychotic disorder.

Acknowledgment of how meditation addresses the neurobiological hindrances occupational stress may create for healthcare practitioners leads to the dissection of its role in enhancing substandard doctor-patient relationships and patient well-being, across cultures. In a medical facility composed of patients and medics, workers, or hospital staff, stressed medics’ responses to interpersonal demands could often precipitate to become faulty diagnoses. Therefore, meditation serves as a means to address the problem at its core, and afterward, ensure satisfactory interpersonal relationships in the workplace. Through an elaborate evaluation of Kate Chopin’s “The Story of an Hour,” one is introduced to the recuperative value of mindfulness meditation. The story presents a 19th-century American woman named Mrs. Mallard, who receives the news of her husband’s supposed death. Upon giving said news by her sister, Mrs. Mallard heads to her room where she experienced “the delicious breath of rain was in the air,” and that “the notes of a distant song which some one was singing reached her faintly” (1894, 42). The fact that Mrs. Mallard was “pressed down by a physical exhaustion that haunted her body and seemed to reach her soul,” and that “her gaze was fixed off yonder on one of those patches of blue sky,” hints at her engagement in mindfulness meditation (1894, 42). As the story progresses, Chopin exemplifies how through self-reflection, introspection, and meditation, Mrs. Mallard momentarily coped with the initial distress she experienced upon hearing of her husband’s passing and contemplated the benefits newfound freedom would pose for her. Upon reading this book, some readers resort to construe that Mrs. Mallard’s gratification, to some extent, had little to do with meditation and more to do with her innate desire for freedom. However, the fact that her realization was made possible through meditation is unequivocal. On that note, the constructive effects of meditation, having been introduced throughout American literature, can be applied in the context of a medical facility as well. Mindfulness-Based Stress Reduction Meditation, which serves as the subject matter for multiple studies based in Indian populations, diminishes mental stress and aids soon to be medics in the prospect of enhancing their concentration and memory (Deepika[27], Priya[28], & Gayathridevi[29], 2019). Evaluation of the extent to which a correspondence between meditation and occupational stress relief is evident leads to the notion that medic-patient-relationships will also be ameliorated.

The matter of how implementing meditation practices within the hospital setting fortifies doctor-patient relationships, and therefore patient well-being statuses, is one that though not directly stated, is inferred by the 14th Dalai Lama, much like it is in the “Story of an Hour.” Through the excerpt from The Book of Joy: Lasting Happiness in a Changing World, the 14th Dalai Lama divulges how “happiness can be experienced at the deeper level throughout our mind, such as through love, compassion and generosity” (Bstan-ʼdzin-rgya-mtsho & Tutu, 2016, 53). The Dalai Lama, being a monk, reflects a cultural, Buddhist perspective on meditation as he explicates how a deeper mindset provides a framework for genuine, and fulfilling interpersonal connections, a remedy for depersonalization[30]. Buddhist practices like meditation “promote social resilience, prosocial behavior, and social connections,” both of which are of paramount importance when operating in service to others (Winzer[31] & Gray[32], 2019, 412).

Limiting solutions unrelated to meditation are currently present to redress the preceding outcomes and negative implications of burnout, among those being the global expansion of Paid Time Off (PTO) across hospitals and health facilities. PTO amalgamates vacation days, sick days, personal days, and vacation days. Business consultant Bridget Miller expounds on how PTO would allow employers (including those employed in the health field) to choose their time off when needed, and to use their “PTO days when encouraged” (2015). However, PTO days could be viewed as vacation days, causing health workers to attend work if ill (considering that they utilized all their sick days), which would be detrimental for both medic and patient, therefore classifying this solution as ineffective. Incorporating short, but frequent meditative sessions throughout the health practitioners’ work-day, will guide medics in the prospect of addressing the implications of their occupational stress successfully.

CONCLUSION

Burnout, also known as occupational stress, proves to be deleterious for both the health professional and the patient, and perhaps the quality of work that characterizes a hospital. Injurious cortical reductions in brain regions that diminish the cognitive acuity of medics and substandard doctor-patient relationships, are corrected or improved through engagement in meditation. Therefore, it becomes certain that the implementation of meditative sessions throughout medical facilities is a surefire way of approaching the problem. Despite the evidence of sporadic cases that counter meditation, devoting a slight amount of time from practitioners’ work schedules to integrate progressive meditative sessions, will address the growing impediment to medical progress that is burnout.

References

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and Dimitris Niakas. “Physician burnout and patient satisfaction with consultation in

primary health care settings: evidence of relationships from a one-with-many design.”

Journal of clinical psychology in medical settings 19, no. 4 (2012): 401-410.

Blix, Eva, Aleksander Perski, Hans Berglund, and Ivanka Savic. “Long-term occupational stress

is associated with regional reductions in brain tissue volumes.” PLoS One 8, no. 6

(2013): e64065.

Chopin, K. “The story of an hour. Originally published in Vogue, December 6, 1894.” (1894).

Deepika, R., A. Jothi Priya, and R. Gayathridevi. “Effect of meditation on mental stress among

dental students.” Drug Invention Today 12, no. 8 (2019).

Dodich, Alessandra, Maurizio Zollo, Chiara Crespi, Stefano F. Cappa, Daniella Laureiro

Martinez, Andrea Falini, and Nicola Canessa. “Short‐term Sahaja Yoga meditation training modulates brain structure and spontaneous activity in the executive control network.” Brain and behavior 9, no. 1 (2019): e01159.

Golkar, Armita, Emilia Johansson, Maki Kasahara, Walter Osika, Aleksander Perski, and Ivanka

Savic. “The influence of work-related chronic stress on the regulation of emotion and on functional connectivity in the brain.” PLoS One 9, no. 9 (2014): e104550.

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emotional well-being.” Proceedings of the national academy of sciences 107, no. 38 (2010): 16489-16493.

Kang, Do-Hyung, Hang Joon Jo, Wi Hoon Jung, Sun Hyung Kim, Ye-Ha Jung, Chi-Hoon Choi,

Ul Soon Lee, Seung Chan An, Joon Hwan Jang, and Jun Soo Kwon. “The effect of meditation on brain structure: cortical thickness mapping and diffusion tensor imaging.” Social cognitive and affective neuroscience 8, no. 1 (2013): 27-33.

Kuijpers, Harold JH, F. M. M. A. Van der Heijden, Siegfried Tuinier, and W. M. A. Verhoeven.

“Meditation-induced psychosis.” Psychopathology 40, no. 6 (2007): 461-464.

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in a changing world. Penguin, 2016: pp 51-57.

Loizzo, Joseph. “Meditation research, past, present, and future: perspectives from the Nalanda

contemplative science tradition.” Annals of the New York Academy of Sciences 1307, no. 1 (2014): 43.

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(2019): 411-425.

  1. Thomas P. Reith: Medical College of Wisconsin scholar, located in Milwaukee, U.S.A.

  2. Daniel Kahneman: American-Israeli economist and psychologist.

  3. Angus Deaton: British-American academic and economist.

  4. Kate Chopin: American, 20th-century author and writer of what were short novels, with the setting being Louisiana.

  5. Eva Blix: A researcher at Stockholm Brain Institute, in the Division of Pediatric Neurology.

  6. Positron Emission Tomography (PET scan): A form of imaging examination that assesses organ functionality in an individual.

  7. Srmita Golkar: Researcher at the Department of Clinical Neuroscience, in Stockholm, Sweden.

  8. Negative affectivity: The establishment of an inferior self concept.

  9. Fotios Anagnostopoulos: Psychology researcher at the Panteion University of Social and Political Sciences, in Athens.

  10. Luzia Travado: Specialist on clinical psychologist.

  11. Luigi Grassi: Professor of psychiatry at the University of Ferrara.

  12. Francisco Gil: Researcher at the University of Valencia.

  13. Cidalia Ventura: Lisboa Center researcher.

  14. Cristina Martins: University of Porto researcher.

  15. Joseph Loizzo: Founder of the Nalanda Institute for Contemplative Sciences, and renowned psychotherapist.

  16. Do-Hyung Kang: Postdoctoral scholar at Seoul National University College of Medicine.

  17. Brain Wave Vibration: A form of meditation based on ancient Eastern practices

  18. Alessandra Dodich: Researcher at the San Raffaele Scientific Institute.

  19. Sahaja Yoga Meditation: A form of meditative technique where focus is established in the present moment, diminishing mental activity.

  20. Polymorphic Symptomatology: A psychotic disorder characterized by delusions or hallucinations.

  21. H.J.H Kuijpers: Researcher at the Vincent van Gogh Institute for Psychiatry, located in Venray.

  22. van der Heijden F.M: Contributing researcher of psychopathology at the Vincent van Gogh Institute for Psychiatry, located in Venray.

  23. S. Tuinier: Contributing researcher of psychopathology at the Vincent van Gogh Institute for Psychiatry, located in Venray.

  24. Wil Verhoeven: Researcher at the Vincent van Gogh Institute for Psychiatry, located in Venray; researcher in Erasmus University Medical Centre, Department of Psychiatry, located in Rotterdam, The Netherlands.

  25. Bstan-ʼdzin-rgya-mtsho: The 14th Dalai Lama, and a monk of the Tibetan Buddhism Gelug school.

  26. Desmond Tutu: A South African theologian and cleric.

  27. Raj Deepika: Researcher of social sciences at Anna University, located in Guindy, Chennai.

  28. A. Jothi Priya: Researcher of medical physiology at Saveetha University, located in Chennai.

  29. Gayathri R. Devi: Duke Department of Surgery researcher.

  30. Depersonalization: A behavioral trait frequently exhibited by health practitioners suffering from occupational stress, characterized by a sense of detachment from oneself and ultimately one’s surroundings.

  31. Lylla Winzer: Researcher at the University of Potsdam and Humboldt University of Berlin.

  32. Rossarin Soottipong Gray: Corresponding author and researcher at the Institute for Population and Social Research in Thailand.

About the Author

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Melissa is a high school junior at School for Advanced Studies, and was born in Pinar Del Rio, Cuba. She came to the United States when she was eight years old. It was then that she began to explore her love for writing and for scientific research. In the future, she plans to pursue an education in Biology, and expand her knowledge in the medical field.

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