Minimizing Medical Burnout: Dr. John M. Kennedy On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout
An Interview With Dan Rodrigues
Exercise groups — encourage doctors to participate in regular walking groups. This is the most practical and accessible. If weather does not permit walking outside, use a staircase or hospital wing or corridor.
As a part of this series, we had the pleasure of interviewing John M. Kennedy.
John Kennedy, MD, is a board-certified cardiologist with 25 years of experience in his field. In addition to being a renowned clinical practitioner, he has dedicated a large portion of his time to research, focusing on the impact of stress on cardiovascular health. Dr. Kennedy is the author of two popular books dealing with simple yet powerful programs that emphasize the power of prevention. The Heart Health Bible presents a five-step plan to preventing and reversing heart disease, while The 15 Minute Heart Cure tackles the impact of stress on the cardiovascular system and details his stress-reduction technique BREATHE, which has been proven effective even for people working in highly stressful environments.
Thank you so much for joining us in this interview series! What or who inspired you to pursue your career? We’d love to hear the story.
I was inspired and motivated to pursue a career in medicine by an incredible mentor who was my high school friend’s father, Dr. James Price. I met Dr. Price when he visited my science class for show and tell. A phenomenal teacher with humorous and charismatic style, Dr. Price made an indelible impression on me when he demonstrated a heart model. His entertaining and fascinating demonstration sparked my interest in Cardiology, and I have never looked back. I remember how in just a heartbeat after this experience I attended Dartmouth then Brown and before I knew it, received my MD degree.
During medical school at Dartmouth, I became fascinated with the relationship of emotional stress and heart disease which inspired two books The 15 Minute Heart Cure and The Heart Health Bible and multiple research articles on the subject.
Below please see a link of a 90 second animated story describing how I developed the BREATHE Technique
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
As a cardiologist I have seen thousands of examples of how stressful life events trigger cardiac events. I have learned that effective stress reduction exercises can lower blood pressure and lower risk which is why I created the BREATHE Technique.
I have also learned that the most common stressful trigger is workplace stress and regardless of industry employees feel they have too much to do with too little time and do not take enough work breaks.
I recently produced the BREATHE video library help employees reduce stress at work, students reduce stress at school, and to help all users focus, concentrate and relax.
Here are the current projects I am involved with.
BREATHE for Brown University Medical Students and Faculty 2022
Research shows that medical 20 to 90% of medical students report stress and burnout which correlates with burnout.
In order to help medical students reduce stress and prevent burnout, I have gifted the BREATHE Stress Reduction Video program to al Brown University Medical Students.
BREATHE for First Responders 2022
Stress is common in the workplace for first responders and has been linked to increased cardiovascular risk. In order to help first responders reduce stress in the workplace I have gifted the BREATHE stress reduction program to first responders.
Research shows how the BREATHE technique helped first responders lower stress in the workplace.
BREATHE for Kids and new illustrated e-book The Heart & Brain Play Jump Rope
Heart disease starts early and has a long asymptomatic lag time. Helping kids reduce stress can help protect their hearts and promote a heart healthy lifestyle.
In March 2022, I completed an illustrated children’s e-book entitled The Heart & Brain Play Jump Rope which teaches kids about the importance of the heart-brain connection and how the BREATHE™ technique can help them better cope with stress created by school, sports, performance, and social pressure.
I am gifting the book to Junior Achievement, Southern California and Montessori Schools and have partnered with Goldie Hawn and her MindUp program.
BREATHE Exercises designed for kids include:
- BREATHE for Test Taking
- BREATHE for Public Speaking
- BREATHE for Time Management
- BREATHE for Studying
- BREATHE for Study Breaks
You are a successful leader. Which three-character traits do you think were most instrumental to your success? Can you please share a story or example for each?
Work Ethic. I like most physicians, have a strong work ethic, am goal-oriented, high achieving, and enjoy working on multiple projects at once. I am passionate about my work, research, writing and golfing. That said, I often remind myself to be ethical to myself by spending quality time away from work with my family and friends. I have re-structured my practice schedule, so I have regular time to meet with my daughters and spend time away from work for their various activities. Last Wednesday my daughters and I watched a sunset at the beach, talked about Tik Tok, attending driving education this summer, then had Pizza at Village Pizzeria.
Belief in Importance of Work Breaks. I am constantly reminded of a friend and colleague who ignored the importance of taking breaks. He was a phenomenal cardiologist, doctor to the stars, and professional sports teams though rarely found time for himself. Shortly following his divorce, he was found lifeless, head on his desk, still in his white coat from his hospital rounds, with his computer screen illuminating his overdue charts he was signing. Ironically, he died from sudden cardiac arrest, the disease he literally spent his life combatting for his patients.
I have learned taking short breaks during the workday helps improve focus and concentration. Walking a few flights of stairs, practicing a short visualization or exercise, or taking a short break away from the office or ICU helps to reboot, feel revitalized, and energized. I have seen how people take a few minutes between patients or calls and continue working by answering emails or calling families. This is not a true break and increases work stress. I believe in taking a break from your break. At least once during my workday I imagine being on the tee box on hole #7 at Pebble Beach golf club and hitting a golf ball out toward the beautiful blue Pacific ocean. I can feel the mist of the water the wind at my back and hear the waves crash as I imagine my golf ball climb through the air and land gently on the putting green. For me, this visualization works like a charm and consistently helps me feel revitalized, energized and motivated when back at work to accomplish the task at hand.
Presence & Empathy. I learned in medical school when taking a history from a patient to imagine them as a family member or friend. Then think of your how your patient is a brother, sister, mother, or father and how important they are to their loved ones. This simple rule has helped me remain engaged and to hone my skills as an active listener.
Being present has allows me to hear fascinating stories from people from all over the globe and from all walks of life. When present and actively listening, I hear incredible stories from immigrants from foreign countries, Holocaust survivors, prisoners of war, CEOs and celebrities. My patients are fascinating people from all socio-economic backgrounds with different religious and cultural beliefs all sharing human stories and health problem that I have the opportunity to help solve.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?
I think “burnout” is a syndrome many physicians and healthcare workers experience when they feel physically and emotionally exhausted and their work seems purposeless. They feel like they are on a hamster wheel, unrecognized, unappreciated, and ineffective which causes them to become cynical, sarcastic, and negative about medicine, their job, and their patients. Burned out physicians are often sleep deprived, easily fatigued, lethargic, irritable and lose the ability to have empathy for their patients and their families.
How would you define or describe the opposite of burnout?
Healthcare workers that are not burned out have purpose and meaning and genuinely enjoy their work. They are motivated and enthusiastic and grateful for the opportunity to help others. They are passionate, engaged, motivated to work, and self-actualized. They enjoy working as an integral part of a well-oiled machine and feel satisfaction executing a multidisciplinary plan. Even daily ICU rounds on patients which include input from RNs, Respiratory therapists, pharmacists, dietitians, and physical and occupational therapists is rewarding.
Personally, I am grateful to be part of such a team and am fascinated by cardiology. I continue to enjoy talking to patients and families and get satisfaction from teaching them about the respective diagnosis and plan. I am grateful for being able to solve complex clinical puzzles, diagnose, treat, and in some cases cure patients.
From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout?
- The automated, impersonal, and distracting Electronic Medical Record.
- Loss of autonomy.
- Overemphasis on documentation and underemphasis on doctor-patient relationship.
- Endless Workload.
- Feeling unappreciated.
- Feeling as though on a hamster wheel which creates loneliness and social isolation.
- Sleepless nights from work stress.
- Loss of interest in self-care.
- The Covid 19 Pandemic was the straw that broke the camel’s back for many physicians and has led to mass exodus from medicine.
Reasons include:
- Missing the opportunity live a slower paced life outside of medicine.
- Fear of contracting the virus and dying.
- Fear of infecting family members and loved ones.
- Frustration of having inadequate therapies to treat our patients.
Have you seen burnout impact your own organization? Can you give a first hand description of how burnout can impact the operations of an organization?
I have seen first-hand how when burned-out physicians leave their practice earlier than expected it negatively impacts the group or organization. Research estimates when physicians leave the field, the practice loses $500,000 to $1,000,000 of revenue and additional costs required replace physicians of $90,000.
Also, when burned out physicians leave, other physicians in the group are responsible to absorb the extra work which can cause more burnout in the group.
I have also seen how staying in practice when burned out can be problematic and specifically lead to drug and alcohol use, divorce, depression, and suicidal ideation.
Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.
I am currently in private practice and am fortunate to have amazing resources available to me and my family when feeling stressed or overwhelmed. My work has made me keenly aware of the stressful pitfalls of my job and career in medicine.
Prior to entering private practice, I worked as Director of the cardiac catheterization laboratory, in Marin County, California, where I started a “Heart Alert” program designed to provide emergency cardiac care for patients with heart attacks. As is the case for all Trauma Surgery and Cardiac Catheterization Laboratory teams around the country, team members are responsible for assembling quickly in response to cardiac emergencies. The work is time sensitive, high pressure, and requires consistent execution with precision and accuracy. The work is stressful and demanding and can be physically and mentally exhausting. In anticipation of the stress encountered by me and my team members during this 8 year program, the HMO Administration Team provided accessible, effective, and robust mental health resources for me and my staff. The program was private, smart-phone accessible, and available 24–7. The program was called kp.org/gethelp
Now, I use my program at:
Breathewithdrkennedy.com
All exercises use the proven and effective BREATHE Technique, a seven-step relaxation exercise that combines guided imagery, focused controlled breathing, and positive self-talk.
I use specific exercises:
- BREATHE for Teamwork
- BREATHE for Leadership
- BREATHE for Innovation
- BREATHE for Communication
- BREATHE for Job Promotion
I also use:
- BREATHE with Waterfalls
- BREATHE with Forests
- BREATHE with White Sand Beach
- BREATHE with Mountain Tops
- BREATHE with Red Rock
All exercises are designed to help users focus, concentrate, and relax.
Studies show how BREATHE helped even the most stressed populations reduce stress at work.
BREATHE helped doctors in a multi-specialty medica group reduce stress during their workdays, RNs reduce stress during busy work shifts, and firefighters reduce stress once they returned to base after a run.
In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
I have worked with many of the best and largest electronic medical record systems and automated computerized medical transcription systems available today ( EPIC, Cerner, GE Healthcare, Allscripts) and although potentially faster, more efficient and improve work flow, I have found a slippery slope exists when computerized and automated work is introduced to the workplace for doctors.
On one hand, automation makes access to information and workload faster and more efficient, though on the other, computerized medical systems can be distracting and interfere with the doctor-patient relationship which can make work less impactful and meaningful for the patient.
I find the electronic medical record to be more stressful because I get further behind saving documentation of progress notes and orders until after the patient encounter making the process more laborious and time consuming.
I have also found the real-time word recognition programs to be distracting and interfere with the one-on-one doctor patient communication.
My practice is to talk the patient and family in person first and to save documentation for later.
This counterintuitively makes workflow less efficient, though in my opinion best for the patient.
Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?
1 . Encourage self-care in a private secure setting — doctors are stressed and tend to suffer in silence.
Hospitals that provide stress reduction programs should be sensitive to privacy and provide effective, accessible stress reduction tools such as the BREATHE™ technique.
2. Personal Acknowledgment by Hospital Leadership Team — Acknowledge each doctor, nurse, or healthcare provider personally for their work, expertise, and important contribution to healthcare — I have learned that simple personal recognition and appreciation with “thank you cards” from the CEO go a long way and help doctors feel appreciated — Make these cards personal and reference the doctor’s schooling, area of specialization, board-certification, and years of practice.
3. Exercise groups — encourage doctors to participate in regular walking groups. This is the most practical and accessible. If weather does not permit walking outside, use a staircase or hospital wing or corridor.
4. Encourage work breaks and use of effective stress reduction exercises for Doctors offered by hospitals — like BREATHE™
Taking short work breaks have been shown to improve productivity, efficiency and help healthcare workers reboot, and feel energized and revitalized.
My research has shown how taking short work breaks for a multi-specialty physician group helped doctors feel less stressed and revitalized. Studies have also shown how BREATHE helped RNs and firefighters feel less stressed at work.
5. Teamwork and Team Member acknowledgment — Teams are an integral part of the healthcare delivery system. Acknowledgment and appreciation of team members at work during or after team activities helps foster comradery and improves efficiency and outcomes. I was the director of the cardiac catheterization laboratory for Kaiser Permanente where I ran a Clinical Event Team Training program which simulated CODE Blue situations and patients with cardiac arrest. This program emphasized acknowledgement and appreciation for each of the team members, their respective roles and responsibilities, and important contributions during the simulated Cardiac Arrest and fostered teamwork and comradery which led to improved clinical outcomes.
What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?
First, tell them they are not alone.
According to data from the AMA
“More than half of U.S. physicians are now experiencing professional burnout.” 3
“Physician burnout is reaching crisis proportions in the United States.”
Next, tell them how feeling “burned out” is understandable and affirm how their job is known to be one of the most stressful. Workload, compassion fatigue and sleeplessness are all encountered by most healthcare professionals.
Next, refer them to AMA Practice Transformation
https://www.ama-assn.org/practice-management/sustainability/practice-transformation
Explain to them that reaching out is a sign of strength and commendable.
Encourage them to get help and how there are effective resources available and accessible.
What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?
1.A common mistake made by physicians when trying to reverse burnout by themselves is to start taking days off without appropriate coverage for their patients.
Although time away from work, exercising, relaxation, family, and social life are essential for physicians to reverse burnout, successfully executing this plan requires reliable sign out to an alternative covering physician which must be established and confirmed.
2.Arriving late to work late to work to get more sleep and scheduling social events that conflict with office hours or scheduled procedures can cause unnecessary stress for office/hospital staff and patients.
3.Starting an aggressive exercise regimen without being medically cleared can be unsafe and even dangerous. Many physicians ignore their own health care. Last year a colleague started running at lunch which triggered a heart attack. He collapsed in the parking lot from sudden cardiac arrest and was resuscitated. He was admitted to the hospital where we practice, and he underwent emergent cardiac surgery for blocked coronary arteries. This could have been prevented if he had seen a doctor for regular follow-up appointments.
It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
Early in my training, when I was in medical school learning to take a history and perform a physical examination, I underestimated the importance of the stress in a patient’s life.
A woman presented with chest pain and difficulty breathing. She reported feeling overwhelmed with the stress in her life which included her difficult relationship, young children, and finances. My teacher underestimated her symptoms and after reviewing her lab reports, we all agreed to send her home from the hospital.
Two weeks later she presented with similar symptoms of chest pain and difficulty breathing. She reported the same story of being overwhelmed by the stress in her life — though this time she had a heart attack and was admitted to the intensive care unit for emergency care.
I underestimated how the stress in her life was triggering and exacerbating her heart symptoms.
Since then, I have made it a routine practice to inquire about the stress in a patient’s life because medical research shows clear associations between psychological health and CVD and risk.
I believe strong consideration of psychological health is advisable in the evaluation and management of patients with or at risk for cardiovascular disease.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
“Your presence is the most precious gift you can give a human being.” — Marshall B. Rosenberg
When we are present we are calm, focused, and relaxed — the opposite of stressed.
The goal of practicing the BREATHE™ Technique is to learn to be present and to acknowledge how the heart and brain are connected — in constant communication.
BREATHE helps users practice being present and how to see, feel, hear and participate in the communication between the heart and brain.
Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
Stress effects all of us. No one is immune. Data shows how stress increases the morbidity and mortality of heart disease and stroke, two of the leading causes of death. Therefore, I believe we can all use a BREATHEr.
Learning a simple, seven-step stress reduction exercise known as BREATHE will help you focus, concentrate, relax, and protect your heart and brain — all at the same time.
Remember, when stressed in life regardless of the trigger, whether work, finances, or health issue, instead of reacting with fight, flight, freeze — you can learn to respond to stress and listen, focus, and BREATHE.
How can our readers further follow your work online?
breathewithdrkennedy.com
BREATHE for Doctors & Preventing Burnout
https://www.youtube.com/watch?v=pjztYkHUTM8
The BREATHE Technique
https://www.youtube.com/watch?v=Pzxx-uqHhFQ
BREATHE Stress & Our Heart
https://www.youtube.com/watch?v=xt5UK5SLODw
This was truly meaningful! Thank you so much for your time and for sharing your expertise!
Minimizing Medical Burnout: Dr John M Kennedy On How Hospitals and Medical Practices Are Helping T was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.