Evidence-based Wellness – A Physician’s Journey

Is compassion-focused mindfulness the antidote to the stress experienced by health professionals? Dr. Dawn DeWitt is a Professor and Senior Associate Dean for the Washington State University College of Medicine’s Collaboration for Interprofessional Health, Education, Research, and Scholarship. Dr. DeWitt practices “Mindful self-compassion,” a process developed by Dr. Kristen Neff and Dr. Chris Germer, which teaches individuals how to acknowledge emotional challenges and respond with compassion. Listen to learn more about why Dr. DeWitt thinks mindful self-compassion is critical to reducing stress symptoms. She also shares new insights about how accessible techniques like meditation can impact brain and gene structure. 

“Finding Joy: The Health Care Professional’s Journey to Well-being" is a podcast resource developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.

The Interprofessional Education Research team wishes to thank the following individuals for their invaluable contributions to this project:

• Dr. Barb Richardson, nurse, educator, and interprofessional champion;

• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine;

• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and

• Claire Martin-Tellis, Executive Producer, and Solen Aref, student intern, who developed the first five episodes of the “Finding Joy” podcast.

This episode of “Finding Joy” was produced by Doug Nadvornick, Program Director, Spokane Public Radio.

If you would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu We also encourage you to visit our podcast blog as well as our team's website at: https://opioideducation.wsu.edu/about/.

Transcript

 Finding Joy podcast 11 (season 3, podcast 1): Dawn DeWitt about mindful self compassion.  

This is “Finding Joy: The Health Care Professional’s Journey to Wellness and Resiliency.” It’s a podcast developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting wellness among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration. 

[theme music]  

I’m Doug Nadvornick.  Health care professionals have developed a variety of ways to deal with the stresses of their work. Some take up athletic endeavors. Some turn to charitable work. Dr. Dawn DeWitt has her own diversions. One is called mindful self compassion, in which a person both acknowledges his or her emotional struggles and responds with compassion.  

Dr. DeWitt is a professor and senior associate dean for the Washington State University College of Medicine’s Collaboration for Interprofessional Health, Education, Research, and Scholarship, or Ciphers.  

Doug: “So tell me a little bit about your path toward learning about mindful self-compassion.” 

Dawn DeWitt: “So I’m one of those people that would've told you probably 10 years ago, or something like that that mindfulness, yeah, that's all very nice, but I'd rather play tennis or go for a walk in the woods or, you know, exercise or do music, something else that would give me some happiness. And then my son got quite ill and part of his treatment was to learn mindfulness. So I was trying to be supportive of him and this is not a secret because he made some YouTube videos about this for other teens, struggling with issues. And I started to get really interested in some of the science behind mindfulness, things like how it could change your brain for the better or things like how it could help with depression, for example, or anxiety. And I tried to do a little bit of it for him and learn a little bit about it. Then I had a couple of these sort of Zen experiences where you sort of get into it enough that you come out of a session of people could do it for five minutes a day and there's benefit there. But I had one of these experiences where I was like, oh yeah, I actually get it. I can feel that feeling in my brain. And then being a little bit techy, I realized that there are some technical things like there's this thing called a muse headband, that's basically an EEG or for doctors and electroencephalogram that measures your brain waves. And we can quantify, count and measure brain waves that are associated with meditation and happiness and sleep. Delta waves are the ones everybody knows about, because those are sleep, right? Then there are other devices that can help with biofeedback, your blood pressure, your heart rate, those sorts of things that can tell you that you're actually training your body to do something that's good for you. And then I read the really cool thing, which was that it can actually change the length of your chromosomes. So all of our chromosomes are, they look like little Xs and they have the branches of them that are called telomeres. Well, it turns out that people with things like cancer have short telomeres, especially in those genes that are affected by the cancer. But if you meditate for 30 days for 30 minutes, I think that's the right metric, they can measure that your telomeres get longer, longer being good. And I was like, wow, if meditation can change your genes, I really ought to be paying attention to this. So, then the next thing that happened was somebody recommended a Ted talk by this woman named Dr. Kristen Neff, N-E-F-F, and a man named Chris Germer, who's a psychologist at Harvard who developed this mindful self-compassion business. And I signed up to go take a course with them, which is something I've never done in my life. I've never done a week of yoga for self-improvement or a week of, you know, when you're a doctor, you just don't do that stuff usually. You're too busy trying to get your continuing medical education credits and so on and do your day job. But anyway, I went to this retreat for a week and I suddenly thought, oh my goodness, this is the special sauce because doctors and health professionals in general are selected to be hypercompetitive. I mean, you have to go through all the college with straight As through pre-med, all that, all those exams, all those things. And you're selected to be very hard on yourself because, if you aren't, somebody's gonna die. So if you forget to put in the orders or you forget to dictate the note, something could happen. So we're all selected and trained to be super compulsive and hard on ourselves. And those are correlated with doing a good job for the most part, until you get burnout or you get, exhausted from being on call for 40 hours at a time or something like that. So this mindful self-compassion, it's mindfulness, but it was the self-compassion part that really got my interest. And Kristen Neff in this Ted talk spends some time talking about the difference between self-indulgence and self-compassion. And it's not that you say, oh, well, you know, nobody will care if you take the day off and pull a sickie, that's not the point. The point is that when something happens to acknowledge, oh gosh, that's really hard. You know, my patient died or my dog died, or my mother died and, or I'm sick and that's really hard. And I need to be nice to myself about this and be understanding as well as the mindfulness part of it. And that really changed the way I looked at the world and myself and how, you know, I was used to, my mother was like, when the going gets tough, the tough get going. And I don't think I was sick or took sick days off probably in school. I think I took one sick day during medical school when I got food poisoning and one sick day during residency. But, like, I went to work, come hell or high water or whatever else. And, of course, we know that's not the best way to be, but that was the culture at the time. So to make a long story short, I decided I was gonna get certified as a mindful self-compassion facilitator and I've done the second course, which is a week of silent retreat, which was really interesting. Oh my goodness. I'm only a moderate or mild extrovert actually, but being quiet for a whole week was really, really interesting. I think there's really something there in terms of finding joy and giving yourself permission and being kind to yourself as somebody who is always trying to focus at least in your day job on the health and wellbeing of others.” 

Doug: “Going back to your days as an early physician, would you have thought this is quackery?” 

Dawn DeWitt: “I would've been going, oh, can I go out for a hike on Mount Rainier or can I go out and bicycle for a half a day off instead of sitting in a chair and meditating? Yeah. The other important thing about that is that apparently the research shows that even if you only meditate for five minutes every day, that's better than trying to meditate for an hour once a month. So there's some habit and practice there that helps your nervous system reset. And one of the quotes I love from John Kabat-Zinn, who was this guy who went to MIT, he's a scientist, not a physician, but he works at the Massachusetts medical school. He was having a lot of patients with pain or cancer, et cetera, and he wanted to change patients’ relationship with their pain. But one of the things that he said is our entire society is suffering from hyperactivity, attention deficit disorder because of all of the media machines, computers, all the constant input that we get and demand for attention, for things that are really not important. And the little time that we just spend letting our brains sort themselves out and relax and meditation basically does that. It helps you clean out your brain, but 20 years ago, I would've been, ‘Go away. I don't have time to sit still for that.’ And I guess what I meant is that that mind body connection wasn't preached as much a generation or two ago, whereas now it seems to be so intuitive for so many people. And the other thing we all acknowledge is that you can't fix systems-related burnout for 40-hour days by just a little meditation in yoga. You know, that's not the whole point to fixing the burnout problem that we have. One of the experiences that I was lucky enough to have was going to practice in Australia. And I wrote an article about this a few years ago, but having less bureaucracy, less paperwork, I had to do a lot less in Australia. I could see 40% more patients without even blinking because I was spending FaceTime with patients and less time with computers and documentation. And that was really joyful. I miss that type of practice every time I'm trying to get my electronic health record to give me some new dropdown menu. I'm like, oh my God, let me out of here. It's just crazy.” 

Doug: “So do you think that is the big reason why we are hearing about so many doctors wanting to leave? Is it just the system that you work under?” 

Dawn DeWitt: “I think a lot of it is the system and the corporatization of medicine. I mean, we know it's not all just the electronic health record, but there’s a woman, Smith is her last name, who did a Ted talk on there's more to life than happiness. And one of the things she talks about is that meaning in life is important. And for me, that's what I get when I'm seeing patients or working with students. It's those moments of meaning where I'm doing something that I care about and where I get some meaningful interaction with the person and meaningful helping, whether it's that I'm just educating them about something or that they're telling me what would make their health better. And I can help them achieve that, whether it's through medicine or referral to a surgeon or whatever it is, but it's that meaning that is so important and makes such a big difference. And we're losing that. To some degree it's getting lost in the corporatization and financial profit issues around medicine. So we need to repower, somehow, providers, I'm not supposed to use the word providers anymore, professionals, health professionals and patients to say, this is what matters. It's a challenge.” 

"This is the Finding Joy podcast. I’m Doug Nadvornick, talking with Dr. Dawn DeWitt from the Washington State University College of Medicine." 

Doug: “So I'll steer back to mindful self-compassion, now that you're teaching it, what are the the best ways for you to do that, to get the points across?” 

Dawn DeWitt: “I’m not in this to be a commercial mindful self-compassion person and I still need to finish my teacher course, which got put on hold because of the pandemic. I mean, I can do workshops and so on, but I couldn't call myself an accredited, mindful self-compassion teacher, still to be completed. But it's trying to share with others, this kind of aha moment that I had, that if you combine the two, there's lots of science underlying it, and, B, it can really change your relationship with the painful moments in life. It's not gonna take away the pain. You know, my magic wand is on back order and has been for a number of years, but this can change your relationship with the way you deal with stress around some of these issues. And, you know, I think probably every doctor I know has spent sleepless nights when something happens to a patient and, oh my God, did I miss something? Did I do the wrong thing? And you agonize over those moments and it's not that I don't agonize them over them anymore, but I can put them into perspective and say, okay, this really hurts. This is painful. This is unhappy. I am so sorry that this happened to my patient, regardless that it's not my fault, but just that, before, I would've been torturing myself with, oh my God, is there anything else I could have done here? So part of it is just acknowledging the challenges that we all face every day and the stressors that we all face every day and being a good friend to yourself.” 

Doug: “So it's like you had an argument with somebody and you recognize that you've done something wrong, and you say, okay, I understand all of this. You experience the feeling and then you get past it.” 

Dawn DeWitt: “Yeah, you definitely need to feel the feeling and feel the unhappiness, but having either the self-compassion or a compassionate friend, whichever you can get. And, you know, we all know that one of the other big things that mediates joy for people is belonging, belonging and social connections to other people. And meaningful connections, not necessarily the superficial ones, although, you know, going out and singing with a choir for me is really fun. Even if I don't know all the choir people, I get to make music with them and I get to talk with them a few minutes before and afterwards. But it's that meaning and purpose and joy that carries over to medicine or sports or a club or volunteering, all of those things that bring together belonging, social connection, and meaning, and purpose are good things.” 

Doug: “So is there a way to make this more prevalent in your industry with doctors and with nurses and others who see patients every day? Is this something that you think is going to be a trend?” 

Dawn DeWitt: “I think it's absolutely a trend. When I took my course, which wasn't that long ago, it was six or seven years ago now, they had done a few courses and now they've got thousands of people certified to teach this and out there doing courses. And a lot of hospitals and health systems now are starting to have wellness programs that include these kinds of techniques. More of them include mindfulness than mindful self-compassion. And I personally think, again, I think the mindful self-compassion is more of the secret sauce. And then there are these fun tech devices that help you understand. So for me having the, the M headband, the electroencephalogram, it gives you little bird sounds whenever you get the right brainwaves. And I was like, oh, I got birds today, although, after a while, there's a little performance anxiety there. Oh my gosh. I only got 10 birds today and [laughing] last week was 20, but we're all competitive, right?”  

Dawn DeWitt is a professor and senior associate dean for the Washington State University College of Medicine’s Collaboration for Interprofessional Health, Education, Research, and Scholarship, or Ciphers. We thank her for her perspective.  

[theme music] 

The Interprofessional Opioid Curriculum team also wishes to thank these people for their contributions:  

• Dr. Barb Richardson, nurse, educator, and interprofessional champion;  
• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine 
• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and 

This episode of “Finding Joy” was produced by Doug Nadvornick. 

If you are interested in sharing your perspective about wellness and resiliency as a healthcare professional or would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu  We also encourage you to visit our website at: https://opioideducation.wsu.edu/about/.