Just Breathe

Strategies to ward off burnout and enhance physician well-being.

By Jullia A. Rosdahl, MD, PhD; and Karen Kingsolver, PhD

Physician burnout has become an increasingly popular subject in the media because it is on the rise, increasing from 45% to 54% between 2011 and 2014.1 Ophthalmology is not immune, with a reported prevalence of about 50%, which is similar to that of other surgical specialties, such as neurosurgery and general surgery.

Burnout is a syndrome of emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment.2 It can result in loss of productivity and loss of workforce, with physicians choosing to leave medicine.3 In short, burnout is bad for our patients, for our medical practices, and for us as individuals.

Combatting burnout is a big job that requires local and national attention. However, there are steps that individual physicians can take to become more resilient in these changing times.


One increasingly popular strategy for fostering resilience is mindfulness. Mindfulness is the practice of paying attention, on purpose and without judgment, to the present moment, according to Jon Kabat-Zinn, founder of The Center for Mindfulness. Practicing mindfulness helps participants train their brains to pause during stressful situations so that they can respond instead of react. Interventions that include mindfulness have been proven to reduce physician burnout.4

You can try practicing mindfulness by simply taking a breath and paying attention to the sensations in your body. Breathing meditations can also be found on YouTube (www.youtube.com/watch?v=V7J5NV26THU) or in the app store on your phone (www.10percenthappier.com). But just about any activity, such as eating and walking, can be done mindfully.

An exercise in mindfulness. Find a ripe summer fruit. Before your first bite, smell the fruit and consider all of the effort—from the sunlight and the soil to the farmer and grocer—that brought that fruit to you. As you take the first bite, notice the feel of the fruit on your teeth, lips, and tongue. Before chewing, hold that bite in your mouth, noticing the texture and flavors, and then chew slowly to savor and appreciate it. It is a challenge to eat a whole meal mindfully, but even mindfully eating the first few bites can be a resilience-building, mindful practice.

For physicians, being on constant autopilot is a common coping technique, but it can be exhausting. Next time you are in the clinic or the OR, take a micro-pause to connect with one of your senses; this can give you a needed reset on busy days. Try using the feel of a doorknob or the feel of hand sanitizer to remind you to notice the temperature and other sensations of touch. Notice the feeling of the breath you are taking. These micro-pauses are quick, life-enhancing resilience practices that go a long way.


Mindfulness is just one of many ways physicians can enhance their well-being. Recognize that self-care is important. Create a wellness plan for yourself to foster your own resilience; in addition to a mindfulness practice, many physicians also thrive by connecting with others, such as friends, family members, and patients, and by connecting the work that they do to their core values and vision for their lives. It can be overwhelming, so simply start with the breath.

1. Peckham C. Medscape National Physician Burnout & Depression Report 2018. Medscape. January 17, 2018. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235. Accessed July 3, 2018.

2. Professional Satisfaction and the Career Plans of US Physicians. Mayo Clinic Proceedings. November 2017. https://www.mayoclinicproceedings.org/article/S0025-6196(17)30637-7/fulltext. Accessed July 3, 2018.

3. Peckham C. Medscape Physician Lifestyle and Happiness Report 2018. Medscape. January 10, 2018. https://www.medscape.com/slideshow/2018-lifestyle-happiness-6009320#1. Accessed July 3, 2018.

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015; 90(12):1600-1613.

2. Maslach C, Jackson SE. Maslach Burnout Inventory: Manual Research Edition. Palo Alto, CA: Consulting Psychologists Press; 1986.

3. Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14:325.

4. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272-2281.

Jullia A. Rosdahl, MD, PhD
• Associate Professor of Ophthalmology and Director of Patient Education, Duke University, Durham, North Carolina
• Financial disclosure: None

Karen Kingsolver, PhD
• Clinical Psychologist and Assistant Professor of Pyschiatry and Behavioral Sciences, Duke University, Durham, North Carolina
• Financial disclosure: None


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