Doctoring to Heal: Fostering well-being among physicians through personal reflection

Physicians routinely face stressful situations. These include dealing with difficult patient interactions, balancing personal and professional joys and responsibilities, coping with medical mistakes, overcoming concerns about professional competence, and processing grief.1,2,3 Physicians-in-training have additional challenges that complicate these routine stresses. During medical school and residency, many trainees confront these issues for the first time, during a period in their lives when they may have recently moved away from supportive family and friends and in the context of a daunting work schedule and intense evaluative process. For physicians of all levels of experience, inadequate coping with such stresses may lead to job dissatisfaction, burnout, isolation, and maladaptive behaviors, including substance abuse and even suicide.4,5 Fostering deeper personal awareness may help physicians to deal with these challenges, improve professional effectiveness, and increase personal satisfaction.6 Several methods have been proposed for enhancing personal awareness: personal awareness groups, physician groups that focus on the patient-physician relationship (such as Balint Groups), individual therapy, role playing, keeping a journal, and exploring literature and art.7,8 We developed a discussion group, called Doctoring to Heal (DTH), that has been held monthly since 1996 in the Division of General Internal Medicine (DGIM) at the University of California, San Francisco, Medical Center. Each DTH session is based on the sharing of clinical narratives and personal stories exploring meaning and emotion in the practice of medicine, with the intention of improving physician well-being. The format of DTH, described below, can be adapted easily to other clinical settings.