In its Sustainable Development Goals, the United Nations is pushing for countries to “ensure healthy lives and promote well-being for all at all ages.” As with all of the SDGs, this is a monumental task, not least because of the myriad of factors that contribute to a person’s health. Within a medical setting, the outcome for any given patient is determined by, among other things, their overall health and preexisting conditions, access to doctors and hospitals, diagnostic capabilities at those facilities, access to medicines and technologies, and the skills and attentiveness of doctors and nurses themselves. The list goes on and on.
Typical policy proposals focus on investing in medical infrastructure in some way; building new hospitals, purchasing new equipment, developing new vaccines or drugs or training more doctors. This is all well and good, but infrastructure does not necessarily offer a solution for poor- and middle-income countries with limited resources. Even wealthy nations are rife with inequality that makes it difficult to impossible to simply buy good health for a populace.
There is another approach, however, which can complement and enhance the impact of investments in medical infrastructure. A human flourishing lens, looking at all facets of human life as interconnected and paying particular attention to human beings’ innate inner strengths and abilities, can offer one way of moving beyond thinking in purely financial and material terms. Rather than just pouring more resources into the health systems—essentially attempting to purchase good health and wellbeing—enhancing the effectiveness of what already exists in almost every community—doctors and medical professionals themselves—can pay great dividends over time, particularly if it is accompanied by new investments.
Research shows that doctors and healthcare providers in developing countries overall tend to be more stressed because on top of the regular stressors of the job, they also have extra economic burdens. In addition to other work-related stressors, Mexican healthcare providers, for instance, experience harsh working conditions. They routinely have multiple jobs (often a position in a public institution, augmented by private practice) and are frequently employed on informal contracts with minimal job security and access to sick leave. A recent cross-sectional study conducted with a sample of 5,938 Mexican healthcare providers identified insomnia, depression, and post-traumatic stress disorder as the most prevalent mental health problems, all of which were more frequent in frontline healthcare workers and women.
In other words, not only are doctors and nurses in low- and middle-income nations often compensated poorly compared to their counterparts in wealthy nations, but the resources and facilities available to treat patients are also constrained. Elevated stress levels among healthcare providers directly translate to poorer patient outcomes. Doctors and nurses who are under stress are more likely to make mistakes, become impatient, and struggle to connect emotionally with the needs of their patients. This creates a feedback loop in which stress creates even more stressful situations. When someone is very stressed, they become fixated on their stressful thoughts, and then the stress itself becomes bigger and bigger, and on and on.
This cycle, sometimes referred to as a “burnout cascade” shows up in virtually all fields and professions when resources are limited and stressful situations occur. In the context of education, for instance, research shows that when teachers don’t have sufficient resources to manage social and emotional challenges within their schools and classrooms, pupils perform more poorly. Consequently, the classroom climate can suffer, with teachers experiencing more stress and student behavior becoming more troublesome, causing teachers to become even more emotionally exhausted. As Patricia Jennings and Mark Greenberg noted in their 2009 paper “The Prosocial Classroom: Teacher Social andEmotional Competence in Relation to Student and Classroom Outcomes,” these conditions may lead teachers to “resort to reactive and excessively punitive responses that do not teach self-regulation and may contribute to a self-sustaining cycle of classroom disruption,” and they argue that “emotionally exhausted teachers are at risk of becoming cynical and callous and may eventually feel they have little to offer or gain from continuing, and so drop out of the teaching workform.” This same dynamic—a lack of resources and high stress situations leading to deteriorating conditions and professional burnout—can be seen in medical fields.
However, although it is difficult to Interrupt this cycle of stress, doing so can deliver incredible results. When someone is able to shift their attention to their breathing via a mindfulness practice—for instance—they are then able to recenter and return to a calmer state of mind. While this may sound like a small thing, it is a learned skill that can have a huge impact. To understand how improving stress responses changes healthcare outcomes, AtentaMente and the Center for Healthy Minds have developed character-based interventions to help doctors mitigate their own stress. We have developed two programs, the Stress Toolbox for Health Providers and the Healthy Minds Program, which respectively use Zoom and an app to teach doctors methods for managing stress. These tools are currently being tested with 4,000 healthcare providers in Mexico.
Under our framework, we target skills which fall into broad categories of awareness, connection, insight and purpose and that have been scientifically proven to benefit from training and practice. Practically speaking, this means helping doctors develop everything from greater empathy, attention regulation, mindfulness, kindness, gratitude, self-knowledge and inquiry, to a sense of what brings meaning, purpose and fulfillment in one’s own life. There is strong evidence that developing these skills leads to improved mental health and actually alters neural circuitry in numerous positive ways, even potentially helping to prevent neurodegenerative disorders.
By helping doctors manage stress and develop character traits such as resilience and emotional regulation, we hope to improve their own health and wellbeing—both mentally and physically—and consequently the health and wellbeing of the communities they serve. When doctors are able to effectively combat stress and marshal their own innate, inner resources, patients come out of the hospital feeling they were treated kindly and attentively. The incredible thing about character strengths is that they can be developed throughout life, even as we age and certain types of skill acquisition, such as new languages, becomes more difficult. Traits like kindness, patience, and resilience have a great deal of plasticity—they can be trained in other words—and can be continually developed and improved even into old age.
This triple focus on the individual, their relationships, and the larger world or system, is applicable in any medical setting anywhere in the world. In our work with healthcare providers, we try to help develop skills to promote inner change. This inner change in turn improves their relationships and connections with close circles of friends, colleagues, neighbors and patients, and as those healthy communities align and work more collaboratively together, they can begin to promote systemic change. While it may not be possible to build new hospitals or give state of the art technology to every facility that needs one right now, it’s far easier and cheaper to help doctors themselves grow. Doctors who are calmer, kinder and more centered also have a greater sense of purpose. And they are better doctors because of it. By developing their character strengths, doctors can deliver better care to their patients, and this is something which potentially can be implemented in any healthcare setting in the world right now.
Leandro Chernicoff
Leandro Chernicoff is a Founding Partner and Academic & Research Director at Atentamente.
He is a teacher and Ph.D. candidate in Educational Psychology from the University of Wisconsin at Madison. He studied a bachelor's and a master's degree in Physics at the National Autonomous University of Mexico and is a professor-researcher at the Academy of Physics of the Autonomous University of Mexico City.
For more than 20 years he has been dedicated to social-emotional education, specializing in methodologies for the regulation of attention, emotions and the strengthening of ethics and prosocial behaviors. At AtentaMente, he leads curriculum development, professional training, as well as educational and technological innovation. In addition, he spearheads scientific research for the contemplative-based, socio-emotional learning programs in collaboration with the Center for Healthy Minds at the University of Wisconsin–Madison.
Richard J. Davidson, PhD
Richard J. Davidson, PhD is William James and Vilas Research Professor of Psychology and Psychiatry and Founder & Director of the Center for Healthy Minds, University of Wisconsin-Madison.
He received his Ph.D. from Harvard University in Psychology and has been at Wisconsin since 1984. He has published more than 465 articles, numerous chapters and reviews and edited 14 books. He is the author (with Sharon Begley) of "The Emotional Life of Your Brain" published by Penguin in 2012, a New York Times bestseller. He is co-author with Daniel Goleman of “Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain, and Body”, published by Penguin Books in 2017.
He is the recipient of numerous awards for his research including the William James Fellow Award from the American Psychological Society. He was the year 2000 recipient of the most distinguished award for science given by the American Psychological Association - the Distinguished Scientific Contribution Award. He was the Founding Co-Editor of the American Psychological Association journal EMOTION. In 2003 he was elected to the American Academy of Arts and Sciences. He was named one of the 100 most influential people in the world by Time Magazine in 2006. He served on the Scientific Advisory Board at the Max Planck Institute for Human Cognitive and Brain Sciences from 2011-2019 and served as a member of the World Economic Forum's Global Agenda Council on Mental Health 2014-2018. In 2017 he was elected to the National Academy of Medicine and in 2018 appointed to the Governing Board of UNESCO’s Mahatma Gandhi Institute of Education for Peace and Sustainable Development (MGIEP). His research is broadly focused on the neural bases of emotion and emotional style and methods to promote human flourishing including meditation and related contemplative practices.
