Physician Wellness: Benefits of Gratitude

CHOC Physician Wellness Subcommittee Update
by Dr. Grace Mucci, Pediatric Neuropsychologist

Physician burnout is prevalent. According to the Mayo Clinic, up to 54% of doctors report at least one symptom of burnout. Further, it is estimated that the annual cost of that burnout is $4.6 billion per year in the form of physician turnover and reduced clinical hours, according to a study recently published by the Annals of Internal Medicine.

The experience of burnout results in feelings of cynicism, detachment from work, low sense of personal accomplishment, and emotional exhaustion. The reasons for burnout remain complicated, and a recent systematic review by the Journal of the College of Physicians and Surgeons Pakistan revealed both individual characteristics of physicians and variables within the working environment as contributory factors.

More specifically, work load appeared to be one of the main drivers and includes working hours, overnight duty, administrative duties, schedule and flexibility, and complexity of tasks. Feeling disconnected from colleagues or patients, poor communication or cooperation between colleagues and dealing with patients who disagree with treatment choices are additional sources of burnout.

Just as the causes of physician burnout are multi-factorial, the solutions encompass many strategies that include engaging in various lifestyle changes and systemic interventions.

One individual intervention that has been receiving more interest among researchers is gratitude. A 2017 study at UC Berkeley shows that the health benefits of expressing gratitude include increasing resilience to stress and boosting mental health. Gratitude also has been found to strengthen relationships and enhance mindfulness.

So, just how can we implement gratitude in everyday life? Here are a few ideas that can be applied easily:

  • Express gratefulness for the beauty in nature
  • Give thanks before eating food that has been prepared
  • Acknowledge service people you encounter throughout the day, such as a barista or worker
  • Keep a gratitude journal and write about all the things you’re thankful for prior to retiring for the night
  • Remember to tell your loved ones how much they are appreciated and one thing that you are grateful that they do every day
  • Surprise coworkers or even strangers by performing a random act of kindness
  • Keep a gratitude board where you document things you are thankful for, and be sure to review those items when you are having a difficult moment

At CHOC, several initiatives that promote this practice of expressing gratitude are underway. CHOC has partnered with the Institute for Healthcare Excellence (IHE) to offer an outstanding curriculum that helps build respect, trust and compassion, ultimately improving communication and empathy toward co-workers and patients and restoring joy to the practice of medicine.

In addition, CHOC’s Physician Wellness Subcommittee is busy planning a Wall of Gratitude in the physician dining room, where doctors can show gratitude and appreciation for their peers in real time.

We know that peer-to-peer recognition is important for strengthening the level of engagement and positive bonds among colleagues. We have all experienced the satisfaction of receiving kudos from our peers, and we want to make this easier and more visible to others. As we continue to advance these initiatives, be sure to practice those small but powerful strategies of expressing gratefulness in your everyday life.

Causes and Treatment for Pain Amplification Syndrome

Andrew Shulman, MD, PhD, pediatric rheumatologist at CHOC Children’s, discusses the causes and treatment for this common yet complex condition.

1) What is pain amplification syndrome?

Pain amplification syndrome is a condition (not a disease) in which patients develop an abnormal pain sensitivity. The nervous system registers and processes normal sensations from movement and environmental experience as pain signals. Think of the nervous system as an electronic sensor: The sensor has a detection threshold. All signals with an intensity level below the threshold are perceived as “normal” and all signals above the threshold are “pain.” In children with pain amplification syndrome, the threshold is too low. Normal sensations and movements cause the nervous system to experience pain.

2) What are the causes?

We need to understand much more about what causes pain syndromes, experience over time with many patients with this condition reveals some common triggers. Joint flexibility is the most common cause of musculoskeletal pain in children, and is often responsible for what is known as “growing pains.” Patients with pain amplification syndrome often have flexible joints and have previously experienced joint and muscle discomfort. Some patients have had numerous orthopedic injuries in the past, or a particular traumatic injury that causes pain sensitivity in one part of the body.

In some patients, emotional trauma, psychological difficulties or psychiatric conditions can trigger pain sensitivity. In most patients, sleep is affected and is not restful. Even when psychological factors are not an initial cause, the stress from experiencing pain and the resulting disruption in school and activities can amplify pain sensitivity. We don’t know enough about the genetics of pain perception, but children with pain amplification syndrome commonly have family members with pain difficulties.

3) What are the symptoms?

Symptoms include body aches, joint and muscle pain, abnormal sensations of burning, tingling, numbness or pressure, headache, and chronic abdominal pain. In some cases, light touch to the skin causes pain sensations. Accompanying features include “dysautonomia,” wherein the autonomic nervous system does not perfectly regulate blood flow throughout the body. This results in symptoms of Raynaud’s phenomenon (cold sensitivity of the hands and feet with color changes, numbness, tingling and burning) and dizziness, particularly when standing up. These symptoms are not dangerous but can be uncomfortable and worrisome to patients.

4) What are the treatments?

A number of therapies work together to reset the abnormal pain sensitivity. Physical activity, particularly aerobic exercise, is very important in normalizing the pain threshold. Therapeutic massage can desensitize the nervous system and help the patient feel touch and movement as normal and not painful. Developing a regular, restful sleep schedule is important.

Finally, psychological therapy is often a critical aspect of the therapeutic program. This therapy is focused on stress management and coping techniques. In some cases, medications that decrease nerve signal transmission can be used. These medical treatments only assist the other therapies and are generally not effective in children when used alone.

5) What kind of testing is involved?

No laboratory or imaging tests can confirm the diagnosis of pain amplification syndrome. The diagnosis can be difficult to establish because numerous other medical conditions could potentially cause the symptoms. It’s important to take a step back and look at the “big picture” of a patient’s history and symptoms. Patients commonly have extensive investigations with many specialists before reaching a pain amplification syndrome diagnosis. Physicians with experience in pain amplification syndrome can help recognize the condition. Rheumatologists often help because they are familiar with symptoms and diagnostic challenges posed by autoimmune and inflammatory diseases.

6) Is there a cure?

Pain amplification syndrome is not a disease, so no cure is needed. This is a condition that patients learn to manage and control.

7) What can patients and families expect when treating pain amplification syndrome?

Families can expect more good days and fewer bad days as patients work through the abnormal pain sensitivity. The overall trend is gradual recovery, which can be measured by regular school attendance and activity participation. Reassurance that the patient does not have a serious disease often provides a big boost as the therapeutic program moves forward.

8) How bad does pain have to get before you see a pediatric rheumatologist?

Patients should be evaluated when symptoms become a significant concern and affect school attendance or participation in sports and activities. Pediatricians and subspecialty colleagues should seek rheumatologists’ expertise for help evaluating a pain amplification syndrome diagnosis and/or making treatment recommendations.

For questions or more information, please contact Andrew Shulman, MD, PhD, pediatric rheumatologist at CHOC Children’s, at 714-509-8617. 

CHOC recognized as one of nation’s best children’s hospitals

CHOC Children’s is one of only 50 pediatric facilities in the nation to earn recognition as a best children’s hospital by U.S. News & World Report. The following CHOC specialties are honored in the 2019-20 Best Children’s Hospitals rankings: diabetes/endocrinology, cancer, neonatology, neurology/neurosurgery, pulmonology and urology. Cancer ranked in the “top 20.”

“The national recognition for CHOC’s cancer program is well-deserved. There’s nowhere else I’d rather have gone through treatment than CHOC,” says 17-year-old Sydney Sigafus, CHOC patient and cancer survivor. “Everyone who works at CHOC cares about you as a person, not just a patient. I was included in every decision and conversation about my care.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

“We understand how scary it can be for parents whose children are dealing with life-threatening illnesses or injuries. That’s why we are committed to the highest standards of care, safety and service,” says Dr. James Cappon, CHOC’s chief quality officer. “While we are proud of our accolades, including being named a best children’s hospital, we remain focused on preserving the magic of childhood for all kids, whether they are seriously ill or healthy, or somewhere in between.”

More information about the Best Children’s Hospitals rankings can be found here.