The Importance of Self Care

To care deeply for others, we must know how to care for ourselves. As Cassell (2004) says, ". . . virtually all the doctor's healing power flows from the doctor's self-mastery." True primary care, therefore, also includes what we do for ourselves. Up to 60% of practicing physicians report symptoms of "burnout" (Shanafelt et al., 2003; Spickard et al., 2002). This is associated with emotional exhaustion, depersonaliza-tion (seeing patients as objects), reduced empathy, and the loss of meaning in work.

The characteristics lost in burnout are important ingredients in facilitating health and healing in others. If the health team physician leader is "burning out," the health home will not be healthy. When physicians practice healthy lifestyle behaviors, they are more likely to educate patients on the importance of these behaviors (Lewis et al., 1991) and to become more motivating to their patients toward positive change (Frank et al., 2000; Lobelo et al., 2009). Every family physician benefits from a self-reflective inquiry about personal balance toward health. This behavior will constantly be challenged and will require attention and "mastery."

Most primary care physicians are attracted into the field to make a difference in people's lives through continuous healing relationships. When the demands of the working environment tax the sense of control to maintain these relationships, stress and potential burnout can ensue. One remedy for this is to use the patient encounter to allow meaning to flow through the work. The healing-oriented primary care approach recognizes each patient as a unique individual with specific needs in the physical, emotional, and spiritual domains and sets aside both mental space and physical time to deal with those needs. To be aware of these personal needs is a mindful practice in which the physician is fully present in the moment with the patient, where each is able to reduce suffering in the other (Epstein, 1999). This "mindfulness" approach has been found to enhance well-being and physician attitudes in patient-centered care (Krasner et al., 2009). It requires that physicians create physical time in the health home to sit and listen to patient stories (Rakel, 2008).

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