Saundra Jain, MA, PsyD, LPC, and Andrew Laster, MD, on Wellness for Patients With RMDs: Part 4

Drs Laster and Jain wind up their podcast with a discussion about the importance of focusing on positive emotions to help patients with rheumatic diseases maximize their wellness, and their own favorite wellness practices.

Saundra Jain, MA, PsyD, LPC, is an adjunct clinical affiliate at the University of Texas at Austin with the School of Nursing a psychotherapist in private practice in Austin, Texas. Andrew Laster, MD, is a rheumatologist in private practice in Charlotte, North Carolina.

Listen to their previous podcasts here, here, and here.

TRANSCRIPT:

Thank you for joining us for this final installment on wellness for patients with rheumatic diseases with Drs Saundra Jain and Andrew Laster. Today they’ll be talking about the power of positive emotions in enhancing wellness among these patients.

RALN: The article also discusses positive emotions. Dr. Jain, what do we need to know about that?

Dr Jain: Well, that's a great question, Rebecca, because I think oftentimes we think about positive emotions as something that a psychotherapist or something that psychiatry manages. We're trained as clinicians to focus on negative emotions. We're interested in things like depression, we're interested in insomnia, anxiety. I mentioned earlier, our goal is symptom reduction—super important, we're not minimizing that in any way. I would say this: we don't want to overlook the power of positive emotions. Things like joy, contentment, happiness, optimism. There are many more than that. But all of these contribute to both mental and physical well-being. Here's a great opportunity for all of us to extend beyond, to go beyond, our traditional treatment approach of symptom reduction. Positive emotions really are no longer considered soft science. There's a lot of hard data.

We don't want to just leave this to the mental health arena. We can all engage in this. We actually have— Andy and I have a colleague in Birmingham, a rheumatologist, and she will tell you very clearly that part of her prescription practice is prescribing joy to her patients. And even as I think about her talking about that, it lifts my wellness. I smile because she is so enthused with her own positive emotions and she just exudes that to her patients. Her enthusiasm is a great testament to the power of positive emotions.

RALN: During the pandemic we've all seen just staggering rates of burnout amongst clinicians and other health care providers. In response to this, there's been a lot of focus recently on clinician wellness and resilience, taking care of the caregivers. I'd love to get both of your thoughts on this. Dr. Laster?

Dr. Laster: Yeah. So it really has been challenging. Look, we've talked about these elements and think about what COVID has done. We have isolated, we're not going out to eat at restaurants like we did before, people aren't going to meetings. All of that social connectedness that we talked about, how hugely important that is, has really been severely pruned back. Gyms have closed, people aren't exercising regularly. They're not sleeping as well because they're stressed at work. And so this is concern for all providers. There was an interesting Medscape survey, just came out, that looked at how people felt outside of work prepandemic and then currently. And the percentage of providers who are very happy outside of work before the pandemic was 41%, it dropped to 24% now. Those who were either very or somewhat unhappy, went up from 9% to 26%.
 

Within the field of rheumatology 46% of rheumatologists said that they were burnt out in this Medscape survey. So why is that? I think about our practice and what we've gone through. When the pandemic first hit in March 2020, we set out to modify our clinic work environment. People were wearing gowns, and face shields, and masks, and gloves. We installed HEPA filters. We limited the waiting room and who could come in with the patient to the exam room. We very quickly tried to acclimate to virtual medicine. We then had issues about vaccines, and guidance, and timing, and what to do about the drugs people were on. We wanted to make sure that our staff had rapid at-home testing kits, so they wouldn't come in if potentially they had the disease. We had staff shortages related to COVID. We then had to understand pre-exposure prophylaxis with Evusheld and antivirals and long haul COVID.

It's like drinking from a fire hose. Incredibly stressful, but we care for our patients and it was a very important part of who they are, because many of them were immune compromised. So we needed to assume the mantle, not of the primary care doctor, but of the expert for this, because a lot of the medications we use can have an impact on the immune system. It's been challenging. It's also been incredibly rewarding. I think patients have realized...treating patients like this is just amazing, when you can also provide additional help when they're confused or the information isn't out there and they can turn to you for a source of knowledge. It’s been incredibly rewarding, as well.

Dr Jain: I was just sitting here thinking about Andy, what you just described. And so much of it is so heavy in terms of what clinicians encountered and probably still are encountering, as a result of COVID and what we have in front of us. I know in the mental health space, we always talked about it like there was a tsunami headed towards our shore. And sadly, we feel like the tsunami has landed and the demand for mental health care is tremendous. And sadly, there's not quite enough of us to really meet the need. And so that increases the burden on, really, all of us. Not just in mental health, because my guess is, Andy, and in your setting, along with all of our listeners, you're taking care of mental health as well, there's really not this division.

But there's one other thing when I think about all of this, another consideration. When we talk about our patients and wellness, we talk about our wellness as clinicians. We don't want to place the burden of wellness too heavily on the individual, whether it be patient or the clinician without taking into consideration both their organizational context and their societal context. And so let me just quickly give an example of that. I may be working with a patient who's a single mom, she's working 2 jobs, she's raising 3 children alone without the help of family or friends or a partner/spouse, however that may present.

And for me to ask them to add to their already hectic schedule extra time for exercise, for documenting their food intake. "Oh, add a couple of 10 minutes of mindfulness meditation to that. Oh, be sure to do some healthy food prep as well." Well, you see where I'm going with this. All of a sudden, I'm not really sensitive to their societal situation, to the demands that are already placed on them.

We can think about us as clinicians. What if we're working in a toxic work environment? A system that has not really been created to support an environment of wellness. The work schedule may be too demanding. There may not be enough staff to cover the needs, pay may not be considered reasonable. We all read about those horrible cases in hospital settings where needed supplies weren't available. And they were just having to figure out, off the cuff, what to do.

So these individual clinicians in those situations, they really may not be supported in their systemic setting in a way that really is in the interest of and focused on wellbeing. Really struggling, if you will, just to keep their head above water. So again, just to make that point, whether we're working with our patients or we're focusing on our own well-being, we've got to move, I think, a little bit beyond just the individual and consider the context as well as the system.

RALN: As we approach the end of our conversation today, I'd like to ask each of you this question. When it comes to your own wellness, do you have a favorite wellness enhancing practice? Dr. Jane, why don't you take that on and begin?

Dr Jain: Well, I already said everyone I hear I'm like, "Oh, that's my favorite." But this question's a really good one, Rebecca, and I really do have a solid answer for it. Without a doubt, it's mindfulness. Over the years, I've found almost all of my wellness practices really are based on a foundation of mindful awareness. Doesn't matter whether I'm exercising or I'm having a mindful meal. If I am focused on a to do list and I am not fully present in my wellness regimen, whether that's exercise, or whether it's developing a really mindful sleep preparation practice. Any of the things that Andy and I have talked about today, whatever pulls me out of that present moment and the experience, it just becomes a barrier.

And it's true for all of them—nutrition, sleep, socialization. We've all been around people socially and you know they're not present. They're in their head thinking about what they need to be doing as soon as they get home. And that's just a human failing, we all do it, so I'm not pointing fingers. But mindful awareness—I think that is where we really can be present and experience the absolute benefits of wellness enhancing practices, because when we're fully present in all things, honestly, I believe most everything improves.

RALN: How about you Dr. Laster? What's your favorite wellness practice?

Dr. Laster: Yeah. Thanks Rebecca. And look, it's good that we wrap up with this. We've been talking a lot about patients and wellness, but we've also implied, and certainly you're hearing, that wellness is important for providers as well. And I think that, also, if we understand wellness, it's much easier for us to communicate it to patients and lead by example. So for me personally, it's actually swimming. And I'm really blessed, we've got a terrific athletic complex, about 10 minutes away from our home and it's got 2 indoor and 1 outdoor lap pool. And so getting out there early in the morning, at dawn and the pools are never crowded. I have my own lane, sometimes the entire pool and I'll swim a mile.

And for me that's combining exercise, but it also is meditative for me and mindfulness because I'm aware of my body and the stroke and the initial few laps you’re aware of, but then you just get into a zone and it's just incredibly, for me, beneficial. I feel great when I'm done working out and my mind feels a lot clearer. So that's the way of me combining exercise and mindfulness meditation in one. And I'm more efficient at doing that, but everybody has their own and the great thing is there's so many different things you could do to enhance wellness.

RALN: Well, this has been a fascinating conversation. I'm really grateful to both of you for participating in this today and I hope we will continue this in the future. Thank you so much.

Dr. Laster: Thanks, Rebecca.

Dr Jain: Glad to be here with both of you.