Physician Watches Stress Float by

As a new physician in 1991, Dr. Jay Winner was troubled by the number of patients who complained of telltale stress symptoms such as severe headaches, elevated blood pressure, and stomach cramps.

"I could have done what I'd seen many other physicians do: Say, 'Here's Fioricet for your headache,' or 'Here's some Ativan; I'll see you back in 3 months,' and just ignore that they talked about stress, but I would not be doing my patients any good," recalled Dr. Winner, who practices family medicine in Santa Barbara, Calif. "The standard of care was woefully inadequate to address patients' real needs."

He found that a 15-minute office visit left little time to teach his patients stress-management skills, so in his spare time, he began to teach stress-management classes at Sansum Clinic in Santa Barbara.

"I thought it was important to teach people skills that could last a lifetime, that could help them deal with a whole variety of problems, and help with a variety of their physical ailments," Dr. Winner said.

Topics included how to reduce anger and frustration, how to get a better night's sleep, practical ways to achieve relaxation, and how to squeeze the most enjoyment out of every day.

He assembled his class notes and other material into the 2008 book, "Take the Stress Out of Your Life: A Medical Doctor's Proven Program to Minimize Stress and Maximize Health" (Cambridge, Mass.: Da Capo Press, 2008), which includes two CDs of stress-reduction exercises.

Stress is no stranger to physicians, with ready triggers such as tight patient schedules, reimbursement hassles with insurance companies, and administrative paperwork that never seems to end. Physicians are "seeing scores of different people in a day, all of whom have their different personalities and idiosyncrasies," Dr. Winner added. "Dealing with those different personalities can be stressful. Then there are sometimes stressful things at home."

He discussed three stress-management skills for his physician peers:

▸ Diaphragmatic breathing. Breathe through your nose and focus your attention on your abdomen, expanding it with the in breath, and breathing out through your nose or mouth. "As you do that you'll likely have a thought, such as 'if only this or that were different,' " said Dr. Winner, founder and director of Sansum Clinic's stress-management program. "Just notice it as a thought and let it float by, like a cloud floating overhead, and tune your full attention to the breath."

This ability to put aside your thoughts and observe them in a nonjudgmental way puts a different face on the stress trigger, he said; you start to view the trigger as no big deal.

For example, when you are scheduled to see a patient who has been difficult to deal with in the past, instead of dreading the appointment, "take 20 seconds before going into the exam room and focus on your breath; let go of the thoughts of how you want them to be different, and then be really present with that person," he explained. "Let go of all thoughts of the other patients and be fully with that person."

A 6-minute mini-meditation exercise that includes diaphragmatic breathing can be heard on Dr. Winner's Web site at www.stressremedy.com/relax

▸ Reframing. This involves placing a situation into a new context. For example, if you're running late in the office and a patient is rude to you for the extra waiting time, "Your temptation is to get angry," Dr. Winner said. "Instead, you can think, 'Hey, what's going on with that person?' When people are rude, they are usually suffering in some way. If people are always rude, they often have chronic depression, pain, or anxiety disorders. Maybe this is the case with your patient."

In his book, Dr. Winner noted that this principle can be applied to seeming mundane aspects of life as well, such as finding yourself in a long line at the grocery checkout counter. Consider that "free time," he writes, a rarity for many physicians.

He would reframe the wait at the grocery store "as an opportunity to focus on my breathing, reflect on my plans, maybe list those aspects of my life for which I am grateful. I might even chat with another person in line or indulge in the opportunity to flip through a magazine I wouldn't normally buy."

▸ Mindfulness. "Most of us have had the thought 'I'm overwhelmed' at one time or another," Dr. Winner writes in another passage from the book. "Mindfulness teaches us to let that thought go and do what's next."

He went on to describe his first year of when at times "I might get called to see three people at once: Mr. A with shortness of breath, Mrs. B with chest pain, and Mr. C with leg pain. Rather than getting increasingly stressed, I let go of the thought 'I'm overwhelmed' and focused my attention on taking care of one person at a time. I might ask Dr. Y to see Mr. A; then I would see Mrs. B, and then Mr. C. Alternatively, I might quickly check one patient to see that he was stable, then go examine the next patient, and then return to the first. The point is to do what is next and focus on one thing at a time."

He likened mindfulness to a basketball player being "in the zone," or being in the moment. "Instead of thinking, 'I don't want to do all of this dictation at the end of the day; what a pain,' let go of that thought," he advised. "Dictate one word at a time with the energy of an actor on stage. Get into what you're doing at the moment. That's mindfulness."

Diaphragmatic breathing, reframing, and mindfulness "are skills that can be learned, just like the skill of riding a bike," Dr. Winner offered.

"Once you get the hang of it, it's something that you can have the rest of your life. The first step is to notice your thoughts and not necessarily believe all of them. That way you can let them go, reframe them, or dispute them if they're irrational," he added.

He underscored the importance of embracing life's present moments instead of fretting about yesterday or tomorrow. "Unfortunately, a lot of people try to rush through life as opposed to enjoying each of the moments," Dr. Winner said.

"When you start thinking about things that aren't going right, take a moment to list the things that you're grateful for, including your family, your friends, and having a job where you have the opportunity to help people and think about science," he added.

Dr. Jay Winner, pictured with his book, began teaching a stress-management class after seeing patients under stress. Courtesy Dr. Jay Winner

As a new physician in 1991, Dr. Jay Winner was troubled by the number of patients who complained of telltale stress symptoms such as severe headaches, elevated blood pressure, and stomach cramps.

"I could have done what I'd seen many other physicians do: Say, 'Here's Fioricet for your headache,' or 'Here's some Ativan; I'll see you back in 3 months,' and just ignore that they talked about stress, but I would not be doing my patients any good," recalled Dr. Winner, who practices family medicine in Santa Barbara, Calif. "The standard of care was woefully inadequate to address patients' real needs."

He found that a 15-minute office visit left little time to teach his patients stress-management skills, so in his spare time, he began to teach stress-management classes at Sansum Clinic in Santa Barbara.

"I thought it was important to teach people skills that could last a lifetime, that could help them deal with a whole variety of problems, and help with a variety of their physical ailments," Dr. Winner said.

Topics included how to reduce anger and frustration, how to get a better night's sleep, practical ways to achieve relaxation, and how to squeeze the most enjoyment out of every day.

He assembled his class notes and other material into the 2008 book, "Take the Stress Out of Your Life: A Medical Doctor's Proven Program to Minimize Stress and Maximize Health" (Cambridge, Mass.: Da Capo Press, 2008), which includes two CDs of stress-reduction exercises.

Stress is no stranger to physicians, with ready triggers such as tight patient schedules, reimbursement hassles with insurance companies, and administrative paperwork that never seems to end. Physicians are "seeing scores of different people in a day, all of whom have their different personalities and idiosyncrasies," Dr. Winner added. "Dealing with those different personalities can be stressful. Then there are sometimes stressful things at home."

He discussed three stress-management skills for his physician peers:

▸ Diaphragmatic breathing. Breathe through your nose and focus your attention on your abdomen, expanding it with the in breath, and breathing out through your nose or mouth. "As you do that you'll likely have a thought, such as 'if only this or that were different,' " said Dr. Winner, founder and director of Sansum Clinic's stress-management program. "Just notice it as a thought and let it float by, like a cloud floating overhead, and tune your full attention to the breath."

This ability to put aside your thoughts and observe them in a nonjudgmental way puts a different face on the stress trigger, he said; you start to view the trigger as no big deal.

For example, when you are scheduled to see a patient who has been difficult to deal with in the past, instead of dreading the appointment, "take 20 seconds before going into the exam room and focus on your breath; let go of the thoughts of how you want them to be different, and then be really present with that person," he explained. "Let go of all thoughts of the other patients and be fully with that person."

A 6-minute mini-meditation exercise that includes diaphragmatic breathing can be heard on Dr. Winner's Web site at www.stressremedy.com/relax

▸ Reframing. This involves placing a situation into a new context. For example, if you're running late in the office and a patient is rude to you for the extra waiting time, "Your temptation is to get angry," Dr. Winner said. "Instead, you can think, 'Hey, what's going on with that person?' When people are rude, they are usually suffering in some way. If people are always rude, they often have chronic depression, pain, or anxiety disorders. Maybe this is the case with your patient."

In his book, Dr. Winner noted that this principle can be applied to seeming mundane aspects of life as well, such as finding yourself in a long line at the grocery checkout counter. Consider that "free time," he writes, a rarity for many physicians.

He would reframe the wait at the grocery store "as an opportunity to focus on my breathing, reflect on my plans, maybe list those aspects of my life for which I am grateful. I might even chat with another person in line or indulge in the opportunity to flip through a magazine I wouldn't normally buy."

▸ Mindfulness. "Most of us have had the thought 'I'm overwhelmed' at one time or another," Dr. Winner writes in another passage from the book. "Mindfulness teaches us to let that thought go and do what's next."

He went on to describe his first year of when at times "I might get called to see three people at once: Mr. A with shortness of breath, Mrs. B with chest pain, and Mr. C with leg pain. Rather than getting increasingly stressed, I let go of the thought 'I'm overwhelmed' and focused my attention on taking care of one person at a time. I might ask Dr. Y to see Mr. A; then I would see Mrs. B, and then Mr. C. Alternatively, I might quickly check one patient to see that he was stable, then go examine the next patient, and then return to the first. The point is to do what is next and focus on one thing at a time."

He likened mindfulness to a basketball player being "in the zone," or being in the moment. "Instead of thinking, 'I don't want to do all of this dictation at the end of the day; what a pain,' let go of that thought," he advised. "Dictate one word at a time with the energy of an actor on stage. Get into what you're doing at the moment. That's mindfulness."

Diaphragmatic breathing, reframing, and mindfulness "are skills that can be learned, just like the skill of riding a bike," Dr. Winner offered.

"Once you get the hang of it, it's something that you can have the rest of your life. The first step is to notice your thoughts and not necessarily believe all of them. That way you can let them go, reframe them, or dispute them if they're irrational," he added.

He underscored the importance of embracing life's present moments instead of fretting about yesterday or tomorrow. "Unfortunately, a lot of people try to rush through life as opposed to enjoying each of the moments," Dr. Winner said.

"When you start thinking about things that aren't going right, take a moment to list the things that you're grateful for, including your family, your friends, and having a job where you have the opportunity to help people and think about science," he added.

Dr. Jay Winner, pictured with his book, began teaching a stress-management class after seeing patients under stress. Courtesy Dr. Jay Winner

As a new physician in 1991, Dr. Jay Winner was troubled by the number of patients who complained of telltale stress symptoms such as severe headaches, elevated blood pressure, and stomach cramps.

"I could have done what I'd seen many other physicians do: Say, 'Here's Fioricet for your headache,' or 'Here's some Ativan; I'll see you back in 3 months,' and just ignore that they talked about stress, but I would not be doing my patients any good," recalled Dr. Winner, who practices family medicine in Santa Barbara, Calif. "The standard of care was woefully inadequate to address patients' real needs."

He found that a 15-minute office visit left little time to teach his patients stress-management skills, so in his spare time, he began to teach stress-management classes at Sansum Clinic in Santa Barbara.

"I thought it was important to teach people skills that could last a lifetime, that could help them deal with a whole variety of problems, and help with a variety of their physical ailments," Dr. Winner said.

Topics included how to reduce anger and frustration, how to get a better night's sleep, practical ways to achieve relaxation, and how to squeeze the most enjoyment out of every day.

He assembled his class notes and other material into the 2008 book, "Take the Stress Out of Your Life: A Medical Doctor's Proven Program to Minimize Stress and Maximize Health" (Cambridge, Mass.: Da Capo Press, 2008), which includes two CDs of stress-reduction exercises.

Stress is no stranger to physicians, with ready triggers such as tight patient schedules, reimbursement hassles with insurance companies, and administrative paperwork that never seems to end. Physicians are "seeing scores of different people in a day, all of whom have their different personalities and idiosyncrasies," Dr. Winner added. "Dealing with those different personalities can be stressful. Then there are sometimes stressful things at home."

He discussed three stress-management skills for his physician peers:

▸ Diaphragmatic breathing. Breathe through your nose and focus your attention on your abdomen, expanding it with the in breath, and breathing out through your nose or mouth. "As you do that you'll likely have a thought, such as 'if only this or that were different,' " said Dr. Winner, founder and director of Sansum Clinic's stress-management program. "Just notice it as a thought and let it float by, like a cloud floating overhead, and tune your full attention to the breath."

This ability to put aside your thoughts and observe them in a nonjudgmental way puts a different face on the stress trigger, he said; you start to view the trigger as no big deal.

For example, when you are scheduled to see a patient who has been difficult to deal with in the past, instead of dreading the appointment, "take 20 seconds before going into the exam room and focus on your breath; let go of the thoughts of how you want them to be different, and then be really present with that person," he explained. "Let go of all thoughts of the other patients and be fully with that person."

A 6-minute mini-meditation exercise that includes diaphragmatic breathing can be heard on Dr. Winner's Web site at www.stressremedy.com/relax

▸ Reframing. This involves placing a situation into a new context. For example, if you're running late in the office and a patient is rude to you for the extra waiting time, "Your temptation is to get angry," Dr. Winner said. "Instead, you can think, 'Hey, what's going on with that person?' When people are rude, they are usually suffering in some way. If people are always rude, they often have chronic depression, pain, or anxiety disorders. Maybe this is the case with your patient."

In his book, Dr. Winner noted that this principle can be applied to seeming mundane aspects of life as well, such as finding yourself in a long line at the grocery checkout counter. Consider that "free time," he writes, a rarity for many physicians.

He would reframe the wait at the grocery store "as an opportunity to focus on my breathing, reflect on my plans, maybe list those aspects of my life for which I am grateful. I might even chat with another person in line or indulge in the opportunity to flip through a magazine I wouldn't normally buy."

▸ Mindfulness. "Most of us have had the thought 'I'm overwhelmed' at one time or another," Dr. Winner writes in another passage from the book. "Mindfulness teaches us to let that thought go and do what's next."

He went on to describe his first year of when at times "I might get called to see three people at once: Mr. A with shortness of breath, Mrs. B with chest pain, and Mr. C with leg pain. Rather than getting increasingly stressed, I let go of the thought 'I'm overwhelmed' and focused my attention on taking care of one person at a time. I might ask Dr. Y to see Mr. A; then I would see Mrs. B, and then Mr. C. Alternatively, I might quickly check one patient to see that he was stable, then go examine the next patient, and then return to the first. The point is to do what is next and focus on one thing at a time."

He likened mindfulness to a basketball player being "in the zone," or being in the moment. "Instead of thinking, 'I don't want to do all of this dictation at the end of the day; what a pain,' let go of that thought," he advised. "Dictate one word at a time with the energy of an actor on stage. Get into what you're doing at the moment. That's mindfulness."

Diaphragmatic breathing, reframing, and mindfulness "are skills that can be learned, just like the skill of riding a bike," Dr. Winner offered.

"Once you get the hang of it, it's something that you can have the rest of your life. The first step is to notice your thoughts and not necessarily believe all of them. That way you can let them go, reframe them, or dispute them if they're irrational," he added.

He underscored the importance of embracing life's present moments instead of fretting about yesterday or tomorrow. "Unfortunately, a lot of people try to rush through life as opposed to enjoying each of the moments," Dr. Winner said.

"When you start thinking about things that aren't going right, take a moment to list the things that you're grateful for, including your family, your friends, and having a job where you have the opportunity to help people and think about science," he added.

Dr. Jay Winner, pictured with his book, began teaching a stress-management class after seeing patients under stress. Courtesy Dr. Jay Winner