R. Murali Krishna, MD, DLFAPACommunity Ambassador and Board Member, Arcadia Trails INTEGRIS Center for Addiction Recovery

Co-Founder, Founding President, and Board Member, INTEGRIS James L. Hall Jr. Center for Mind, Body, and Spirit

Co Founder, Founding President, and Board Member, Health Alliance for the Uninsured

Clinical Professor of Psychiatry, University of Oklahoma Health Sciences Center, Department of Psychiatry and Behavioral Sciences

Distinguished Life Fellow American Psychiatric Association

• I have no financial relationships or affiliations to disclose.

• I have no conflicts of interest related to material discussed in this presentation.

2

• Most physicians go into their profession to make a difference to others.

• They are incredibly smart, work hard, sacrifice immensely, have noble intentions and kind hearts.

• Society has traditionally respected physicians, rewarded them with reverence and treated them as pillars of their communities.

3

• Physicians today face monumental challenges unlike any in the entire history of modern medicine!

• Our sacred profession has not yet found a resilient way of responding to the challenge.

• We are paying a heavy price.

4

• Less time with our patients Doctor-Patient sacred relationship is weakened

• More demands to produce, to perform, to justify

• Loss of autonomy

• More non-essential, non-clinical work (paperwork, emails, reviews)

5

• Repetitive exposure to trauma, illness, suffering, inadequate options and death

• Sense of isolation and decrease in connectivity and collegiality

• Fear of malpractice suits

• Decline in life-work balance and quality of life

• Less time for self-care

• Loss of meaning and purpose

6

• Almost half of U.S. physicians report symptoms of burnout* A state of physical, mental exhaustion combined with doubts

about your value, competence and the value of your work.

1. Exhaustion Physical Emotional Spiritual – losing enthusiasm for work

*”More than half of U.S. doctors experience burnout”, www.reuters.com/article/us-health-burnout-doctors-idUSKBN0TL2QP20151202

7

Depersonalization Treating people as objects Having less empathy

Low sense of personal accomplishment, loss of meaning and purpose

Irritability, low tolerance for frustration, anger, impatience and cynicism

8

*Carol Peckman, Medscape Lifestyle Report 2016: Bias and Burnout, January 13, 2016

9

• Have you become cynical or critical at work?• Do you drag yourself to work and have trouble getting started

once you arrive?• Have you become irritable or impatient with co-workers or

patients?• Do you lack the energy to be consistently productive?• Do you lack satisfaction from your achievements?• Do you feel disillusioned about your job?• Are you using food, drugs or alcohol to feel better or to simply

not feel?• Have your sleep habits or appetite changed?• Are you troubled by unexplained headaches, backaches or

other physical complaints?

10

• Quality of care goes down Low empathy, compassion Low professionalism, poor decisions Higher medical errors

• Quality of patient outcomes goes down Lower patient satisfaction of care Decrease trust and confidence in their physicians Lower adherence to recommended treatment

11

• Personal consequences

• Marital discord, higher divorce rate

• Five times more likely to abuse prescription drugs and alcohol

• Higher depression and suicide rates 70% higher in men 400% higher in women About 400 physicians commit suicide every year

• More vulnerable to illness

• More likely to leave the profession early

12

• Rates of suicide and magnitude of the problem

• Risk factors

• Barriers to treatment

• Prevention and treatment

• Conclusions

13

• Build more resilience• More balance in work and life• More connectivity• Increased capacity to cope with change and to influence

change• Better self-care• Rediscover meaning and purpose• Attitude of gratitude

RECLAIM YOUR JOY IN MEDICINE!

14

It means learning to understand, cope,influence and adapt to change; stayingphysically, emotionally and spiritually

active; cultivating new strengths, skills andways to find joy, purpose and harmony; and

feeling connected with those you serve,loved ones and your community.

~ R. Murali Krishna, MD, DLFAPA

15

• Discover the Stress Neutralizing System

• Telomere length for health and longevity

• You may influence gene expression!

• Neuroplasticity:Improving brain connections for better health!

16

1. Learn to quiet the mind2. Reignite your passion and purpose3. Act with empowerment4. Cultivate harmony5. Rejuvenate and care for yourself6. Nurture healthy connections7. Savor altruism and spirituality

17

Mutation Research 730 (2012) 85-89

Contents l ists available at SciVe rse ScienceDirect

Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis

jou rna I homepage: www .elsevier .com/ I oc te/mol mut Community address: www .e I sevier .co m/locate/m utres

Review

Telomeres and lifestyle factors: Roles in cellular aging jue Lin a•*, Elissa Epelb, Elizabeth Blackburn a

• University of California. San Francisco, Department of Biochemistry and Biophysics,San Francisco, CA 94158,USA b University of California, San Francisco,Center for Health and Community,3333 California St.. Suite 465,San Francisco. CA 94118,USA

ARTICLE INFO

Article history: Received 3 May 2011 Received in revised form 4 August 2011 Accepted 16 August 2011 Available online 22 August 2011

Keywords: Telomere Telomerase Lifestyle Aging Stress

ABSTRACT Recent research has demonstrated that telomere maintenance might be a key integrating point for the cumulative effects of genetic, environmental and lifestyle factors on aging and aging-related diseases. It is timely to 'take stock' of where this work has led the field. This.review summarizes studies that have examined associations between lifestyle factors and telomere length and telomerase activity. In most of the studies described in this chapter, telomere length was measured in leukocytes (LTL) or peripheral blood mononuclear cells ( PBMCs), taken from blood draws from the study subjects.Much of this chapter focuses on psychological stress, a widespread factor often intimately tied in with lifestyle or behavioral factors that in turn are related to risks of clinical diseases. Together, these findings suggest that cellular aging is linked to a range of influences, with an individual's life events and lifestyle parameters playing significant roles. Lastly, we propose possible biochemical mechanisms that mediate these associations and discuss future directions.

© 2011 Published by Elsevier B.V.

18

Mutation Research 730 (2012) 85-89

Contents l ists available at SciVe rse ScienceDirect

Mutation Research/Fundamental and Molecular

Mechanisms of Mutagenesis

jou rna I homepage: www .elsevier .com/ I oc te/mol mut

Community address: www .e I sevier .co m/locate/m utres

Review

Telomeres and lifestyle factors: Roles in cellular aging

jue Lin a•*, Elissa Epelb, Elizabeth Blackburn a

• University of California. San Francisco, Department of Biochemistry and Biophysics,San Francisco, CA 94158,USA

b University of California, San Francisco,Center for Health and Community,3333 California St.. Suite 465,San Francisco. CA 94118,USA

ARTICLEINFO

Article history:

Received 3 May 2011

Received in revised form 4 August 2011

Accepted 16 August 2011

Available online 22 August 2011

Keywords: Telomere Telomerase Lifestyle Aging

Stress

ABSTRACT

Recent research has demonstrated that telomere maintenance might be a key integrating point for the cumulative effects of genetic, environmental and lifestyle factors on aging and aging-related diseases. It is timely to 'take stock' of where this work has led the field. This.review summarizes studies that have examined associations between lifestyle factors and telomere length and telomerase activity. In most of the studies described in this chapter, telomere length was measured in leukocytes (LTL) or peripheral blood mononuclear cells ( PBMCs), taken from blood draws from the study subjects.Much of this chapter focuses on psychological stress, a widespread factor often intimately tied in with lifestyle or behavioral factors that in turn are related to risks of clinical diseases. Together, these findings suggest that cellular aging is linked to a range of influences, with an individual's life events and lifestyle parameters playing significant roles. Lastly, we propose possible biochemical mechanisms that mediate these associations and discuss future directions.

© 2011 Published by Elsevier B.V.

19

April 26, 2018Richard Knox

20

21

22

23

23

Article

A functional genomic perspective on human well-being1. Barbara L. Fredricksona, 2. Karen M. Grewenb, 3. Kimberly A. Coffeya, 4. Sara B. Algoea, 5. Ann M. Firestinea, 6. Jesusa M. G. Arevaloc, 7. Jeffrey Mac, and8. Steven W. Colec,d,1

Author Affiliations1. aDepartment of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; 2. bDepartment of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599; 3. cUniversity of California, Los Angeles, School of Medicine, Los Angeles, CA 90095; and 4. dJonsson Comprehensive Cancer Center, Norman Cousins Center for Psychoneuroimmunology, AIDS

Institute, and Molecular Biology Institute, University of California, Los Angeles, CA 90095

1 Edited* by Burton H. Singer, University of Florida, Gainesville, FL, and approved July 2, 2013 (received for review March 20, 2013)

Proceedings of the National Academy of Sciences

25

http://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befahttp://www.pnas.org/search?author1=Barbara+L.+Fredrickson&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-1http://www.pnas.org/search?author1=Karen+M.+Grewen&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-2http://www.pnas.org/search?author1=Kimberly+A.+Coffey&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-1http://www.pnas.org/search?author1=Sara+B.+Algoe&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-1http://www.pnas.org/search?author1=Ann+M.+Firestine&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-1http://www.pnas.org/search?author1=Jesusa+M.+G.+Arevalo&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-3http://www.pnas.org/search?author1=Jeffrey+Ma&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-3http://www.pnas.org/search?author1=Steven+W.+Cole&sortspec=date&submit=Submithttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-3http://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#aff-4http://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#corresp-1http://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befahttp://www.pnas.org/content/110/33/13684.abstract?sid=48591e05-d2dc-4afd-8dae-510aa480befa#fn-8

26

27

1. Activate Your Healing System

2. Cultivating Mindfulness

3. Cognitive Reappraisal

4. Attitude of Gratitude

5. Finding Meaning and Purpose

6. Igniting Your Passion and Transforming It into Action

7. Forgiveness – Cultivating Equanimity

8. Nurturing Connections

9. Finding Joy

10. Making a Difference

28

Skill of…

ACTIVATING YOUR HEALING SYSTEM

29

Skill of…

MINDFULNESS

30

Skill of…

COGNITIVE REAPPRAISAL

31

Skill of…

GRATITUDE

32

Skill of…

FINDING MEANING AND PURPOSE

33

Skill of…IGNITING YOUR PASSION

ANDTRANFORMING IT INTO ACTION

34

Skill of…

FORGIVENESS

35

Skill of…

NURTURING CONNECTIONS

36

Skill of…

FINDING JOY

37

Skill of…

MAKING A DIFFERENCE

38

The most sacred part of our healing profession is caring for people in their

most vulnerable and fragile times.

Through our knowledge, wisdom and spirit we kindle their hope and healing.

Let no challenge take these reverential, fulfilling, humble, and healing moments

away from us.

~ R. Murali Krishna, MD, DLFAPA

39

40

Arcadia Trails Addiction Recovery Center

41

Arcadia Trails Addiction RecoveryConference Center

42

• Go to www.integrisok.com/imh

• Click on Live Life Well Video Series, select video you wish to listen to from your computer, tablet or select smart phones

• Click on Happy Living™ Podcast and follow instructions under header “Download Podcast”

Accessing Dr. Krishna’s Presentations“The Art of Happy Living™” Podcasts & Live Life Well Video Series

43

Proceeds from book sales will be donated to the Dr. R. Murali Krishna Family Eliminate the Stigma of Mental Illness Award Endowment Fund through the INTEGRIS Foundation.

44

WAKE-UP CALL:�Preventing Burnout and Suicide in Physicians�Confessions and DeclarationsA Noble Profession Physician Wellness Challenges We Are Facing Today Challenges We Are Facing Today (cont’d) Challenges We Are Facing Today (cont’d) Challenges We Are Facing Today (cont’d) Specialty Rates of Burnout*Could You Be Experiencing Burnout?Consequences of Stress and �Burnout in Physicians Consequences (cont’d) Physician Suicide Desired Change For PhysiciansThe Key is Learning to�Continuously Reinvent YourselfThe Science and Art of Thriving in Change,�Finding Balance and Cultivating Joy Dr. R. Murali Krishna’s Keys�for Physician WellnessSlide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Ten Key Practical Skills to Cultivate Key Practical Skills to CultivateKey Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Key Practical Skills to Cultivate (cont’d) Slide Number 39Slide Number 40Slide Number 41Arcadia Trails Addiction Recovery�Center Meditation PathSlide Number 43Slide Number 44