Article Review: “Mindfulness and GAIN: The solution to burnout in medicine?”
I remember getting the call and going to the ICU. It was another COVID patient that after holding on for many hours finally needed intubation. We all put on our PPE and went into the room, each going through our own rituals to prepare. I explained the best I could through the helmet what we planned to do to help him with his breathing. He asked me for something to drink. Unfortunately, I told him, we couldn’t offer that. Those were his last words. We intubated him successfully. But he sadly passed the next day.
We all have similar stories to tell from the pandemic. I still think about him. And his family. And of how others have been affected by COVID. As physicians on the frontline of the pandemic, we have carried the burden of additional stress and anxiety at levels higher than usual. This has led to burnout amongst many physicians in our specialty.
I found solace in an article by Greg Hammer, MD, from the Department of Anesthesiology at Stanford university. His article, “Mindfulness and GAIN: The solution to burnout in medicine?”, offers an approach to stave off burnout by employing the practice of mindfulness.
Dr. Hammer begins by reviewing the drivers and costs of burnout in medicine and among anesthesiologists. Hampered physicians can make mistakes that harm patients, reduce work hours, and may leave medicine altogether.
According to the WellMD rubric at Stanford there are three domains that represent the drivers of and solutions physician burnout, including the Culture of Medicine, Practice Efficiency, and Personal Resilience. Of these three, personal resilience is the driver we can best control as individual physicians.
After describing these domains, Dr. Hammer then reviews how meditation can help active physicians. We often spend more time perseverating on events in the past, overthink what will happen in the future, and do not spend enough time enjoying the present moment.
His instructions for a simple, pragmatic approach to meditation can be helpful even to the busiest anesthesiologist: the GAIN method. It is an acronym standing for Gratitude, Acceptance, Intention, and Non-judgment.
Mindfulness meditation starts with “gratitude” for what we have, including our health and our wealth. Acceptance turns our attention to what we can control, and more importantly what we cannot, and being at peace with it. Intention involves deciding how we want to think and act – we can re-wire our brains with a simple, daily practice of GAIN. And finally, non-judgement means that we do not need to label everything as good or bad but observe it with “benevolent indifference”. We did not create the world and we will not significantly change it. It simply is as it is. Over time, we can learn to apply this “benevolent indifference” to ourselves. This is perhaps most difficult for us, as we are our own harshest judges. When we apply these simple principles as a daily practice, we will be able to look back after several months and recognize that we are indeed happier people. And happiness is all that the 7 billion of us on the planet truly want.
As we start in the next chapter of the pandemic with the delta variant, we can certainly benefit from Dr. Hammer’s words. Let’s remember to care for ourselves. I hope you have a chance to check out his article.
 Hammer GB. Mindfulness and GAIN: The solution to burnout in medicine? Pediatr Anesth 2021;31(1):74-9. PMID: 33034156. DOI: 10.1111/pan.14033