Transdisciplinary Strategies for Physician Wellness: Qualitative Insights from Diverse Fields.

BACKGROUND: While barriers to physician wellness have been well detailed, concrete solutions are lacking. OBJECTIVE: We looked to professionals across diverse fields whose work requires engagement and interpersonal connection with clients. The goal was to identify effective strategies from non-medical fields that could be applied to preserve physician wellness. DESIGN: We conducted semi-structured interviews with 30 professionals outside the field of clinical medicine whose work involves fostering effective connections with individuals. PARTICIPANTS: Professionals from diverse professions, including the protective services (e.g., police officer, firefighter), business/finance (e.g., restaurateur, salesperson), management (e.g., CEO, school principal), education, art/design/entertainment (e.g., professional musician, documentary filmmaker), community/social services (e.g., social worker, chaplain), and personal care/services (e.g., massage therapist, yoga instructor). APPROACH: Interviews covered strategies that professionals use to initiate and maintain relationships, practices that cultivate professional fulfillment and preserve wellness, and techniques that facilitate emotional presence during interactions. Data were coded using an inductive thematic analysis approach. KEY RESULTS: Professionals identified self-care strategies at both institutional and individual levels that support wellness. Institutional-level strategies include scheduling that allows for self-care, protected time to connect with colleagues, and leadership support for debriefing after traumatic events. Individual strategies include emotionally protective distancing techniques and engagement in a bidirectional exchange that is central to interpersonal connection and professional fulfillment. LIMITATIONS: In this exploratory study, the purposive sampling technique and single representative per occupation could limit the generalizability of findings. CONCLUSION: Across diverse fields, professionals employ common institutional and personal wellness strategies that facilitate meaningful engagement, support collegiality, and encourage processing after intense events. The transdisciplinary nature of these wellness strategies highlights universal underpinnings that support wellbeing in those engaging in people-oriented professions.

Audible Coronary Artery Stenosis.

OBJECTIVE: Hemodynamically significant coronary artery stenoses generate turbulent blood flow patterns that manifest as intracoronary murmurs. This study aims to evaluate the performance of modern acoustic detection of these murmurs by acoustic signals captured from patients undergoing gold standard comparative coronary angiography. METHODS: We prospectively studied 156 patients undergoing elective coronary angiography, excluding those with acute coronary syndrome, prior chest surgery, or significant valvular disease. Acoustic signals were captured before arterial access. Angiographic degree of stenosis in each coronary artery was graded blinded to clinical and acoustic data. Acoustic data were analyzed blinded to clinical and angiographic data, categorizing subjects as "normal," "diseased," or "inconclusive." Of 156 patients examined, 123 generated analyzable data. RESULTS: Angiographically significant stenosis (≥50%) prevalence was 52% (18%, 23%, 11% with 1-, 2-, 3-vessel disease, respectively). Acoustic detection sensitivity and specificity for stenosis ≥50% in any vessel were 0.70 and 0.80, respectively (negative predictive value, 0.71; positive predictive value, 0.79). Acoustic detection optimally identified stenosis ≥50% with an area under the curve of 0.75. For stenosis ≥50% in major vessels only (left main, proximal-mid left anterior descending, proximal-mid circumflex, proximal-mid right coronary), prevalence was 46%; sensitivity and specificity were 0.72 and 0.76, respectively (negative predictive value, 0.76; positive predictive value, 0.72; area under the curve, 0.76). CONCLUSIONS: Acoustic signal patterns and modern analysis techniques may be used to identify intracoronary murmurs generated by hemodynamically significant coronary artery stenoses in all major vessels. Further investigation is warranted to compare the clinical performance of this modality with current noninvasive approaches that evaluate patients at risk for atherosclerotic and obstructive coronary artery disease.