Balint groups: an effective tool for improving health professionals' perceived well-being.

BACKGROUND: Physician burnout is a common problem that negatively impacts their well-being and patient care. Balint groups (BGs) deal with doctor-patient relationships. Previous studies that have demonstrated the positive effects of BGs are descriptive and based on small sample sizes. This study aims to evaluate the perceptions of health professionals who participated in BGs, determine the impact of BGs on their personal and professional well-being, and identify the factors related to these positive outcomes. METHODS: On January and February 2023 the authors have distributed a questionnaire to 142 healthcare providers in a conference and internet networks. Most respondents were family physicians. RESULTS: Participation in BGs is seen to have a positive impact on healthcare professionals' perceived well-being and professional development. Respondents who had participated in the BG reported a reduction in burnout, increased empathy, and enhanced professional identity and relationships with patients and colleagues. The study also highlighted the importance of duration of participation in BG, with attendance longer than 5 years linked to significantly more positive outcomes compared to less than 1 year. In a logistic regression analysis two factors were significantly associated with self-reported well-being: attending BGs for more than five years and perceiving BGs as a means of relieving burnout. CONCLUSIONS: The findings suggest that medical organizations should encourage the regular availability of BGs to support physicians' well-being.

Telemedicine Could Reduce the Role of Family Physicians to Case Managers.

The COVID-19 pandemic led to the widespread and continuing use of telemedicine in primary care. Despite telemedicine's benefits, it threatens to reduce the role of family physician to that of gatekeeper and case manager, nullifying decades of experience and medical intuition that is more difficult to develop and apply virtually. Additionally, many values of family medicine have eroded during this global process. The narrative presents 3 vignettes that illustrate different ways in which we contend with this complex issue. The challenges presented by telemedicine require us to re-examine our professional and personal values such as maintaining the centrality of the therapeutic relationship with patients. The greatest concern, however, relates to the future of the profession and the ability of new family doctors to overcome the challenges of telemedicine in an increasingly digital world.

Promoting advance care planning (ACP) in community health clinics in Israel: Perceptions of older adults with pro-ACP attitudes and their family physicians.

OBJECTIVE: We examined barriers and facilitators to patient-family physician discussions in Israel about advance care planning, including preparation of an advance directive by adults over age 65, as part of a program in two community health clinics which afforded family physicians the opportunity to dedicate time to such discussions with patients. To the best of our knowledge, the program is the first of its kind in Israel. METHOD: We used thematic analyses of qualitative data collected through 22 interviews with patients with pro-advanced care planning attitudes and three focus groups with eleven family physicians. RESULTS: Overall, three themes in the interviews with patients and two themes in the focus groups with physicians emerged. The program gave people with pro-advanced care planning attitudes the opportunity to follow through with their ideas. We found that patients viewed their family physicians as facilitators and that the use of an information leaflet was an effective way to promote advance directives. Family physicians expressed positive attitudes toward assisting patients in the preparation of advance directives and welcomed an allotment of time for this endeavor as part of their schedule but expressed hesitation about assisting patients concerning legal and moral issues. SIGNIFICANCE OF RESULTS: A pro-advanced care planning attitude is not enough for patients to complete the process of creating an advance directive; patients need active encouragement and intervention in order to turn their ideas into action. More patient and physician education are necessary to enable patients to protect their right to self-determination in end-of-life medical decision-making and to support physicians as facilitators of the process.

A family doctor contends with the unspoken face of the corona pandemic for the Reflective Practice section.

A family physician discusses the indirect effects of the Covid-19 pandemic on her patients and their families. Although her clinic did not suffer any deaths due to the virus, two cases are presented that depict what she terms the "unspoken pandemic" - the detrimental psycho-social effects of Corona. The narrative illustrates how a family doctor who is authentically engaged with her clients over the years has the advantage of being able to identify and address these psycho-social issues, despite the limitations imposed due to Corona. It is suggested that the potentially destructive impact of issues such as violence, anxiety and depression on families and society is no less significant than that of the virus itself.

Mourning My Patient, Mr Schwartz.

The story depicts my close relationship with Mr Schwartz, an elderly Holocaust survivor, spanning over 20 years. During those years, he became a significant patient to me; during my many home visits, we often shared significant conversations about life. When Mr Schwartz was diagnosed at age 90 with advanced cancer, we made an alliance whereby I would represent him in his decision not to receive medical interventions. For the next 4 years until his death, Mr Schwartz pleaded with me to kill him, which I could not do either legally or morally.Over the years; I was moved by his honesty, frustrated at my inability to offer him relief or a sense of meaning, and pensive, as I would inevitably reflect on existential issues pertaining to myself and my dear ones. Mourning his loss was complex, for I was very close to him, yet not a part of his family. With whom can we physicians share our sadness at the loss of a person with whom we never actually spent a holiday or family dinner?

The Phoenix: A 20-Year Patient-Doctor Journey.

In a previous story ("On Blindness and Blind Spots")1 I sought to understand the psychological causes of a long-time patient's myriad of seemingly inexplicable symptoms. Since then, I learned more of her story, which helped me understand my patient with a new perspective.Dana shared with me, and now with the readers, short poetic pieces she has written to describe her traumatic experiences as a child-and the efforts she makes as a grown woman to heal, like the phoenix rises from its ashes. The value of belief in one's patient, alongside patience and the opportunity to build a trusting relationship over many years-as the truth has a pace of its own-are underscored.

[METHODS FOR BURNOUT PREVENTION AND THEIR IMPLEMENTATION IN THE COURSE FOR FAMILY MEDICINE RESIDENTS IN BEN-GURION UNIVERSITY OF THE NEGEV].

INTRODUCTION: Professional burnout of physicians is common and culminates in the residency period. Burnout affects the doctor's health and quality of life, and it is associated with worse patient outcomes and an increase in the incidence of medical errors. The Israeli Ministry of Health recently conducted a survey on the burnout of health professionals in Israel and showed the extent of the phenomena, calling on health organizations to provide actions in order to reduce or prevent it. In the Department of Family Medicine at Ben-Gurion University of the Negev, there is a four-year course for family medicine residents in which we teach various clinical and psychosocial topics essential for the family medicine profession. As part of this course, we set up a program to prevent burnout. Four "mini-courses" were chosen and integrated into the course curriculum for family medicine residents: "Healers' art™", "meaning in medicine ", narrative medicine and reflective writing, mindfulness, meditation and relaxation techniques. In addition, the Balint groups continued to exist during the 3rd and 4th year of residence. Health institutions and organizations are committed, as part of the interventions to improve medical quality and patient safety, to detect and monitor the burnout of doctors and to offer changes in the work environment and interventions to prevent burnout. Although it is difficult to examine the long-term effects of these courses, the residents were very satisfied with the burnout prevention courses. There is a need to step up interventions and build a research and follow-up program to assess the short and long-term outcomes of these experiences on the physicians' well-being and patients' safety.

HELLP-I need somebody.

This narrative traces the development of a relationship between a family physician and a challenging patient who undergoes a cerebro-vascular accident following severe eclampsia. The story describes the patient's complicated relations with her husband, her community, the medical system, and the newborn whom she unconsciously blames for her situation. The slow painful process of developing trust in the therapeutic relationship over nearly 2 decades enables the patient to eventually reflect on herself and consider forgiveness. All identifying information regarding the case was changed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

On Blindness and Blind Spots.

This story is a reflection on the evolving relationship of a family physician with a patient suffering from a severe conversion disorder, expressed inter alia through "blindness." The narrative follows our journey as I attempt to unravel the meaning of the symptoms as a metaphoric expression of her agony. Eventually, I conclude that clinicians at times also may have a "blind spot" that prevents us from entirely grasping patients' complex inner struggles.

A good daddy.

This personal narrative presents the imagined inner dialogue of my father, when caring for me as a young sickly child. It is a compassionate exercise in attempting to understand the remote inner emotional world of my father, a Holocaust survivor, as he contended with my ongoing medical challenges that perhaps triggered his traumatic memories from the war. I am the daughter who eventually grew up to be a physician herself. (PsycINFO Database Record

To Come Full Circle.

This story is a reflection on the concept of friendship and forgiveness, on belief in change and the difficulty in letting go. It is presented through the story of two elderly patients, sisters-in-law, next-door neighbors and friends, treated by the same family physician. A trivial argument causes a rift between the two, severing a 60-year friendship. Five years later, as one lays dying in her home, the physician, accompanied by her nurse, attempts to reconcile between the two. The article includes the physician's reflections on this process, her role as a "multi-system" physician in these patient's lives and its impact on her work.

Hope.

A young woman in my care had 4 siblings diagnosed with mental illness. The story describes how, along normative family-cycle situations, she struggles to define and keep her sanity. I reflect on the shared anxiety of both the doctor and the patient of her losing her mind. As a family physician practicing in a small rural community, I believe that psychiatric, social, and family issues are also family medicine concerns.

The Untaught Lesson.

My fellow physician and friend died from a rare type of cancer. She was a model for me in many respects. She showed me how to cope with a chronic disease together with a demanding professional life, yet she left me without any comfort or guidelines on how to contend with a terminal disease. This story is a reflection on my frustration and disappointment with my friend's final choices that prevented us from processing our feelings and sharing our deepest thoughts. The story includes reflections and insights about our ability to understand and accept the preferences of patients and others close to us.

It finally happened to me.

It finally happened to me: I was sued for malpractice by the family of a patient who had died suddenly. My inner turmoil in the aftermath of this traumatic event affected me deeply. While I was an experienced family doctor dedicated to patient-centered medicine, the event challenged my customary approach to my patients. I share three vignettes from my practice that describe my inner dialogue both "preprosecution" and "postprosecution" and explain how I acted in each case.

Measuring up: musings of a family doctor on the employee time clock.

Recently, at the health maintenance organization (HMO) where I work, they introduced an employee time clock. As in many other workplaces, doctors across the country are now obligated to punch the clock at the beginning and end of their workday. This is the final act in an ongoing attempt to enhance management of doctors' schedules: limit nonurgent appointments to 10 minutes, define planned or urgent home visits, and control a physician's time, as well as managerial and clinical decisions. In this story I describe a day in the life of a family doctor, a salaried employee at a large HMO where there is now a time clock. I provide details on how the introduction of the clock influences small everyday clinical decisions that potentially affect the quality and depth of treatment while sharing the internal dialogue that accompanies me as I reaffirm my professional integrity again and again with each hastened visit. I also bring the internal dialogue of 2 of my patients, to illustrate the emotional world on the other side of these 10-minute interventions.

Disremembering the holocaust.

The essay describes an elderly Holocaust survivor, who re-experiences the horrors of the Holocaust through his senile hallucinations. Although he is demented, telling and re-telling the story to a therapist helps him regain a sense of control and feel less frightened. He is finally able to revise the nightmarish story into a narrative that enables him to find strength and meaning.

"Jum'ah" syndrome.

This is my memoir as a sick child, hospitalized in the Pediatric ward of a large hospital, many years ago. The story tells about my friendship with another young patient, Jum'ah, a Bedouin child who suffered from Congenital Cyanotic Heart Disease, to whom the pediatric ward was Home. My Childish understanding of Jum'ah's loneliness, anxiety and struggle to be loved and belonged are described in this narrative. I describe how this experience still has an influence on my adult professional and personal concepts.

Tsunami.

Tsunami is a fictionalized, based on the true story of a mother and baby patients who attended my rural clinic for 12 months and disappeared. (All personal identifiers have been removed.) It is a story of a family physician trying to establish trust relationship with a young mother, that her past history and living conditions make it almost impossible for her to raise a baby. The narrative describes the struggle of the clinic staff to help the mother to keep a safe and healthy environment for her baby, and their failure to maintain open communication and support for the young mother, until the inevitable end.