Structured Discussion Groups Can Prevent Burnout

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I wasn’t totally burned-out five years ago, but I was, let’s say, crispy.  

I wish I had known then what I know now about Balint groups – a wonderful way to provide meaning and prevent burnout among physicians, one that has been hiding in plain sight for decades.

Balint Groups were started in England by Dr. Michel Balint and his wife, Enid, a social worker and therapist, to help general practitioners deal with the burdens of providing care in the aftermath of World War II. The purpose of the groups is to provide a safe, structured space for physicians to regularly share their experiences and learn from each other. They have been correlated in studies with decreased physician burnout.

The structure is simple and elegant. Eight to twelve physicians commit to regular – once a week to once a month – hour-long meetings to discuss notable cases, the patients we tend to carry with us.

At the start of each session, a volunteer from the group presents a case for up to five minutes. During the next five minutes, group members ask the presenter follow-up questions about the case. After that, the presenter remains but is asked to observe in silence while the others discuss the case as if the presenter were not there. The group is encouraged to wonder, to imagine nooks and crannies of the case that have not yet been explored. The leaders serve as guardrails to keep the discussion focused and make sure that all participants feel safe.

About ten minutes before the end of the session, the presenter is invited to resume participation in the discussion however they wish. At the end, no summary is made; everyone carries away their own interpretation. All content is confidential. In residency programs, formal evaluation or “grading” is excluded.

Problem-solving per se, as in, “This is what you need to do next,” is off-limits. However, participants learn to think in new ways and improve their diagnostic acumen. They add tools to their belts: “How does the patient’s childhood impact the illness?” “What relationships impact the picture?” “What else am I missing?”

Balint groups also differ from support groups, where soothing words and positive feedback are expected. Nonetheless, mutual support is given through comments such as: “I’m thinking of how difficult it must have been to see this patient monthly for five years!”

Many family medicine residencies offer Balint groups. A behavioral therapist and I lead our residency Balint group, and we are exploring ways to offer the experience to other physicians. The American Balint Society offers training sessions several times a year around the country for new leaders to learn the ropes. These “intensives” are four days long and reasonably priced. Training is recommended to practice how to keep the discussion focused, deal with unhelpful behaviors and avoid other pitfalls. Those who are interested in learning more may tap the abundant resources on the website of the American Balint Society.

It is difficult to convey how significant my personal experience with the Balint process has been. I attended two intensives. The thoughtful reflections and insights of the strangers I met there had a lasting effect on me – each time I returned with a renewed sense of purpose and greater comfort with the snarls and tangles of real practice. Our regular sessions with the residents continue to lift me, reminding me of what I went into medicine for.

Keeping the fire lit is important. Imagine how our profession would change if sparks of meaning, like those that come to light in Balint groups, were to spread!

Jim Deming

Jim Deming, M.D., was a family physician for 27 years in Tomah, Wisconsin and the Wisconsin Family Physician of the Year in 2007. Since 2013, he has practiced palliative medicine in the Mayo Clinic Health System in Eau Claire, Wisconsin, where he recently became hospice medical director. In addition to leading the Balint group for family medicine residents, he leads a course in which health care team members practice communication skills.

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