Jay A. Harolds

Mentoring and coaching are activities that are quite helpful in having doctors become happy, engaged, and successful in their work and also help prevent burnout. Coaching helps promote a better balance between work, rest, family, and fun pursuits. Coaching also helps the one being coached develop better emotional awareness, become more cognizant of the good he/she has done, develop a positive outlook on life, find more meaning in work, and be better able to overcome obstacles. In ways such as these, the coach helps his/her client become more resilient and recover from burnout.

Some of the approaches to prevent and recover from burnout focus on the individual, and others focus on organizational initiatives. A common recommendation for the individual with burnout is to practice meditation and mindfulness. Mindfulness may be defined as focused awareness without judgment regarding the current instance in time. The practice of mindfulness and the outcome of various mindfulness courses will be discussed in this article. Other approaches on the subject of burnout regarding individual efforts and organizational changes will be discussed in subsequent articles in this series.

Burnout not only is a serious problem for physicians, but it also adversely affects the quality and safety of health care for the patients they care for. A doctor with burnout may commit more errors, exhibit unprofessional behavior and a callous attitude to others, have diminished productivity, and cause other problems for the health care system. Furthermore, the percentage of doctors who experience at least 1 symptom of burnout is increasing.

Percutaneous coronary interventions (PCI) are done for a variety of indications. Data from the CathPCI Registry is highly useful to evaluate the outcomes from performing a PCI procedure in unusual circumstances, such as in cases of chronic total coronary artery occlusion, cardiogenic shock after a myocardial infarction, syncopal patients, asymptomatic patients, and before surgery that is noncardiac. Registry information is also valuable in evaluating the efficacy of coronary stents. This article summarizes some of the information available on these subjects.

Models to predict patient risk in undergoing a percutaneous coronary intervention (PCI) have been put forward by authors studying data from the CathPCI Registry. CathPCI data can be used to improve processes and decrease the rate of complications. Outcome data from the CathPCI Registry can be used to assess not only institutional performance but also the performance of the physicians performing the PCI. CathPCI data can also be used to assess the complication rate from various types of vascular closure devices.

The CathPCI Registry was started in 1998 to improve health quality for those patients having a percutaneous coronary intervention or diagnostic cardiac catheterization. This registry studies complications, outcomes from placing coronary artery stents of different types, appropriateness of performing the procedures, special indications for performing the procedures, safety of devices, patient characteristics, possible relationships between volume of procedures and quality, models to adjust for patient risk, and so on. The registry encourages using the information to promote research and quality improvement and public reporting of the data.

Studies based on PINNACLE registry data include the management of high blood pressure, relationship of socioeconomic status and prescription practices, eligibility for medication therapy management programs, relationship of patient volume to adherence to guidelines, and relationship between quality and the type of provider. This article summarizes studies on all of those topics.

There have been numerous publications in the scientific literature based on data from the PINNACLE Registry. The current article includes PINNACLE studies on cardiology outpatients regarding anticoagulation therapy, the relationship between weight loss and atrial fibrillation, and the usefulness of the registry information for training cardiac fellows.

There is an important opportunity for improvement in the care of cardiology outpatients by having greater compliance with published guidelines, and the PINNACLE (Practice Innovation and Clinical Excellence) Registry seeks to do that. One of the major areas studied by this registry is the use of secondary prevention medications for patients with coronary artery disease. Appropriate use of these medications decreases later myocardial infarctions and death from a cardiac cause.

The PINNACLE (Practice INNovation And Clinical Excellence) program was started in 2008 by the American College of Cardiology and its National Cardiovascular Data Registry. This was the first and now the largest countrywide prospective registry to improve care quality for cardiac outpatients. The registry focuses on reporting about the adherence to guidelines in treating individuals with high blood pressure, atrial fibrillation, coronary artery disease, and/or cardiac failure.