The design of the FMM story-telling group is based on the highly successful pilot program ISHI has run for San Francisco Bay Area physicians since 1998. This pilot has, by participant self-report, proven highly effective in reversing depression and cynicism and has demonstrated a powerful effect on physician commitment to and enthusiasm for the practice of Hippocratic medicine. At present there are more than thirty physicians who participate on a drop-in basis and two splinter groups have formed from the original FMM group.

The Bay Area FMM pilot, a three-hour Wednesday evening group, meets once a month in the living room of a participant. The group has grown from an initial six physicians per meeting to an average size of 12-15 physicians per meeting. These doctors represent the full spectrum of medical specialties (Family Practice, Hospice, Internal Medicine, Oncology, Gynecology, Pediatrics, Emergency Medicine, Surgery) and medical practice styles (private practice, HMO practice, academic practice and teaching.)

Among the topics the Bay Area FMM group has selected for discussion are the following:

Service / Covenant Compassion Collaboration Listening Suffering Loss Forgiveness and Mistakes Grace

Clarity Gratitude Dignity Integrity Fear Commitment/Calling Humility Surrender

Awe Prayer Devotion Failure Love Mystery Joy

We were frankly surprised by the outcomes of this pilot program. Physicians invariably commented that they had never had an opportunity to discuss the meaning of their work with physician colleagues before and found it profoundly supportive and satisfying. Many felt that the story telling community had enabled them to see greater meaning in their work and to live closer to their spiritual values.

It was evident that the FMM group addressed a significant unmet need. Physicians showed extreme group loyalty, coming to almost all meetings and bringing physician friends. Some regularly drove over an hour to attend the meeting. Physicians contacted each other by phone outside the meeting to offer additional discussion and support in specific clinical situations. Physicians reported a strengthening of their affiliation to their work and a diminishing of burnout. Physicians also reported a far greater sense of meaning in their daily work and felt less isolated, grief-stricken and vulnerable. In the course of the two years, physicians who had attended several pilot group meetings spontaneously initiated two new discussion groups. Both these new groups are ongoing and report outcomes similar to the original pilot group.

Our experience with this pilot suggests that the support physicians can offer one another is unique and can affect attitudinal change far more effectively than the support offered by those outside of the profession. This support can affect change even when offered on a monthly basis. The model was found to have autonomy; it required time-sharing skills, but no group leadership skills.

The simply structured story-telling format was highly effective across physician personality types, ages and training levels; it also established a level of collegial openness and support that was described as unique by all physician participants. Many participants refer to the group as a "spiritual community" and indeed it is.

Creating safety within a professional group allowed physicians to raise professionally specific issues and discuss them in surprising depth. Material was handled in ways that were highly and immediately relevant to the daily work of a physician and also served to validate participants and reinforce the basic values that underlie the practice of medicine.