Modern conversation is dominated by discussion of mindfulness. The implication is that “being in the present moment” will magically help us but, unfortunately, we are constantly distracted by email, Facebook, and the most recent text message, or, just as easily, by our own thoughts. Let’s look at 5 benefits of being in the now:
Mindfulness brings Calm
Often our minds spin wildly, jumping from thought to thought. The swirl of thoughts can be like the torrent of a waterfall. We try to focus on a task and our mind goes to an argument we had that morning, a recent text, or how guilty we feel for eating those 3 scoops of ice cream last night. When we aren’t ruminating about the past, we fixate on a concern about the future, and anxieties and worries take hold. Even if there are no current stressors, our thoughts can take us into a downward spiral driving fear, rumination, and distress.
Mindfulness helps us realize that thoughts are simply thoughts, not reality.
Instead of being swept away by the waterfall, we learn to watch it from the comfort of the water bank. Creating some distance from our thoughts frees us from being trapped by them and allows us to access a natural calm and ease.
Despite being physically present with loved ones, it’s easy for our minds to be elsewhere. Often we stew about a meeting we have to plan for or replay a tense conversation with our boss, missing what’s in front of us. Mentally living in another moment, we can see our partner or children as the annoying distraction. We find ourselves impatient and short-tempered.
When we’re in the present moment, we detach from past experience and future worries, and give our full attention to those we’re interacting with. Drifting from the now is inevitable, but we can note this and gently return to the present. We all know how good it feels to interact with someone fully invested in us in that moment, and others immediately sense when we’re fully there with them. Staying in the present, we often find that it’s easier for others to join us there.
The Present Allows Broader Perspective
When we’re in mindless mode, we develop tunnel vision. We become stuck in a fixed reality that we have assumed to be true. Watching the world through this clouded lens, we have difficulty simply seeing and appreciating what is. Often times the way we see a problem can in fact be our problem, and part of being mindful is being open to challenging our own assumptions. One of the cornerstones of mindfulness is a quality of open awareness and curiosity. When we become inquisitive about a problem and question our assumptions, we see options that were previously outside of our field of view.
In addition, by shifting our focus to the present moment the magnitude of our problems begin to shrink. Right here, right now, it’s likely that our needs are being met, our health is manageable, and we can meet the challenges we face.
Be More Resourceful
What if you could focus on what is rather than how you think things should be? Releasing expectations about your situation allows you to take action from where you actually stand. If you know what you’re facing, as opposed to an altered version of it, it’s likely that you’ll have more clarity. You’ll be able to see what the real constraints are and where there are openings for change. And all that energy that you’re putting into wishing things were different can be harnessed to take action with what actually is.
When you stay in the present moment, there is more available to you to come to a solution. You can then respond wisely and in a fully informed manner, rather than reacting blindly. You develop the superpower of conscious clarity. Watch this light animation of Dan Harris explaining how practicing mindfulness can be a superpower.
A Mind in the Now Fosters Confidence and creativity
When we focus on what’s actually going on right now, we shed comparisons with others, harsh judgments about ourselves, and our analysis of our circumstances. All of these thoughts sap our natural creativity, and besides being overly-critical, they are rarely accurate.
When we live in the present moment, our attention is focused on what we’re experiencing and instead of getting caught up in negative self-talk, we can simply note it and move on. We leave rigid ways of understanding our experience behind. This flexibility clears room for new thoughts and ideas, and the results are often a rush of creativity.
Integrating mindfulness practices into our lives provides a multitude of benefits: we spend more time in the here and now, we experience less anxiety and more calm, and we enjoy deeper and more meaningful relationships. We reduce the tendency toward tunnel vision and see more options and choices, and this helps us feel less trapped by our circumstances. And we remove barriers that stifle our creativity and confidence.
It’s easy to get absorbed in our email, phones, and the most recent text message. Just as easily we get lost in our own internal thoughts. When you find yourself distracted, worried, or anxious, take a few minutes to bring your attention to your breath. It’s a sure-fired way to access the present moment.
Learn How to Be Mindful Within the Present
Through her experience as a physician coach, Dr. Gail Gazelle improves the lives of doctors throughout the United States. If you would like to learn how to become more aware and mindful, reduce stress, and decrease burnout, contact Dr. Gazelle today.
How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you? Thinking that everyone in your peer group is smarter than you? Or fretting about how much more fit, thin, smart, or successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.
You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?
Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.
As a physician coach, here are four steps I teach to overcome the pull to comparisons:
Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.
These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.
Ron Epstein, MD, Professor of Family Medicine at the University of Rochester Medical Center, has played a key role in bringing mindfulness to American healthcare. His research focuses on improving communication between patients and physicians, and promoting mindful practice and self-awareness in clinicians. His 1999 Journal of the American Medical Association article was one of the first on mindfulness in a major medical journal.
Gail Gazelle: Thanks for taking time to speak with me about the importance of mindfulness in healthcare. How did you become interested in the topic?
Ron Epstein: When I was 17, a friend taught me how to meditate. I found that it gave me a sense of grounding and connection. I continued my contemplative practice. Many years later, while developing an assessment system for our new curriculum in Rochester, I began thinking, “What is it that makes a good doctor?” I knew that it was more than just skills and factual knowledge. A student can list the causes of cryoglobulinemia but that doesn’t necessarily make him or her a wise clinician. It is more – it is the ability to be attentive, curious and present and to cultivate a “beginner’s mind.” So I started asking students different types of questions – reflective questions – such as “What are you assuming about this patient or this situation that might not be true?” “Are you having strong feelings about the patient that could affect your decision-making?” Typically students hadn’t been asked questions like these. It made them stop, think, and be self-aware and present.
Being a good doctor involves the ability to listen deeply and to be present with someone who is in distress. But, no one teaches those skills; even in communication skills courses we learn what to say but less attention is about how to listen. When I took a careful look at myself I could see that there were times when I practiced well and when I didn’t, and it had to do with the same sort of mind states in my meditation practice – when I’m at my best, I’m more self-aware. Mindfulness goes beyond cognitive reflection. When you’re in the presence of someone who’s depressed you may feel a heavy feeling in your chest. You might feel a tensing of your neck with someone who’s agitated. Being open to your own somatic markers and your own emotions is important– not only for you as a clinician, but for your patients. Your bring your whole self to the care you provide. Mindfulness involves awareness of the physical, emotional, and cognitive–and also of your own mental state– are you tired or distracted, how well is your mind working right now?
It’s possible to cultivate these qualities. The brain works differently when you’re being mindful as opposed to not, and meditation practice is a kind of deep learning, that we now know can promote neuroplasticity.
Gail Gazelle: Where do you meet resistance about mindful practice in the medical profession?
Ron Epstein: Those physicians who consider that their stress only has to do with the work environment may have difficulty looking inside themselves to appreciate the ways in which their reactions to stress are healthy or unhealthy. If their clinical environment feels out of their control then they wonder if their efforts really make a difference. Some might even ask, if the world of medicine is so crazy and you’re helping people be more accepting, are you being complicit? My answer is no. I think that in becoming more self-aware, people become more energized to change themselves– and change the system.
It’s also important to realize that mindfulness does not necessarily create a state of peace, it’s cultivating awareness of things as they are. That can be difficult. It’s building awareness and resilience at the same time.
With meditation, you become more comfortable being present with a wider range of emotions, learning that you actually have a greater degree of control and choices about your reactions. You can choose how you respond. You can temporarily set your distress aside – metaphorically putting it on a shelf next to you. You see that you are not your anger, or your sadness, or your pain. You begin to understand that anger or distressing physical sensations are things you have the ability to work with.
Gail Gazelle: True. It’s important that we don’t let our feelings define us. Is it fundamentally the separation, the “I am not this?”
Ron Epstein: It’s the ability to notice “there I go again. So and so said something and my blood pressure went up by thirty points, isn’t that interesting.” With practice you get the capacity to be a little bit more able to make choices in situations that you thought were choiceless. I think it’s allowed me to engage on a personal level or principled way, without getting caught up in the fear, emotion, and the distress. So all of that’s there but I can step back and think: what’s wrong with this situation, well this situation is unhealthy. And then choose how to respond. I also think it’s important to be public about being mindful –it encourages and emboldens others to do the same.
Gail Gazelle: What does mindfulness offer when you can’t control the external circumstances, for example, when practice demands are impacting patient care?
Ron Epstein: I think you can first offer clarity regarding what you can impact and what you can’t. In virtually every environment you have some choices. The environment may be very toxic in American medicine but medicine has always been difficult, albeit in different ways.
Gail Gazelle: We’re in a challenging time for physicians. How can mindfulness help?
Ron Epstein: Mindfulness allows you to have a clearer sense of who you are, of what is important, and where to direct your efforts. Sometimes it makes clear the choice to go somewhere else. It’s a sense of control. In the most difficult situations you can still be present, and that presence itself is something patients value. It is something that can’t be taken from you: the capacity to listen, and the capacity of being honest with yourself.
Gail Gazelle: I know you think big about what mindful practice can offer healthcare. Would you share your thoughts on the topic?
Ron Epstein: I do think big. There are some health systems that are committed to becoming more mindful. Several medical schools now have required mindfulness programs for medical students.
I recently worked with a health system that has compassion as their mission statement, and they seem to be taking it very seriously. They believe that if they achieve financial success but are not compassionate, they have failed. At a 2-day workshop for 300 of their clinical staff, the CEO was there the whole time, and I never saw her take out her smartphone. She was present, communicating her availability and commitment. That is important.
Practicing mindfully helps patients feel like they’re being listened and attended to. I believe it can reduce errors resulting from inattention and haste, and it can promote caring and professionalism when things go wrong. Perhaps it can limit the use of mindless aggressive care for people who will only be damaged by it, enhance the sustainability of the healthcare workforce, and reduce turnover, all of which would cost us less.
Mindfulness programs in the corporate world may increase productivity, but more importantly, they can help people feel a greater sense of meaning in their work lives. I recently spoke with a cardiologist friend who was tired and bored after a day reading stress tests and EKGs. Mindfulness could alleviate the boredom by taking that moment when the patient is getting on and off the treadmill to acknowledge the humanness of that person, to see novelty in the familiar, and to appreciate the connections he has with his staff.
Gail Gazelle: So it takes it from isolation to the greater purpose. Isn’t that what’s most important?
Ron Epstein: Yes, because sometimes we forget what it’s all about. Ultimately, medicine is about people.
The importance of this step cannot be overestimated. Of the ~850,000 active physicians in the U.S., over 200,000 currently hold ABIM certification, which is required of internists and most medical subspecialists. Starting in 1990 (the year I was unfortunate enough to complete Internal Medicine residency!), physicians have been required to take the exam every ten years to maintain their board certification.
While the ABIM cites data suggesting that the exam improves quality of care, this has not been definitively established, and questions have arisen from a number of quarters about appropriateness of content, the expense, and whether the exam is contributing to early retirement, a major concern in terms of the growing physician shortage. The ABIM apology focuses on making the exam more relevant to the practice of medicine, allowing CME credits to be used in place of the esoteric MOC (maintenance of certification) modules, and eliminating the onerous practice assessment and patient survey requirements.
Board recertification is expensive, time consuming, and requires intensive preparation. In the setting of increased demands to see more patients in less time, decreased reimbursement, increased scrutiny, increased role definition by non-physicians, and the burdens of the EMR, board recertification is yet one more factor contributing to physician burnout.
Physician burnout is a complex phenomenon and yet it can also be summed up with a very simple equation.
X = all the things that buoy a physician up
X equates to things like positive patient encounters, good relationships with support staff and colleagues, intellectual challenge, or picking up a tricky diagnosis. X also includes meaningful personal relationships, adequate sleep, and personal health, in addition to a sense of meaning and accomplishment.
Y = all the things that drag a physician down
Y includes an EMR that is frustrating to use and eats away at precious time, unrealistic patient loads, having more and more administrative hoops to jump through, inadequate staffing, or not having time to just focus on the care of your patients.
The math is simple:
When Y outweighs X, you get imbalance and physician burnout, almost like two sides of a seesaw.
And board recertification is in the Y category big time. My own experience is telling. When I recertified in 2010, as a hospice physician out of touch with general practice, I prepared for over a year and a half, studying 3 hours a day for 3 months. I spent most “free” moments studying, I was completely drained, and my family was angry and alienated. Prior to that recert, my 13-year-old son had always proudly called himself Dr. Gazelle Junior. By the end of the experience, he said you couldn’t pay him enough to become a doctor. Now, at age 18, he’s planning on a career in engineering.
Many things can be done to decrease physician burnout. Not having to spend time that you don’t have studying for an irrelevant test is one important one, but it is still just one factor. Part two of this blog series will discuss the growing body of knowledge on other interventions.
When you wake up in the morning, are you ready to take on the day, or do you want to pull the covers up over your head and crawl into a cave?
As noted in a recent New York Times article, “Why You Hate Work,” a 2013 Harvard Business Review study of 12,115 white-collar workers revealed that 70% of workers do not have time for creative or strategic thinking at work, and 50% do not find meaning and significance in their workplace.
This problem of finding purpose or engagement at work affects all white-collar workers, including physicians in nearly every specialty and field. A pioneer in burnout research, Christina Maslach defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and lack of sense of meaning and accomplishment. Does any of this resonate for you or the physicians you know?
As a physician coach, I have worked with many clients suffering from physician burnout who are not only dissatisfied in their work, but feel disillusioned and without purpose.
I recently worked with a mid-career neurologist who was frustrated by the never-ending changes in her workplace. It seemed as if the rules changed by the week, with hard-to-understand updates to the EMR, and rotating practice managers, one more challenging to work with than the next. My client became so lost in frustration and negativity that she wondered why she was even practicing medicine anymore.
Engagement is the antithesis of physician burnout, and is defined as a positive, fulfilling, state of mind characterized by vigor, dedication, and a sense of flow in one’s day.
The New York Times article points out that employees are more satisfied and productive when their foundational needs are met, including creativity, value, and a sense of connection and purpose at work.
When engaged, white collar employees are more motivated, feel more personally invested, and tend to become absorbed in their work. When they come up against challenges, they are inspired to find creative ways to problem-solve. In addition, these employees find greater work-life balance, and have an overall sense of optimism and happiness. This is critical for physicians, given that they experience levels of burnout of 30-60%.
Engagement is increasingly recognized as vital for self-determination and productivity in the workplace. Organizations that encourage employee engagement are experiencing higher profits, improved safety records, and higher retention rates. Simple workplace measure such as providing breaks and acknowledging hard work can go a long way in increasing engagement.
Through physician coaching, my neurologist client experienced renewed motivation to effect change in her workplace. She pushed leadership to develop a wellness committee. We worked on many strategies to help her manage the changes and stresses of her position. Over time, she learned to focus more on her strengths, celebrate small daily accomplishments, and gradually re-engage.
Part I of this post explained this common disorder, which strikes physicians in their primes, leads to chronic low self-esteem, and contributes to the epidemic of physician burnout. What else do we know about it?
Many physicians have some form of the Impostor Syndrome (IS) but almost all suffer in silence and isolation. This isolation actually feeds into the syndrome, making physicians focus more on the belief that others are more competent than they are. And the vicious cycle repeats or even intensifies.
Furthermore, IS erodes confidence and sense of accomplishment. There are so many pressures on physicians, so many things that weigh you down. Given this, in order to survive you need to limit or eliminate anything that can contribute to the weight of these pressures. Walking around waiting to be “found out” is definitely in this category.
Here are a few ways to manage IS:
Realize that many of your peers also suffer from IS. You can derive comfort from the knowledge that IS comes with the territory of being a physician. It is an occupational hazard, unrelated to your actual skill or expertise.
Try not to expect yourself to be perfect! No physician is, so stop berating yourself for being human. We would have been much better served if we had been taught this in medical school.
Remind yourself that you’re selling yourself short by comparing yourself to others. You bring unique strengths to your work.
When symptoms hit, consciously shift your focus to at least one specific way you excel professionally.
Regularly acknowledge that there is so much new information out there, you cannot possibly keep up with it all.
Like many treatments, this prescription will not take effect immediately. It must be practiced consistently. Old thought patterns are difficult to change. Take care of yourself in this way and you will promote your well-being over your entire career.
This week, if you experience symptoms of IS, try the methods above. Do they relieve your suffering?