Mindfulness and the New Year | A Mindfulness In Medicine Series

Mindfulness and the New Year | A Mindfulness In Medicine Series

The Demystifying Physician Mindfulness Series

In case this is your first time here, this 12-part series is a mini-crash course in mindfulness. Maybe you’ve tried it before. Maybe the term itself gets on your nerves. If that’s the case, I hope you’ll take a deep breath and let those worries go. Each part of this series looks at a specific way that mindfulness can be useful for busy physicians like yourself. I typically address a real-life story about a common issue that contributes to stress, anxiety, frustration, anger, overwork, and overwhelm, and then provide practices that cost you nothing but a little time and attention. These can help you find more ease and joy in your work, so you can get back to the reason you’re doing what you do.

In this post, I deviate from that pattern. As we enter this new year, I offer an alternative to traditional New Year’s resolutions: using mindfulness to set intentions.

It’s that time of year again when we decide we’re going to tackle major self-improvement. 2019 is the year I’m going to avoid desserts and lose that extra 10 pounds. This is the year I’m going to stop being such a slouch and start exercising five days a week. This is the year I’ll be saving money the way I’ve wanted to.

If you’re like me, though, your track record has not been great. (And maybe that’s why these things remain on the list.) I typically start off great, then February rolls around and I fall off. Then there’s a sense of guilt and not measuring up. By March, I’m using my New Year’s resolutions to beat myself up. And feeling worse about myself and focusing on my flaws does not typically lead to success in reaching my goals.

Try Something Different This Year

Perhaps you can try something different this year: setting intentions rather than resolutions. Intentions are a kinder and gentler approach than resolutions, which tend to be black-and-white. More like guideposts than goals, intentions set a direction, rather than a destination. They help us on our journey to reach the goals we’ve set.

They set the tone for the year ahead, and become a touchstone to help you move toward what it is that you want to achieve. Goals are future-oriented, whereas intentions can be achieved in the moment. They are effective because they help align you with your purpose. Instead of being something to beat yourself up about, an intention can serve as a guiding light. They can provide a positive motivation for change, rather than a negative one.

 

How Do I Set an Intention?

1. The first step is to think about what’s been calling for your attention. What would you like to build into your life? What’s something you’d like to let go of? What’s most significant to you, moving forward? What is it that really makes you feel fulfilled? These questions can help you move beyond explicit goals like losing a specific amount of weight. They can keep you grounded in what is truly most important to you.

2. The second step is getting in touch with your values and passions. What do you find most fulfilling? What is it that you’re pursuing in moments when you’re at your best? Reflect for a moment on your deepest priorities.

3. Third, accountability is critical. You may have an accountability partner, or make a commitment to yourself in a journal. At a minimum, declare your intentions to another person. Place them on your calendar so you’re reminded of them on a regular basis.

 

What Intentions Should I Set?

Be More Mindful

There are endless choices here, but one might be increased mindfulness — to be more aware and pay attention to the moments that make up the fabric of your life. As Thich Nhat Hanh, the Vietnamese monk, reminds:

“Life is available only in the present moment. If you abandon the present moment you cannot live the moments of your life deeply.”

By being more aware, you can stay more present for yourself. You also come to understand your inner workings in a deeper way, and become more familiar with your own patterns. And the more you recognize your patterns, the more you’ll be able to intervene to effect change. You’ll see what it is that is really stopping you from losing that weight or saving that money. Being mindful sets the stage for action.

Cultivate Compassion

Another intention could be around compassion. We can get so caught up in our own problems and challenges that we forget what other people are going through. We lose sight of what it is that they’re struggling with. Our focus becomes narrow, and overly self-focused. It’s said that if we want to be unhappy, we should focus on ourselves, and if we want to be happy, we should focus on others. So there’s a double positive in being compassionate to others. In addition, compassion activates the parasympathetic nervous system, not only leading to decreases in blood pressure but also decreasing levels of inflammatory hormones decrease that contribute to stress.

Grow the Muscle of Self-Compassion

Perhaps this is the year to be more compassionate with yourself. In addition to compassion for others, we can set an intention to include ourselves in the circle of compassion. Many of us who are caregivers can be all too skilled at caring for others, yet habitually leave ourselves out. Caring for others, in the absence of caring for ourselves, sets us up for burnout.

Just as we can turn toward the suffering of others, we can begin to see our own moments of anguish and suffering. Instead of blaming or chastising ourselves, we can try to address our own pain. Like compassion, there’s increasing evidence of the benefits of self-compassion, from reduced psychological distress, increased sense of self-worth, increased happiness, and greater motivation. And motivation is certainly a key ingredient in our ability to reach our goals.

We can practice saying the following to ourselves: “What I’m going through is difficult and this is a moment of suffering. Suffering is part of the human experience: we all go through it. May I be kind to myself in this moment. May I give myself the compassion I need.”

Accept Imperfection

In North American culture, we have many myths about happiness. We often fixate on ways we or our circumstances are flawed — that if only they changed, then we’d be happy. We tend to think that happiness lies outside of ourselves, rather than being something we can cultivate from within. This vantage point can fuel a hypertrophied focus on flaws, and leave us seeking perfection. Yet, when we seek perfection, we set ourselves up for disappointment. Setting an intention to accept our own imperfections, we move toward greater acceptance and peace of mind.

This doesn’t mean accepting things that are unjust or hurtful. Rather, it means leaning into the reality that imperfection is simply part of the human condition. Perhaps our imperfections might actually be what makes us unique.

Question Your Thoughts

Another intention we might set is to question our own thoughts. We all have ways of viewing the world that may not be accurate, yet we assume that just because we think something, it’s a fact. In reality, though, our minds are busy producing thousands of thoughts per day, and these are simply mental events, not reality.

You can set an intention to notice your stories and begin questioning their veracity. By doing so, you step into more direct contact with your experience.

 

What Should I Do With My Intentions?

Keep your intentions close, mentally and physically. Write them down. Journal about them. Consider a ritual to honor your commitment. Start your day by reading over your intentions so they can set your course for the day.

I hope these tips help you leave behind the anguish of New Year’s resolutions. Please leave a comment and let me know.

Medical Error And Physician Burnout

Medical Error And Physician Burnout

Demystifying Mindfulness In Medicine: Part 5 of 12

Demystifying Mindfulness is your mini-crash course in mindfulness. I’ve gathered 12 real-life physician issues that contribute to stress, anxiety, frustration, anger, overwork, and overwhelm, and I’ve broken them down with real practices that cost you nothing but a little time and attention. Whether your challenges show up in your day-to-day work or you’re dealing with big-picture issues, you can build a practice in mindfulness to transform your work and your life and get back to the reason you’re doing what you do. This installment of Demystifying Mindfulness addresses the impact of physician burnout on medical error. Read on to find four tools for finally getting over your burnout and check out other posts in the series for more real questions and answers from one physician to another.

Today’s Topic: Medical Error And Physician burnout

We all know that there’s an epidemic of physician burnout. Many physicians spend hours on the computer after long days in the office, feeling drained and overwhelmed, losing any sense of meaning and purpose. And then there’s the spillover into family life. We can often be so consumed with our work that we’re unable to be present with loved ones. But the burnout epidemic is even more costly than this. In addition to the profound impact on quality of life at work and at home, there is increasing data showing that physician burnout correlates with increased incidence of medical errors.

In a recent study published in the Mayo Clinic Proceedings, a nationwide random sampling of 6,695 physicians in active practice completed the gold standard assessment of physician burnout, the Maslach Burnout Inventory (MBI). In this cohort, 54% were categorized as having burnout. 10.5% reported a self-perceived major medical error in the previous three months, largely error in judgment, making the wrong diagnosis, or a technical mistake. Most of these errors had no perceived effect on patient outcomes, but 5.3% resulted in “significant permanent morbidity” and 4.5% in patient death. The 691 physicians who reported errors had a higher prevalence of overall burnout than the 5,895 who did not report errors (77.6% vs. 51.5%).

The impact of burnout isn’t area-specific. After adjusting for specialty, work hours, fatigue, and work unit safety rating, physicians with burnout were found to have twice as much self-reported medical error. Other studies corroborate these findings. A meta-analysis and a systematic review also established a strong correlation between physician burnout and medical error.

These same systematic reviews have demonstrated that organizational interventions can reduce burnout, but what if your healthcare system hasn’t invested in addressing the burdens that impact physician burnout and patient safety? And, if your health system is not making this a top priority, where does that leave you?

It’s not just your patients’ safety but your own at stake. You may be aware of the term “second victims” regarding medical error:

“Fatal errors and those that cause harm are known to haunt healthcare practitioners throughout their lives. The impact of the errors is felt in their private lives, in interactions with professional colleagues, and in the context of their social lives.” (Grissinger)

The emotional impact of knowing that you contributed to patient harm can affect your health, well-being, and performance. If you want to feel more clear, present, and confident in your work—to feel as you did before burnout—self-awareness is a powerful tool you can begin working with today.

Self-awareness doesn’t require you to change the system, get a new job, or take a two-month vacation. You can start now by cultivating mindfulness. Consider what you’re already noticing in yourself. A key element of physician burnout is the depersonalization of patients—seeing them as objects rather than the whole human beings they are. When you’re struggling, do you put in less effort with your patients? It’s worth taking some time to make note of your burnout symptoms and consider how they show up in practice for you, whether that’s depersonalization, distraction, disinterest, a combination of these, or something more. With awareness, the cornerstone of mindfulness, these patterns can serve as early warning systems to help you realize how burnout may be putting you at risk. And just as with early warning signs in disease, not intervening can be costly.

 

Four Steps To Lower Your Risk of Medical Error

But just how can you affect change? Let’s come back to the concept of self-awareness—it’s important to know where your attention lies, how you’re showing up for your patients, and what your goals in your work as a physician really are. Giving attention to these questions is a practice in mindfulness. Here are four concrete steps you can work with to lower your risk for medical errors. I encourage you to take some time today and give these a try.

  1. Reconnect with why you went into medicine in the first place. If it was to take care of others, remind yourself to keep your eyes on this prize.
  1. Set a daily intention to be more present with each and every patient.
  1. Recognize and attend to your own suffering. Make space for this outside of the time you spend with patients. If you find yourself mentally railing against “the system,” use that moment to remind yourself that you’re doing the best you can. Acknowledge all the ways you’re working at maximum capacity. This may sound trivial, but this self-validation is key.
  1. Utilize any opportunity you can to voice your experience and concerns with your healthcare institution. Keep your emphasis on the shared goal of patient safety rather than your personal complaints.

It’s challenging when you have so many demands on your time, but give yourself a chance to change the patterns that aren’t working and bring vitality back to your practice and your life. Based on my work coaching hundreds of physicians, I think you’ll be pleasantly surprised at the impact a mindful approach can have. I’d love to hear about your experience.

To your resilience,

Gail Gazelle, MD

Patient Satisfaction, and Physician Burnout | A Mindfulness In Medicine Series

Patient Satisfaction, and Physician Burnout | A Mindfulness In Medicine Series

The Demystifying Physician Mindfulness Series

For many of my readers, the concept of mindfulness seems out of reach. We hear about mindfulness everywhere, but what does it mean for you? For many physicians, it can seem impractical and irrelevant. But I’ve found mindfulness to be key in helping physicians struggling with very real stressors and we now have over half a dozen studies demonstrating that mindfulness reduces physician burnout. I’ve developed this series to demystify mindfulness for you and to share bite-sized information through the stories of real-life physicians.

In each post, I’ll provide actions you can take to integrate a mindfulness approach into your practice. My goal is to transform mindfulness from an unapproachable ideal into a useful toolkit to have at your fingertips no matter the circumstances. Simply put, I want to help you be a happier, more productive version of yourself in the workplace and at home. 

Discover ways to improve your patients’ experience with the fourth installment of Demystifying Mindfulness.

Today’s Topic: Mindfulness, Patient Satisfaction, and Physician Burnout

Our physician, Dr. Q, is an emergency physician in California:

My patient satisfaction scores are in the gutter. I’ve tried everything. I’ve been shadowed by a Press Ganey auditor. I use AIDET scripts, I plaster a smile on my face and reduce myself to acting like a clerk asking, ‘Is there anything else I can help with today?’ But nothing has helped. I’m consistently in the bottom quartile of my group. This is never going to improve and it’s pushing my physician burnout through the roof!”

Dear Dr. Q,

I appreciate your honesty and humility in sharing your story. I know many physicians struggle with this same issue. It’s clear you’ve taken real steps to improve patient satisfaction, but there are a few things I’m wondering about that are likely to be helpful.

Let’s start with nonverbal language. Sometimes, no matter what we say or how we try to present ourselves, our impatience, judgments, or stresses are expressed in our body language. Ralph Waldo Emerson once said, “What you are shouts so loudly in my ears I cannot hear what you say.” Is it possible that, even though you’re saying all the right things, patients are responding to your nonverbal cues? When you go into a patient’s room, are you relaxed and receptive? Or are you holding a lot of tension, appearing rigid, or perhaps even braced for an argument? While it may seem like patients wouldn’t see all of this, they may be picking up on more than you realize.

Your body language may be the result of a busy day, a sleepless night, or other personal or professional stressors. But our body language may also relate to the judgments we make about patients. In my coaching, I see physicians get trapped by what they think are imperceptible judgments. Often, emergency physicians I’ve coached realize that, when it isn’t a code or an acute MI, there are a host of negative judgments: “Why are they wasting my time with this trivial matter?” Or they’re frustrated that the emergency room has become an access point for people seeking convenience rather than necessary care, breeding resentment: “This isn’t why I went into emergency medicine, dammit!”

Mindfulness involves cultivating a non-judgmental presence—something you can begin to practice. Simply paying attention to your thoughts and feelings is the key action step. The more you become aware of these, the more you’ll be able to leave autopilot and stressed reactivity and move into mindful response. You’ll find that you actually have more choice about your response than you may have realized. And responding mindfully gets easier with every bit of practice.

Mindfulness also involves questioning our assumptions and trying to understand the circumstances from different points of view. Let’s consider for a moment the lens of the patient sitting in front of you. Did they seek care to make your shift more difficult? Or are they here now because they’re working two jobs and finally found a moment while someone was home with the kids? The more you can look through their lens, the greater the likelihood that your patients will feel tended to and your patient satisfaction scores will improve.

Becoming curious about the patient vantage point is a helpful way to work with the judgments that make it difficult for us to actually fully attend to the person sitting in front of us. While it may sound trivial, what’s key here is to get back to the fact that there’s a suffering human being right in front of you.

Try this practical approach with patients this week:

Pay attention to the judgments that come up for you.

Pay attention to your body language, noticing as much as you can about your inner physical experience. Once you’ve done this, see if you can consciously open your body posture, even a little bit.

Make an effort to become curious about the patient’s experience. Challenge yourself to consider how a situation might look and feel through their lens.

Based on my work coaching physicians, I think you’ll be pleasantly surprised at the impact a mindful approach can have. I’d love to hear about your experience.

To your resilience,

Gail Gazelle, MD

Mindful Parenting | A Mindfulness In Medicine Series

Mindful Parenting | A Mindfulness In Medicine Series

The Demystifying Physician Mindfulness Series

For many of my readers, the concept of mindfulness seems out of reach. The term evokes imagery of tranquil monks and bucolic hillsides, existing miles away, both literally and metaphorically. I created this series to shorten these distances, and to introduce mindfulness to practicing physicians as an easily accessible tool to combat burnout.

With the goal of demystifying mindfulness, I decided to create this 12 part series. Each post examines the relationship between mindfulness and a specific area of the practicing physician’s day-to-day life. They each include a physician’s story, and how the rigors of their practice currently hamper their ability to fully live that part of their life. After detailing their situation, I provide guidance for how that physician can utilize mindfulness to gain fulfillment in that area.

With each post, I give you an actionable step that will help you integrate that post’s topic into your daily life. I’m also going to give you an exercise that you can practice in your free time that will help strengthen your resilience, calm, and fulfillment. My goal is to transform mindfulness from a daunting, unapproachable ideal into a broad toolkit that you have easy access to. Simply put, I want to help you be a happier, more productive version of yourself, at the workplace and at home.

Without further ado, the next installment of Demystifying Mindfulness.


Today’s topic: Mindful Parenting

Our physician, Dr. P, is a general surgeon from a southern state:

“I adore my kids and they mean the world to me. I put in countless hours at the office, and everything I do as a physician is so I can provide for them. But when I’m with them, I can’t seem to be fully present. I get easily upset with them and have trouble just enjoying little moments with them. We argue more than I’d like, and it seems like as a parent I can’t do anything right. What should I do?”


 

Dear Dr. P,

You’re writing in with a problem that many of my clients struggle with. You have important goals, to be the best provider and parent that you can possibly be. As physicians, we want to be the “best” at everything we do, and often become highly self-critical at the first sign of imperfection. This tendency carries over to parenting. We can often have trouble remembering the things that we are doing well, in our practice and at home, as parents.

I want to hone in on a small detail you mentioned: “I get easily upset with (my kids.)” The first key step to changing any negative pattern in your thinking or reacting is to become aware of it. This is a huge step that you have already taken. I want you to key into your pattern of irritability. Notice as much about your internal state at the moment your irritability arises. In other words, get to know your early warning signs. Then, when they occur, take a mental pause and take three slow deep breaths. This helps reset both your sympathetic and parasympathetic systems and creates a space between the stimulus—whatever challenges parenting presents– and your response. This space allows you to see that you have a choice in how you respond. You can then respond in a less reactive way, in a way you’ll likely feel better about.

While retraining yourself to be less reactive around your children, it is important that you extend a sense of compassion to yourself. You aren’t going to be perfect as a parent, and you aren’t going to completely tilt this reactive pattern overnight. Giving yourself space to do your best and be imperfect as a parent is crucial. You, just like your children (and your patients) are simply doing your best. And that’s all we can ask for.

In addition to the protocol, I outlined above, give yourself structured time to recognize your strengths as a parent. Once a week, spend 5 minutes writing down all of the successes that you had as a parent that week. You may surprise yourself. Taking pauses, and gradually training yourself to focus on your accomplishments as a parent will help you be more present and less self-critical when spending time with your children, which will ultimately deepen your relationships with them.

Give these mindful strategies a shot, and look forward to being more present and compassionate with yourself and your children.

To your resilience,

Gail


Have an idea for a future Demystifying Mindfulness post? Want Dr. Gazelle to help you tackle your problem? Write in at drgazelle@mdcanhelp.com or contact us on the website.


Developing Presence |  A Mindfulness In Medicine Series

Developing Presence | A Mindfulness In Medicine Series

The Demystifying Physician Mindfulness Series

For many of my readers, the concept of mindfulness seems out of reach. The term evokes imagery of tranquil monks and bucolic hillsides, existing miles away, both literally and metaphorically. I created this series to shorten these distances, and to introduce mindfulness to practicing physicians as an easily accessible tool to combat physician burnout.

With the goal of demystifying mindfulness, I decided to create this 12 part series. Each post examines the relationship between mindfulness and a specific area of the practicing physician’s day-to-day life. They each include a physician’s story, and how the rigors of their practice currently hamper their ability to fully live that part of their life. After detailing their situation, I provide guidance for how that physician can utilize mindfulness to gain fulfillment in that area.

With each post, I give you an actionable step that will help you integrate that post’s topic into your daily life. I’m also going to give you an exercise that you can practice in your free time that will help strengthen your resilience, calm, and fulfillment. My goal is to transform mindfulness from a daunting, unapproachable ideal into a broad toolkit that you have easy access to. Simply put, I want to help you be a happier, more productive version of yourself, in the workplace and at home.

Without further ado, here is the second installment of Demystifying Mindfulness.


Today’s Topic: Mindfulness and Being Present with Patients

Our Physician: Dr. J, an internist in outpatient practice in the northeast. Dr. J writes:

I’m finding it almost impossible to be fully present with patients. I want to be 100% focused on every patient, but my mind seems to be everywhere else. I feel like such a crappy physician…on top of being overwhelmed with the workload I can’t even empathize with the people I’m treating. What can I do to be more present and caring with each of my patients?”

Sincerely,

Dr. J


 

Dear Dr. J,

I want to emphasize two things: 1. This is something that almost every practicing physician experiences. And 2. As we continue our careers, it takes mindful effort to humanize our patients and maintain presence. We are overworked, are pulled in countless directions, and often have other things on our minds, like responsibilities outside of work. It’s not easy to give 100% of yourself to the patient in front of you when all you can think about is the charts you need to finish. Not only that, but we weren’t trained to empathize with patients! We were taught to be diagnostic scientists, not present, caring doctors. Compassionately dealing with each patient you see requires intention and cultivation. Here’s what I recommend:

Set an intention. You deciding that you want to be more present with your patients is powerful. Before each day of work, decide this again! Setting an intention for your day helps you chart your course, so you avoid finding yourself at the end of the day not having acted  the way you would have liked. The goal is not to be perfect here, but to begin to shift toward your goal. Intentionality is the root of mindfulness, and this is a concept that I’ll expand upon in future installments.

Commit to cultivating empathy toward your patients, and toward yourself. When you’re with patients, and you notice your mind wandering, remind yourself that you want to be more present, and return to the human being in front of you. The more times you remind yourself to feel this way, the more empathy you’ll develop for your patients and for yourself.

Most importantly, don’t beat yourself up for not being perfect. Forgive yourself if you aren’t as present as you’d like to be. Self-compassion is a crucial component of living mindfulness. While it may seem counter-intuitive, the kinder you are to yourself, the more likely you are to enact the changes you want to make.

Deciding that you want to be more present and caring with patients is an important first step. Implementing these mindful strategies will take you the rest of the way.

To your resilience,

Gail

Overwhelm | A Mindfulness In Medicine Series

Overwhelm | A Mindfulness In Medicine Series

The Demystifying Physician Mindfulness Series

Does Mindfulness In Your Medical Practice Seem Unachievable?

For many of my readers, the concept of mindfulness may seem out of reach. The term evokes imagery of tranquil monks and mountain tops, existing miles away, both literally and metaphorically. I created this series to bridge this distance, and to introduce mindfulness to practicing physicians as an accessible tool to combat burnout.

Each post in this series will examine the relationship between mindfulness and a specific area of a physician’s day-to-day life. They each include a physician’s story, and how the rigors of practice hamper their ability to fully enjoy that part of their life. After detailing their situation, I provide guidance for how the physician can utilize mindfulness to gain fulfillment and mastery in that area.

With each post, I’ll give you an actionable step that will help you integrate the post topic into your daily life. I’ll also provide an exercise that you can practice in your free time that will help strengthen your resilience, calm, and fulfillment. My goal is to transform mindfulness from a daunting, unapproachable ideal into a broad toolkit that you have easy access to. Simply put, I want to help you be a happier, more productive version of yourself, at the workplace and at home.

Without further ado, the inaugural installment of Demystifying Mindfulness!

 


Today’s topic: Overwhelm

Our physician: Dr. P, is a cardiologist in a large Midwestern practice: 
“I don’t know what to do. I feel like I’m drowning in my work. Every day of my practice feels like a battle, and when I’m with patients all I can think about is getting to the end of my day. I used to be in love with my practice and I don’t know what happened. Now, my work feels meaningless, and I’m completely overwhelmed.  What can I do?”


Dear Dr. P, 
You’ve already won half the battle. You’ve noticed that you’re locked in an ineffective pattern at work, and you’re interested in strategies to improve your situation. This realization is no small thing! What I want you to start doing is focusing on your physical experience. You’ve just wrapped up with your last patient of the day, you’re late to make it home for dinner with your family, you still have a half dozen charts to complete – what does your body feel like? Is your heart rate elevated? Are your hands tense? Are you sweating? Get in tune with the physical sensations that accompany the feeling of overwhelm, and you’re well on your way to combatting it,  and feeling more in control. 
 
Physical sensations often precede feelings of overwhelm; in some ways they’re an early warning system that can help you break the vicious cycle. Once you notice these physical precursors, take a brief pause. If you can take 5 seconds in between patients to take deep breaths and ground yourself, that’s a victory. See how many of these pauses you can give yourself in a workday. While this may seem trivial, over time, mindful pauses will begin to weave together into a calmer day, and a calmer and happier life. 

In addition to your feelings of burnout, you wrote that you no longer feel connected to your work. Overwhelm and lack of passion and fulfillment often go hand in hand. Of course, it’s challenging to stay connected to work when it’s so demanding. Reducing feelings of overwhelm by mindfully pausing throughout the day will help you feel more authentically connected to your work, and may revive some of the enthusiasm you’ve experienced in the past. Reciprocally, mindfully nourishing your commitment to patients will shrink feelings of overwhelm.

At the end of every day, I encourage you to write down things that went well in your day. Focusing on what went well can reconnect you to your strengths and your sense of meaning. As doctors, we are trained to focus on what is going wrong. Give yourself structured time to focus on what is going right.

Give this mindful strategy a shot and look forward to being more present and fulfilled in your practice.

To your resilience,
Dr. Gail Gazelle


Have an idea for a future Demystifying Mindfulness post? Want Dr. Gazelle to help you tackle your problem? Write in at drgazelle@mdcanhelp.com or contact us on the website.