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.
Modern conversation is dominated by discussion of the benefits 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:
Benefits of Mindfulness # 1: 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.
Benefits of Mindfulness # 2: Improved Relationships
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 experiences 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 at 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.
Benefits of Mindfulness # 3: The Present Allows Broader Perspective
When we’re in the 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.
Benefits of Mindfulness # 4: 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.
Benefits of Mindfulness # 5: 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-fire 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.
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.
Mindful Practice: Dr. Gail Gazelle Talks Mindfulness With Ron Epstein
Gail Gazelle: Thanks for taking the 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. You 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 mindful 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 to 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 the 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.