If someone suggests a mindfulness course might help with your stress and your response is NO! My mind is full already! Guess what—you’re a prime candidate for a mindfulness course.
It’s not really a laughing matter when the thought of finding time and energy for a mind-calming technique triggers anxiety. The impact of stress on physicians, residents and medical students is very real. As a result, interest in creating mindfulness programs for them has been growing steadily for years; increasingly, research is backing up that interest with evidence of its benefits.
The Oxford Dictionary defines mindfulness as “a mental state achieved by concentrating on the present moment while calmly accepting the feelings and thoughts that come to you, used as a technique to help you relax.” Mindfulness originates with Zen Buddhism and is an essential element of yoga, which may account for some people’s skepticism around it: it has overtones of hippydom.
Ronald Epstein, a professor of family medicine, psychiatry and oncology at the University of Rochester Medical Center, is a prominent champion of mindfulness for physicians. His 1999 article “Mindful Practice” in the Journal of the American Medical Association is a seminal work on the topic. In it, he outlined the goals of mindful practice: “…to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognize bias and judgments, and thereby act with principles and compassion.”
It’s not an easy process, he warned. “Mindfulness is a discipline and an attitude of mind. It requires critical informed curiosity and courage to see the world as it is rather than how one would have it be.”
In a 2017 interview with Flavia Munn of Medical News Today, Epstein admitted his support for mindfulness did not come easily. "‘I don't like this touchy feely stuff. I am not a new age kind of person. I am very skeptical,’ Dr. Epstein explained. ‘Some people say 'I can't stop my thoughts.' Well, it's not about stopping your thoughts—it's about paying attention to them,’ he noted.”
When physicians can focus just on the moment they’re in, they and their patients benefit. Physicians feel and engage with their patients’ realities, and patients encounter more open, empathetic and engaged doctors.
In the four decades since mindfulness established a presence in western medicine, its benefits have become increasingly clear. In a JAMA commentary on mindfulness and patient safety, Erica Sibinga and Albert Wu quote a list of seven qualities of mindfulness:
- Patience: understanding that things unfold in their own time;
- A beginner’s mind: one that is open to each experience as if it were new;
- Trust: in your own wisdom and the wisdom of others;
- Nonjudging: being aware of reflexive judgmental thoughts that distract or distort what is happening in the present;
- Nonstriving: shifting focus from goals to what is happening in the present;
- Acceptance: seeing the situation as it is, not how you wish it were; and
- Letting go: allowing thoughts and feelings to come and go without taking your attention with them.
That openness, trust, curiosity and acceptance ideally mean patients are perceived and related to as individuals not as the conditions they are seeking care for. A study of HIV patients found doctors with higher mindfulness scores had better rapport and communication with their patients, spent more time with them and were more empathetic.
A randomized controlled study of primary care doctors found mindfulness training leads physicians away from “habitual reactions to situations and teaches new ways to respond that are more creative and less depleting.” They also reduce burnout.
How can you take the first steps toward mindfulness? Turns out, there’s an overwhelming number of options. Many large health care employers offer versions of Kabat-Zinn’s eight-week mindfulness-based stress reduction courses. Others (since health care providers are busy) have adopted accelerated mindfulness training, which several studies have found to be effective. There are innumerable mindfulness and meditation online courses and apps. But if you’re looking for a way to test the waters, the Medical News Today 2017 interview piece mentioned above offers six mindfulness techniques for physicians:
- Pause and breathe: Munn quotes Epstein’s recommendation, that you pause for three seconds with your hand on the doorknob of a patient’s room, focus on your breath, and clear your mind, so you can prepare yourself to pay attention.
- Mindful meditation: Best done seated. Bring your attention to your breath and the sensations you feel while breathing. If your mind wanders, gently bring it back to your breath.
- Watch your thoughts come and go: In meditation, it’s common for thoughts (like everything on your to-do list) to creep in. Acknowledge them, take a mental note ― or even name them — “This is anger.” Then let them drift away.
- Find your feet: You’ve heard of feeling grounded? Make it literal. Breathe, and focus on your feet, as they meet the ground, the balance between them, the sensations in them.
- Make ordinary tasks extraordinary: Focus on something routine, as though you were doing it for the first time. This can be anything from washing the dishes to eating a raisin. Pay attention to the activity and the sensations, pleasant and unpleasant, involved, but don’t judge.
- Body scan: This takes longer. Lie down and bring your awareness to different parts of your body, sequentially. As with No. 4, bring your focus to your feet, but then keep going, working your way up your body, knees, thighs, buttocks, belly. Don’t judge. Just focus on what each part of your body is feeling. This is often used in bed by people who have trouble sleeping.
Somehow, even these simple exercises ― focusing on the very limited world of your body and breath ― go a long way towards showing what mindfulness is. And the still, small voice of calm you find may be enough to draw you deeper into discovering mindfulness and its benefits for you and your patients.
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule. Feel passionate about physician-led innovation? Please connect with us at firstname.lastname@example.org.