Practicing Mindfulness Can Bring Busy Physicians Back to ‘Now’
Abstract
The practice of mindfulness is a positive addition to a busy physician’s life. This article is part of series on physician wellness and burnout spearheaded by APA President Anita Everett, M.D.
Mindfulness, the practice of being attentive to and accepting of experiences in the present moment, is fast becoming recognized as a way to mitigate stress, increase self-awareness and well-being, and promote more meaningful relationships. For physicians, too, it is a powerful tool for increasing resilience in the face of stress and countering burnout.
Mindfulness is both a natural capacity and a skill strengthened by mental practice. We all have spontaneous moments of noticing our breath while working out, being attentive to the sound of birds in the morning, or “tuning in” to our body’s reaction to a difficult encounter. But this kind of conscious awareness of the present moment in daily life is typically overshadowed by busy thinking or doing and the sense of “being on automatic.”
Tips for Being Mindful Throughout the Day
Choose a routine activity at work and practice pausing and taking deep, conscious breaths before the daily activity. Also practice briefly reflecting on the meaning or intention of your work. Here are some examples:
Meeting with a patient and/or the patient’s family.
Going to a staff meeting.
Looking up a patient in the electronic medical record system.
Before checking email.
Washing hands between patients.
Eating lunch or snacking at work.
Taking a short break and walking to the bathroom or the coffee station at work.
Talking with co-workers or speaking with trainees.
Use reminders for mindfulness practice. For instance, you can have a framed picture or a word (even simply “Breathe”) in your office or in the patient waiting area that serves as your “mindfulness reminder.” Consider also putting similar mindfulness reminders in your electronic calendar.
Fast-paced, multitasking environments, such as health care settings, tend to activate automatic pilot, not an awareness of the present moment. Moreover, our training as physicians often demands that we ignore our own well-being to meet the demands of caregiving. These are the conditions for becoming overextended, emotionally exhausted, and/or disconnected from one’s inner experiences—burnout.
One notable study published in JAMA (September 23, 2009) looked at the effects of an eight-week “mindful communication” course for primary care physicians at the University of Rochester followed by monthly follow-up sessions for 10 months. The study found that mindfulness training resulted in reductions in all scales of burnout, an increase in empathy, improved sensitivity to patients’ psychosocial history, better mood, and increased conscientiousness and emotional stability. A follow up qualitative study in Academic Medicine (June 2012) identified three salient themes in interviews of the physicians who completed the mindfulness training:
Physicians valued sharing personal experiences with colleagues and reported reduced professional isolation.
Physicians reported being able to listen more deeply, be present with patients’ suffering, and have more adaptive reserve.
Physicians developed greater self-awareness and felt the course was transformative, yet struggled to give themselves permission to attend to their personal growth.
Mindfulness has been a core interest in my professional and personal life. As a UCLA research fellow, I developed a mindfulness-based intervention for teens and adults with ADHD. Mindfulness has also been the organizing principle of how I now work with patients or trainees and the main resource to which I turn during stressful moments in my own life. The practice has helped me to counteract my tendency to “suspend myself and plow through” a busy work day only to feel exhausted at the end of it.
Mindfulness Research Links Effects to Brain Regions
Research studies have shown that mindfulness can counteract stress in diverse settings. The proposed mechanisms of how mindfulness works include (1) enhanced attention regulation and executive functions; (2) improved emotional regulation via reappraisal of negative emotions and ability to experience the emotion; (3) increased body awareness; (4) change in perspective on the self. Neuroscience research has shown that mindfulness practice can improve stability and flexibility of attention, protect working memory against age or stress, and favorably modulate the brain regions involved in self-regulation (cingulate cortex, amygdala, insula, prefrontal cortex, and default network).
I have trained myself to notice my breath, deepen my inhalation, and relax whenever I notice myself being “locked in” automatic pilot or hyper-focused on doing. Mindfulness also helps me with processing difficult interactions with patients or colleagues: whenever I feel uneasy about an exchange or catch myself ruminating on it, I practice offering myself self-compassion and become curious what inner reactions, especially body sensations, I am noticing. This practice expands my self-understanding, and it also can reveal what needs to be accepted or let go and what needs to be proactively addressed.
In addition to managing stressful situations, mindfulness practice has helped me acknowledge my limitations. In the last two years, I have found myself running a busy psychiatry practice, teaching, writing, and being a mom to a young child. Having my first child at 43, in the midst of a busy career, has been an exercise in physical and mental endurance. The accumulation of sleep deprivation inherent in having an infant taxed the cognitive and physical reserves on which I always relied in pushing myself to get things done. It became harder than ever to force myself to attend to tasks, and I found myself working more slowly and less efficiently as I became more easily fatigued by encounters with patients or required documentation.
Mindfulness practice helped me recognize and accept the sense of accumulating exhaustion and to let go of nonessential commitments. This letting go is difficult for me because of the model of the “capable physician” to which we are all exposed during medical training. My perception of not meeting the standard of what I should be able to do created an inner struggle and kept me from taking on new projects and working too much for too long. But mindfulness practice has helped me work through anxiety and self-judgments associated with reducing work and turning down professional invitations and reminded me to take care of myself as I take care of others. ■
