The Mindful Doctor



 

Michael Chun, MD1

Perm J 2019;23:19.024 [Full Citation]

https://doi.org/10.7812/TPP/19.024
E-pub: 09/09/2019

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Roughly 2 years ago I was attending a physician wellness program at Kaiser Permanente (KP), where I work. One of the topics was mindfulness, and as I was sitting in the room, I thought that this was the least helpful topic of the program. Little did I know that it would end up being the complete opposite.

Shortly after attending the program, I was relaxing at home and flipping through an issue of Sports Illustrated magazine, when a picture caught my eye. The image was of National Basketball Association (NBA) basketball player Aaron Gordon doing a spectacular dunk over a spinning Stuff the Magic Dragon mascot at the 2016 Slam Dunk Contest.1 The title of the accompanying article was “Mind over Mascot.” The article talked about mindfulness in sports and mentioned the Lucid mental training app (Lucid Performance Inc; Mill Valley, CA) with Graham Betchart as the mental skills coach. I wanted to improve my golf game, and after being introduced to the concept of mindfulness at my recent session, I decided to get the app.

To me, mindfulness is about being in the present moment, not thinking of the past or the future but of what is happening now. It is letting go of things you can’t control. It is a state of nonjudging or accepting the current situation as it is. It’s also as George Mumford,2 author of The Mindful Athlete, calls it—a space between stimulus and response.

The key is to try to be mindful throughout the day. If one meditates regularly, it can become second nature. I discovered, however, that I could benefit almost immediately. First, I learned from the Lucid mental training app to use my breath to get into the present moment. It took only 5 to 15 minutes a day, but I was able to develop the skill of focusing on my breath and not attaching to other thoughts, thus letting them go. Then, I decided to try mindfulness at other times of the day, such as while walking the dogs in the park. I focused only on my breath, and when any other thoughts came into my mind, I observed them rather than attaching to them. What I noticed was how much more observant I was. I noticed the planes flying overhead, the different birds and their calls in the trees, and the train horn blowing in the distance—things that were always there, but because I was preoccupied with other thoughts, I had never noticed. This is a form of what Jon Kabat-Zinn, PhD,3 in his book Full Catastrophe Living, calls a “walking meditation.” I then decided to take it to the golf course. As part of my preshot routine, I would take a few breaths and focus on the things that I could control and not on the things that I couldn’t—like the water to the left, the people nearby watching, or the last hole—and it helped. It didn’t improve my physical skills, but I was much more frequently able to play to the best of my ability, and it certainly improved my enjoyment of the game.

I then wondered if it would work in the clinic. So, just before entering the examination room, I would take a few breaths to get into the present moment, not thinking of the patient before or the one next but the one I was about to see. If I was running behind, I wouldn’t worry about it because there was nothing I could do about it. I found that the visits ended up being more satisfying for me and my patient. I was more observant of my patient’s words and body language and listened better. More than anything, patients want a doctor who listens, and a mindful doctor does that. It’s not easy to see a schedule of 20 or more patients one after the other, but if you are fully present with each visit, it becomes 20 individual human connections, which is the essence of medicine and what makes it so satisfying.

Our breath is always with us, and we can use it to get into the present moment and to focus. As physicians we are constantly being interrupted. It all starts in residency when (in my days) you were handed a pager (now, a cell phone). At first, the pager is a symbol that you have arrived, but you soon realize that it is also a lot harder to focus on what you were in the middle of doing when you got paged. In such a situation, you could use your breath in 2 ways. You could use it to create that space between stimulus and response so you could calmly and intelligently answer the page, and then you could use your breath to refocus, get in the present moment, and resume what you were doing.

Being a physician is a stressful occupation. When we make mistakes—and we will all make them—the consequences sometimes can be devastating for our patients and for ourselves. One of the things taught in the Lucid app for athletes is that we are human beings choosing to play a sport. In our case, we are human beings choosing to make another human being better. We must remember that we are not the white coats that we wear or the successes or failures that happen while wearing the coat, but the person inside who has inherent value for choosing this profession.

Being a mindful physician has other benefits. It helps bring calm to the chaos. After working for 25 years, I can count on 1 hand how many times a patient has yelled at me. But, as we all know, it happens. Recently a young lady came in for her first visit with me after transitioning from pediatrics to adult medicine. She was accompanied by her father. We sat down, and she began telling me about her headaches. Her father suggested that we try some narcotics because he gave her 1 from a family member’s prescription and it helped. As I began to explain that perhaps we should try other things first, he stood up, came closer, and with a raised voice said that I cared more about my license than his daughter. I felt my heart rate increase and the urge to respond. So, I took a few breaths and noticed my heart rate slow as I listened to his words, saw his daughter crying, and thought of my reply. I let him finish and then calmly and gently said that I cared for his daughter, and that was the reason I didn’t think narcotics were a good idea at this time.

We are in the midst of a change in the management approach to chronic pain. I understand why this father was requesting narcotics because that was what he was accustomed to. We need different ways to look at pain, and mindfulness is one.

Roughly 30 years ago, Kabat-Zinn developed the MBSR (mindfulness-based stress reduction) program at the University of Massachusetts Medical Center. Still offered at the university medical school, this 8-week program is not just for stress reduction. Patients are referred to the program for management of stress but also for chronic pain or depression, often after standard medical treatment fails to help them. The program has been shown to significantly reduce anxiety and depression scores for the participants at completion of the program and up to 3 years later. Many other medical centers have modeled clinics after this groundbreaking program, including KP.

I recently saw a patient whom I believe had trigeminal neuralgia. He meditated daily, and as he was giving me his history, he would periodically close his eyes and take deep breaths. He was using his breath to handle the lancinating pain he was having. He was more interested in the cause of the pain than getting a pill to make it go away. Mindfulness can benefit patients if they are willing to try to look at pain, stress, and depression in a nonjudging way, rather than the primary focus being to take medicine to make their symptoms go away.

19.024I used to wake up on Monday morning with the typical blues, thinking of what happened the few days before and what I was planning on doing for the coming weekend. Now, I wake up and look forward to that day and that moment, knowing that the current moment is the most important one and the only one that I can control and that I have the power to make that moment as good as it can be. So, mindfulness can help make every patient encounter, every day, and every moment as good as it can be. If mindfulness can help bring back the joy in medicine and life to a former skeptic and still novice mindful physician, perhaps it can do the same for you and your patients (see references and Sidebar: Suggested Reading for a few resources).

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Acknowledgments

Kathleen Louden, ELS, of Louden Health Communications performed a primary copy edit.

How to Cite this Article

Chun M. The mindful doctor. Perm J 2019;23:19.024. DOI: https://doi.org/10.7812/TPP/19.024

Author Affiliations

1 Roseville Medical Center, CA

Corresponding Author

Michael Chun, MD (michael.chun@kp.org)

References
1. Mind over mascot. New York, NY: Sports Illustrated; 2016 Oct 17. p 23.
 2. Mumford G. The mindful athlete: Secrets to pure performance. Berkeley, CA: Parallax Press; 2016.
 3. Kabat-Zinn J. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Rev ed. New York, NY: Bantam Books; 2013.

Keywords: joy in medicine, meditation, mindfulness, mindfulness-based stress reduction, physician wellness

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