Teaching Doctors to Be Mindful
- October 27, 2011, 12:01 am
Teaching Doctors to Be Mindful
By PAULINE W. CHEN, M.D.
Brett Carlsen for The New York TimesDoctors from
across the world gather at the Chapin Mill Retreat
Center in Batavia, N.Y., to bring intention, attention
and reflection to clinical practice.
It was 6:40 in the morning and nearly all of the
doctors attending the medical conference had
assembled for the first session of the day. But
there were no tables and chairs in sight, no lectern,
no run-throughs of PowerPoint presentations. All I
could make out in the early morning darkness were
the unmoving forms of my colleagues, cross-legged
on cushions and raised platforms, eyes closed and
hands resting with palms upward in their laps.
They were learning to meditate as part of a mindful
communication training conference, held last week
at the Chapin Mill Retreat Center in western New York,
and sponsored by the University of Rochester Medical Center.
There has been a growing awareness among doctors
that being mindful, or fully present and attentive
to the moment, not only improves the way they engage
with patients but also mitigates the stresses of
Mounting paperwork demands and other time and
productivity pressures can lead to physician burnout,
which affects as many as one in three doctors,
recent studies have shown. The loss of enthusiasm
and engagement that results can lead to increased
errors, decreased empathy and compassion toward
patients and poor professionalism. Other problems
include physician substance abuse, abandonment of
clinical practice and even suicide.
Despite the pervasiveness of burnout, few interventions
have been shown to be effective. But two years ago,
University of Rochester researchers studied the effects
of a yearlong course for practicing primary care
physicians in mindful communication. Their findings,
published in The Journal of the American Medical
Association, showed that doctors who took part in
the course became more present, attentive and focused
on the moment and less emotionally exhausted over
time. Moreover, the doctors' ability to empathize
with patients and understand how patients' family
and work life or social situation could influence
their illness increased and persisted even after
the course had ended.
"Mindful communication is one way for practitioners
to feel more `in the game' and to find meaning in
their practice," said Dr. Michael S. Krasner, an
associate professor of clinical medicine at Rochester
and one of the study authors. He, along with his
co-author Dr. Ronald Epstein, a professor of family
medicine, psychiatry and oncology at Rochester,
developed the course in mindfulness.
But it takes training, and that training can
be particularly challenging for physicians who
are used to denying their personal responses to
difficult situations. In addition to learning to
meditate, doctors participate in group discussions
and writing and listening exercises on topics like
medical errors, managing conflict, setting boundaries
and self-care. Small group discussions are meant to
increase awareness of how one's emotions or physical
sensations influence behaviors and decisions.
In one exercise, for example, doctors are asked
to write about a mistake in their professional or
personal life. Examples of such errors have included
missing a diagnosis, prescribing the wrong medication,
making assumptions about a patient that led to
inadequate care or failing to be present for their
own families because of an inability to balance work
and family life. The doctors must then discuss the
issue with two peers, describing not only the event
but also any associated physical and emotional sensations.
One of the other doctors has the task of practicing
appreciative inquiry, or listening without making
judgments or jumping to conclusions. And the other
serves as an observer, offering suggestions at the
end of the session for how the listener might improve
his or her skills.
Many of the participants at last week's conference,
capped by the organizers at 40 and coming from the
United States and Canada and from as far away as
New Zealand, described the four-day experience as "transformative." "I can honestly say that these
have been some of the most important days of my life,"
said Dr. Elissa Rubin, a pediatrician and lactation
consultant who traveled to the conference from
Mineola, N.Y., on Long Island.
But the real challenge for these participants and
the growing number of advocates of such training
is not acquiring mindfulness. It is finding the time
and support necessary to sustain their skills and
Once back in their work environments, many say it
is easy to fall back into old patterns. Dr. Krasner
and Dr. Epstein have had to close down some of their
programs directed at interns and residents because
of financial issues. And a frequent topic of
conversation among several of last week's participants
who hoped to teach at their own institutions were
how to best introduce these ideas to colleagues who
might be skeptical or administrators who might be
hesitant to set aside valuable clinical time for
training courses or pay for a program that does not
Nonetheless, Dr. Krasner and Dr. Epstein remain
optimistic, in large part because they believe that
mindful communication is not just another optional
skill or fringe fad in health care. "Mindfulness,"
Dr. Epstein said, "and the self-awareness it cultivates,
is a fundamental ingredient of excellent care."
Their patients would agree. In clinic, a patient who has suffered for years from chronic pain told me why he remained Dr. Epstein's patient. "He's the best doctor I've ever had because he can get to what I am trying to say quicker than any other doctor.
"I'm not sure how he does it, but he just really gets it."
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