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Teaching Doctors to Be Mindful

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    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
    Message 1 of 1 , Oct 28, 2011
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      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
      clinical practice.

      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
      teach others.

      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
      generate revenue.

      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."

      This article is being shared for educational and
      non-commercial purposes only and thus is usable under
      the Fair Use Statutes.
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