Recent news stories have catapulted the value of providing “mindfulness” and the health community is paying attention. Clinically introduced by Dr. John Kabat-Zinn in 1979, Mindfulness Based Stress Reduction (MBSR) brings together mindfulness meditation, body scanning and simple yoga postures over an eight-week training program. Participants are taught that they can decrease their response to stress through “moment-to-moment, non-judgmental awareness.” Compelling research studies published in 2015 show MBSR is effective for veterans with PTSD, relief of depression and anxiety among patients with cancer, a better quality of life for individuals living with inflammatory bowel disease, treatment of insomnia, alleviation of depression in the elderly living in nursing homes, and decreasing chronic low back pain.
At some point it became relevant to question whether there could also be a benefit for people providing medical care. Research is demonstrating that mindfulness is an important technique to address burnout in the medical community. Maslach defines burnout by “the three dimensions of exhaustion, cynicism, and inefficacy.” The Maslach Burnout Inventory (MBI) measures these elements and a recent study from The Mayo Clinic based on the MBI found that 54.4 percent of physicians expressed at least one symptom of burnout during the previous year (compared to 45.5 percent in 2011). The consequences of burnout are broad, and can include the inability return to work feeling refreshed after a break, cynical attitude towards patients or peers, difficulties in family life, doubting of career choice, or questioning clinical competency.
Drummond proposes several avenues of physician burnout including the nuances of clinical and non-clinical practice management, growing a balanced life outside of medicine, and residual traits that were reinforced and remain from our early training. If left unobserved, these behaviors become engrained as the: “Workaholic, Superhero, Perfectionist, and Lone Ranger.” Living and practicing medicine within these paradigms can lead to significant distress and dissatisfaction. When burnout becomes prominent, clinicians will quit a particular practice or even stop the practice of medicine altogether. Alcohol or drug abuse can manifest and in the most unfortunate of situations, individuals commit suicide. Patients cared for by physicians experiencing burnout are likely to experience decreased attention to detail that leads to diminished care.
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In 2015, research on mindfulness-based interventions in various formats has demonstrated reductions in depression, anxiety, and an improved sense of well-being for mental health providers, residents in training, andphysicians in private practice. These studies demonstrate that independent of the atmosphere or stage of training, mindfulness can have a profound, positive impact for health care providers. Dr. Elizabeth Blackburn, Dr. Elissa Epel, and Dr. Ritchie Davidson have also demonstrated that in addition to changing emotional states, mindfulness meditation can actually promote telomere maintenance or influence epigenetics mechanisms.
How can mindfulness be applied in clinical practice to reduce burnout and provide more satisfaction? It is important to first dispel the myth that stopping your practice and seeking a not-so-cozy nook in the Himalayas is the first step. Somehow, the common vision of today requires either a retreat or an extended time away from our daily lives to achieve the desired effects. As a person who took time away from medical practice to pursue the study of yoga, meditation, and Ayurveda and trek through the Himalayas, I can relay that I did not find the enlightenment I was hoping for or even expecting. Amidst my travels to Nepal and India, I was inundated with many layers of sensory overload. With the high elevation and pollution, breathing was more difficult than it was at home in Arizona and left me with bronchitis and an arduous trip home. Needless to say, the journey wasn’t the mystical awakening I was looking for. I found the need to approach mindfulness and meditation much more practically.
Paying attention to my breathing patterns while working was one of the first steps I implemented. Instead of retreating to find peace, I learned that a slow inhale and exhale in the midst of a busy day could invite contentment to be present. Using this technique while patients are talking has helped me to become more empathetic in my communication as well. Cultivating awareness of my thoughts without judgment, and watching the active “monkey mind” has helped to create relaxation even during a demanding clinic day.
Finding a great teacher is an important consideration. The following techniques may help shift your experience of patient concerns, personal stresses, and practice expectations:
Use the “two feet one breath” technique. Just before entering an exam room, stand in front of the door and concentrate on a deep breath and the feeling of your feet on the ground.
– Incorporate the mindfulness steps of pause, presence, proceed.
– Take a moment to keep track of nine breaths in sequence by striking one computer key at each breath and a different key on the ninth breath in each sequence.
– Take an online MBSR class or find a local MBSR class.
– Journal and observe how you feel when you might be embodying the Workaholic, Superhero, Perfectionist, or Lone Ranger.
– If you find that caffeine increases anxious feelings, switch from coffee to an invigorating chai tea.
– Create time to nourish yourself while working and eat meals at a dining table (and remember a desk is not a table)
While there are many aspects of our day that are beyond our control, we can influence how we respond or react to these cues. Applying these concepts can broaden our experience of qualitative peace and enjoyment of our day-to-day encounters.
Siri Chand Khalsa, MD, is a physician at One Medical Group. She believes that health is linked directly to diet and that making healthy food choices is the best preventive measure for short- and long-term medical issues. Siri Chand has extensive experience with a variety of alternative modalities including Ayurveda, Kundalini Yoga, Reiki, and naturopathic medicine, and offers patients the opportunity to integrate these into their primary care experience and daily routines. She is an avid cook and stays healthy by making nutritious vegetarian meals and snacks and practicing yoga. Siri Chand attended Eastern Virginia Medical School and completed her residency in Internal Medicine at the Mayo Clinic in Jacksonville, Florida. She is board certified in Internal Medicine and Hospice and Palliative Medicine through the American Board of Internal Medicine.