Mindfulness in Medicine

met him for an 18-month Well-Child visit. Little did I know this visit would end a year later in a dark hospital room, sitting quietly with his mom, facing his death. This is when I first realized how ill-equipped I was to deal with grief.

Medical school meant two years of science immersion and two years of clinical clerkships. Residency followed, where we learned how apt the term “resident” was. While these experiences provided knowledge, skills, and expertise to make effective and accurate clinical decisions, a startling gap lurked—I was never taught how to process loss, uncertainty, mistakes, and bad outcomes.

Medical training afforded me the ability to “do things,” but not the ability to be “present” with that which I was doing. This included the effects my “doing” was having on me and my patients. Positive outcomes swept past me like the tail end of a shooting star, ephemeral at best, a neutral event at worst. Negative outcomes hit me like a tsunami, drenching me to the bone with no towel in site. As the wise Dr. Rachel Naomi Remen writes in Kitchen Table Wisdom, “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”

Being too consumed to notice moments that went well and stuck ruminating on those that went wrong, I often ran on autopilot from room-to-room and disconnected from the whole enterprise.

What Epstein and his colleague, Dr. Michael Krasner, realized, was that health care professionals could reduce burnout and enhance flourishing by:

1. Cultivating a consistent mindfulness practice.

2. Connecting health care professionals through storytelling and shared narratives.

3. Building skills in appreciative interviewing: Asking questions of ourselves, our colleagues, and our teams in such a way that mines for what is good and strengthens the capacity for growth.

In sum, health care professionals need to master new qualities and skills.

All over the world, mindfulness practices have been developed to help individuals establish the capacity in the mind to see the truth of how things are. The question then becomes how does mindfulness translate for medical professionals? What does it mean to be a healer, attending to our patients, moment-to-moment, with our full attention, on purpose, and non-judgmentally? Can we establish a capacity to see the true nature of things, when facing illness and death? The four qualities can help guide our treatment, decisions, and approaches as health care professionals.

1. Attentive observation

The human mind is a judgement machine, evolved to make complex, well-considered decisions. How we perceive and conceptualize what we observe around us (and within us) defines our reality. Attentive observation allows us to slow down, attend to our physiological responses, minimize biases, and bring awareness to the realities co-occurring in front of us.

Example: A patient’s collection of signs and symptoms leads to a mental construction that drives our medical decisions.
What can we do? Recognize our judging mind and intentionally suspend judgement. Instead, invite and entertain other possibilities to enhance decision-making and promote skillful action.

2. Curiosity

Curiosity is how we learn about the world. It is our desire to understand the who, what, where, when, and why of patients.

Example: Even the 20th pediatric patient with bronchiolitis in the winter allows for discovery and the possibility of something new and surprising.
What can we do? Learn more about yourself, your peers, your practice, and your patients. Not only does curiosity play an instrumental role in accurate medical decision making, but it also enriches the experience and is a portal to deeper human connection.

3. Beginner’s mind

The Sōtō Zen monk, Shunryu Suzuki, famously said, “In the beginner's mind there are many possibilities, but in the expert's mind there are few.”

Example: Though pattern recognition and other heuristics allow seasoned clinicians to function efficiently and effectively in a complex environment, health care professionals risk flawed decision-making at the hands of cognitive biases that often come with experience.
What can we do? Approach situations with an open mind that acknowledges complexity and entertains alternative explanations. This can short-circuit biases that lead to miscommunication, misdiagnosis, and medical error.

4. Presence

Psychologist and medical anthropologist, Dr. Arthur Kleinman, describes presence as “a calling forward or a stepping toward the other… built out of listening intensely, indicating that the person and their story matter…”

Example: With patients, the more presence you invite into the room, the more depth, meaning, and shared understanding that arises. This undoubtedly enhances the care we deliver and how much we care about that caring.
What can we do? Take time to listen deeply and care about the information you are receiving.

Personal change as a path to cultural change

As a medical student, it was standard operating procedure to work 12-14 hours per day, with a 30-hour call shift every three days. On one occasion, after being up for over 24 hours, I nodded off at a stop light on my way home from work. I was awakened by the jarring thump of my car hitting the car in front of me. This is just one example of the fallout of the culture of medicine. Is it time to recreate the culture of medicine?

Through honest appraisal, self-reflection, clear-eyed wisdom, and compassion towards ourselves and others, can we create new, healthy habits of mind and organizational cultures of well-being that serve us both personally and collectively? Based on conversations taking place across our organization, I believe we can. Ultimately, I believe we will. Medical professionals will always face harsh realities, grief, stress, and less-than-optimal solutions. A clear-eyed response to these realities must begin in the minds of individuals, whose actions are our “only true belongings… and the ground upon which [we] stand.”