Does this ancient tradition have a role in 21st century health care?

December 23, 2019 Jane Coutts

Mindfulness in western medicine

It’s a paradox that a practice intended to calm the mind and focus thought is intimidating and elusive for so many, but that’s the case with mindfulness. 

Letting go of the thoughts and worries that crowd our brains in order to “be in the moment,” and focus on what is happening in the right now has been shown to be beneficial for doctors and patients alike. It enhances communication and removes the mental clutter that gets in the way of both empathy and open-minded diagnosis.

But it requires relinquishing the multi-tasking, high-speed thinking that helps propel many physicians through their training and demanding days on the job, in favour of — not thinking at all? Well, not quite. But it does require a different relationship with the thoughts you have.

Mindfulness, a concept that originated in Zen Buddhism some 500 years BCE, was brought into Western medicine in the 1970s by Jon Kabat-Zinn, who holds a PhD in molecular biology from the Massachusetts Institute of Technology. A student of Zen Buddhist meditation, he took its concepts and integrated them with science to develop mindfulness-based stress reduction, and eventually founded the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.

Kabat-Zinn defines mindfulness as “awareness that arises through paying attention, on purpose, in the present moment, non-judgementally.”

A slightly more detailed definition is offered by David Schoeder and colleagues in an article on a randomized controlled trial of mindfulness in the American Journal of Lifestyle Medicine. They call it “…a form of mental training that enhances one’s ability to nonjudgmentally attend to the present moment, mindfulness is often translated as ‘to see with discernment.’”

If your reaction is still “Wait—what?” you’re not alone. Let’s get concrete. A 2013 study of mindfulness and quality in health care defined mindfulness as “attentiveness, curiosity, presence, and the ability to adopt multiple perspectives simultaneously—all qualities that promote greater awareness of self and others.” By freeing doctors’ minds of mental clutter, biases and other ingrained habits of thinking, the authors say, “Mindfulness may free clinicians’ attention so that they are better able to attend to others’ experience, less likely to distance themselves from distressing situations, and more likely to consider a variety of explanations in complex situations.”

Mindfulness was first introduced to mainstream medical practice in the 1970s as a stress-reduction technique for patients — especially people suffering from cancer, depression and chronic pain and other conditions where mental and emotional distress is an ongoing factor. There is considerable high-quality evidence that shows mindfulness training reduces the anxiety, insomnia and stress that affect patients with a wide variety of health conditions.

It took time for the idea that mindfulness training could also help physicians to gain acceptance, and there are not nearly as many studies of its impact on doctors and trainees as there are on patients. Many have relatively small sample sizes, or self-selecting participants; that said, most find clear benefits.

One Australian study from 2017 randomized 44 emergency department interns into either a control group, which got one hour extra break time per week, or a 10-week mindfulness training program. Those in mindfulness training showed significant reduction in stress and burnout, those in the control group did not.

Another study of surgery interns, published in JAMA in 2018, wanted to know how feasible it would be to add mindfulness to their training. Attendance remained high throughout the 18-month program, participants rated the experience highly and were still practising what they had learned a year after the program ended.

Fear that busy physicians won’t take up mindfulness because they don’t have the time (the original — and still widely used — mindfulness-based stress reduction programs start with a weekend immersion, followed by weekly 2.5 hour sessions for eight weeks, plus 45 minutes of meditation a day) has led to experiments with shorter training. A 2016 study of primary care doctors in Oregon offered a weekend mindfulness immersion and two follow-up sessions. Three months after completing the course, participants reported enhanced mindfulness, and less stress, emotional exhaustion and depersonalization compared to the control group — and most achieved those results with less than 10 minutes of meditation a day.

              In a commentary published in 2018 in the Journal of Patient Experience, Leonard Calabrese of the Cleveland Clinic gives several reasons mindfulness should be added to the medical school curriculum. The first is that care will improve: “The rewards of a calmer physician, capable of focusing on the moment’s work, are transparently beneficial for critical decision making,” he says, adding “Studies have demonstrated that mindfulness/meditation can affect several aspects of quality, including patient-centred communications and patient satisfaction.” It also enhances physicians’ capacity for empathy and compassion, Calabrese notes.

Other benefits to physicians include easing emotional exhaustion, job dissatisfaction and burnout. “Mindfulness/meditation is a ‘no brainer’ (no pun intended) in that no matter why you do it (to relax, to unwind, find joy, make money or bring love and compassion to the world) you win.”

A state of mindfulness — a calm mind, where the hundred thoughts clamouring for attention become no more than clouds floating across a clear blue sky, just gently acknowledged before they drift away — probably seems as remote from the day-to-day reality of a busy medical practice as a mountainside Zen garden does from downtown Manhattan. Achieving it takes discipline, time, effort and focus at the very moments those hundred thoughts are most distracting. But the action required is simple and the rewards great.

If it seems it might be time to give mindfulness a try, read my next post which goes live next week: 6 techniques to calm a busy brain: mindfulness in a crowded life.

 

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Jane Coutts is an Ottawa-based writer and editor who specializes in healthcare issues. She worked as a journalist for 15 years, mainly at The Globe and Mail, where she was the health policy reporter for five years. Since she founded Coutts Communicates in 2002, Jane’s work has focused on making healthcare policy and research more readable and relevant. Jane also leads workshops plain-language writing.

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