The Mindful physiciaNtm

Mindfulness in Medicine

The Mindful Rx

A Real Heart to Heart

A Mindfulness Exercise for Physicians

In general, there are three ways human beings relate to one another -- friend, foe, and indifferent.  Einstein’s insight led him to conclude that feelings of separateness are an “optical delusion of the mind.”  Wisdom traditions from across time and the world speak of our connectedness.  And deep within, during times of vulnerability and also times of compassion, we all sense our inherent oneness.

It is perhaps out of this deep insight that people are drawn to medicine -- to be of service, to heal, and to alleviate suffering.  Indeed, around 2,400 years ago the great ancient Greek physician, Hippocrates of Cos (Hippocrates) advanced many wise principles for treating other people, including the oft quoted “do no harm.”  Interestingly, it was around the same time that Siddhārtha Gautama (Buddha) developed a psychology of the mind that rested in the prescription for living of cultivating presence and alleviating suffering.  This approach to living is commonly referred to as mindfulness.  It is an approach shared by spiritual, religious, and contemplative traditions the world over.

While helping to heal another and alleviating suffering is a noble and beautiful act, mindfulness practices ask us to explore the intention running alongside the act, to examine the state of mind out of which it arises, and the sensations running through the body as we dispense medical treatment.

It is all too often these days that people become fearful of one another and defensive. As this happens, the line between friend and foe is repeatedly crisscrossed. You may be able to sense this in your personal relationships, your professional relationships, and even the occasional traffic incident.  In his influential book, “Love is Letting Go of Fear,” Gerald Jampolsky, M.D., writes of the power of compassion and love to dissolve fear.

In medicine, and in particular in the doctor patient relationship, the line that is often blurred is that between friendliness and indifference.  The reasons for this have been written about  at length and long appreciated by physicians who note a subtle numbing of the heart and a dilution of empathy -- all in the service of offering their patients the very best of care.  This separateness, sometimes subtle (always more subtle to the physician than the patient), it is argued, helps the physician remain objective and not flooded with the pain and suffering experienced by his or her patient -- which, when multiplied by the many patients a physician cares for at the same time, could be overwhelming.

Mindfulness offers physicians the gift of embracing the heart of the patient’s experience. Through the simple practices of attending to the breath, thoughts, and the body, one learns to be there for life as it unfolds -- within and without -- and to bear the unpleasant along with the pleasant.  One learns that what is assumed at a deep level to be overwhelming or unbearable is not only bearable, but the prescription for the highest form of care, and of healing, both for the patient and the doctor.

But in a profession so heavily grounded in the intellect, and in a culture that does little to expose us to a deep mind-body connection, this prescription is akin to the medicine prescribed by the physician and disregarded by the patient.  Adherence is most challenging.

A Mindfulness Exercise.  This simple exercise is one that powerfully shifts awareness from the intellectual, habitual, and strongly conditioned mind that so many physicians experience, as if on auto-pilot, to one that moves into the body and embraces and arouses the natural and deeply felt connective fiber between doctor and patient.

A Real Heart to Heart

Most physicians will examine their patient with a stethoscope.  Even if already done by a colleague or assistant, a patient will rarely object to it being done again.  After all, it is a beautiful symbol of connection and care.

Indeed, the patient’s body -- heart, breath, gut -- is transmitted to the caring and learned ears of the physician who is gently touching the patient’s body -- listening for sounds and signs. 

The below exercise helps to wake us up in the midst of this touching and important part of the doctor patient relationship.  It reminds us of the deepest of connections we share with our patients -- human beings living together.  It also reminds us of the impermanent and always changing nature.  The heartbeat.  The thin line between life and death.

The next time you are about to take your patients pulse, first take your own.  

The instruction is simple.  Remembering it may be challenging (but soon enough it becomes second nature).  Doing it may create a sense of self-consciousness (all the more reason to do it as that sensation may reside at the heart of what creates separation).

1. 1. Stop and take a breath.
   

2. 2. Place the stethoscope atop your clothes and listen for the beat of your heart (or at your wrist or another place you can easily hear your heart beat.
   

3. 3.While this can be done surreptitiously, or before you enter your patient’s room, don’t be shy -- after all, you’re the doctor.  You may want to look over at your possibly bemused patient and say something like -- “we’re all in this together.”  Or “sometimes its easy to forget that mine is beating along with yours in this precious moment.”
   

4. 4.Breath again and bring awareness to your aliveness, to your vulnerability. 
   

5. 5.Notice the sensations arising in your body.
   

6. 6.Proceed to listen to your patient’s heartbeat.
   

7. 7.Breath and bring awareness to your patient’s aliveness, to their vulnerability. 
   

8. 8.Notice the sensations arising in your body.
   

There are many variations you can introduce to this practice.  At its core, it helps us remember our shared connection to our patient. 

It helps us remember who we are. 

Wishing you well.

Scott Rogers