Mending and Deepening the Encounter Between Doctor and Patient Through Mindfulness

We are updating this blogpost to call attention to an amazing event that has come together primarily as a result of the original posting back in September. After sharing this article with our colleagues around the world, and across the Southern California region, we received an outpouring of interest. We have since invited Dr. Krasner to come to San Diego on May 11, 2013 to present a daylong workshop on mindful practice entitled “Mindfulness in Clinical Practice: Our Patients, Ourselves.” This event will include an hour-long presentation on the Neuroscience of Mindfulness by Tom Chippendale, MD, Director of Neuroscience at Scripps Health and longtime MBSR teacher.

stressed-docs-1.25.12As the skirmishes and battles on healthcare rage loudly on in the political and financial arenas of our society, there is a darker, more troubling process unfolding “on the ground” in the day-to-day practice of medicine and healing in general. Within the crucible of the doctor-patient encounter, where human suffering is intended to meet compassionate and effective healing, something isn’t working. Patients aren’t satisfied with the quality of care they receive and doctors are experiencing declining job satisfaction, burnout, “compassion fatigue” and are feeling increasingly alienated from the profession that once inspired passion and dedication. Physician and physician-in-training suicide is a rising and troubling outgrowth of this underlying malaise in the system.

Dr. Mick Krasner, Associate Professor Clinical Medicine at the University of Rochester School of Medicine & Dentistry, and his colleagues, have done groundbreaking research on the potential to address this growing phenomenon. In the Journal of the American Medical Association, they shared the results of a 2012 study of the impact of an extensive course in mindfulness, communication and self-awareness on 70 community physicians. The results are striking in demonstrating the positive effect of this program on physician well-being and satisfaction, including improvements in scores on measures of burnout, mood disturbance, emotional stability and depersonalization.

Mick Krasner, MD

Krasner and his colleagues have now taken their results to the examining room, so to speak, and drawn on them to develop a powerful training program in what they call Mindful Practice. More than just a gathering of health professionals interested in exploring what it would mean to bring mindfulness into their lives both personally and professionally, Krasner notes that “What has become clear is the imperative for what Saki Santorelli calls a ‘Collegial Sangha’ and that is what has been the outcome of our trainings. …this need for community and its absence in many of our health professionals’ work lives is a real force in the loss of meaning in our profession, reduced adaptive capacity and resilience to withstand the changing nature of our work, and the growing trend toward burnout.”

“…isn’t a boundary also a place of meeting and coming together?”

This effort to powerfully change the nature of the healing encounter through the mindful practice of the clinician arises out of exploring what has traditionally been referred to as the “boundary” between patient and doctor. Saki Santorelli, the Executive Director of the Center for Mindfulness at the University of Massachusetts Medical School, writes eloquently in his book Heal Thy Self of the pitfalls and opportunities of boundary-making. He says, “The usual meaning of boundary is “dividing line” – a separation between two things. But isn’t a boundary also a place of meeting and coming together?” He goes on to write “These intertwining movements are similar for us as patients and practitioners. Yet all too often the hard, impenetrable borders of this relationship are carved out of a process of identification that divides self and not-self into mutually exclusive entities. Unconsciously, this process winds up shaping the entire interaction. I am not suggesting that these roles are the same. They are not. But they are just that – roles. And behind these roles lies a much larger field, our shared humanness.”

Ron Epstein, MD

Ron Epstein, MD

Two 4-day retreat-style courses have been developed by Krasner and Ron Epstein, Professor of Family Medicine, Psychiatry, Oncology and Nursing at the University of Rochester, and are offered through University of Rochester Medical Center’s Center for Experiential Learning. The first was entitled Promoting Mindful Practice in Medical Education and Practice and was offered on October 31-November 3, 2012. The second course is Mindful Practice: Focus on Serious and Life-Limiting Illness on May 1-4, 2013. Both programs are offered at the beautiful Chapin Mill Retreat Center in Batavia, New York.

________

Krasner M. S., Epstein R. M., Beckman H., Suchman A. L., Chapman B., Mooney C. J., Quill T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 302, 1284–1293. doi: 10.1001/jama.2009.1384.

Beckman HB, Wendland M, Mooney C, Krasner MS, Quill TE, Suchman AL, Epstein RM.. The impact of a program on mindful communication on primary care physicians Academic Medicine 2012; 87(6): 815-819

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4 responses to “Mending and Deepening the Encounter Between Doctor and Patient Through Mindfulness

  1. I greatly appreciate this effort to explore the boundary between patient and doctor as well as between self and no self. I have been through MBSR and belong to a Sangha based on mindfullness. I have reached out to other physicians who have been through MBSR and attempted to create a physician sangha but so far it has not resonated enough with my colleagues to be continued. I will follow John Kabat-Zinn’s advice. If you want to convince others of the benefits of meditation don’t, just meditate. Namaste

  2. I’m so pleased to hear that mindfulness is being offered to physicians. I love Saki Santorelli’s book Heal Thy Self. I work in the voluntary sector and so many of my colleagues have been attending mindfulness training in the last few years. I have benefited from doing MBSR course and continue to practice. I feel I am more present in sessions with clients and don’t feel so exhausted at the end of the day.

  3. My reflections on this topic go in two directions. I am fully supportive of the development or enhancement of mindfulness among physicians, as well of practices supporting compassionate encounters — real human beings more similar than different meeting each other in their respective roles in any given encounter (and with the hope of positive, helpful outcomes). So I am fully supportive of the processes helping professionals personally engage in that support these practices, and that support themselves in their work (both in the quality of their encounters with others and in their feelings of well-being and satisfaction). I see the physicians’ efforts as like a grass-roots approach, working at the level of the individual professional (or community of individual professionals). It’s valid and important.

    I also believe these issues both do and need to go right back to the political and the financial battles related to healthcare, to that larger arena that looks at the healthcare organizational culture, structure, and expectations within. For the well-being of all, it is imperative that the organizational culture and structure also inherently and overtly support mindfulness and high quality healing encounters. When the organizational structure expects healthcare professionals to see or care for a factory line style number of patients in a day or when patients are expected to talk about their health difficulty and ask the questions they have within as short as a 5 minute appointment — patient and helper satisfaction IS going to be compromised as well as the well-being of both. Although mindfulness can still be practiced under these conditions, I believe a top-down approach to improving the patient-doctor relationship is also ultimately required — where the organizations themselves make changes, not just the physicians.

  4. Pingback: From knowledge to intuition | Vital Paradigms

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