A couple of months ago I scheduled a routine medical checkup with my primary physician. While never a chatty or warm-hearted person, this time my doctor of nearly fifteen years barely looked at me as she sat typing and staring at the computer screen near the windowless wall of the room. After a scant ten minutes of questions and answers, she glanced up, sort of nodded in my direction, and left the room. I doubt I need to tell anyone that this happens daily in doctor’s offices all over our country. Fortunately, my routine visit presented no life-threatening issues. But what if it had? Is it possible that something like mindfulness could benefit both those of us who visit doctors and the doctors themselves? Research now says yes.
It makes sense to me that the practice of mindfulness can benefit just about everyone. But until I was offered a book to review by Dr. Ronald Epstein titled, Attending—Medicine, Mindfulness and Humanity the connection never crossed my mind. And let me assure you, I seldom read, let alone review, books that sound like they are geared toward doctors or western medicine. But something about the title and the blurb that accompanied the request made it sound provocative. And even when not facing an impending health issue, who among us isn’t at least vaguely concerned about the health care system in general? Not only did this book offer a friendly and thought-provoking look into the mind and responsibility of many doctors, it heightens the growing evidence of why mindfulness, in general, can benefit all individuals.
The State Of Doctors Today
I doubt there is a person alive who hopes that any doctor they see isn’t both extremely competent as well as deeply compassionate. Yet how often is that the case? Even when the doctor is a kind and caring person, the system itself appears to train away the personal connection in the name of efficiency and economics. We feel it acutely as patients but according to Dr. Epstein, so do doctors. As Epstein says, even the most compassionate doctors are being pressured to see more patients, do more paperwork, and juggle more responsibilities every single day. Not only are those requirements exhausting, but they are also socially isolating.
Where does all that exhaustion and isolation, not to mention the lack of control they feel in the “bloodless language of healthy economists,” lead? According to Dr. Epstein, in 2014 physicians reporting burnout rose to 54%. And why is that such a big problem? Epstein says, “Burned-out physicians are more likely to take shortcuts, make diagnostic errors, and prescribe recklessly. They order too many tests and refer more, just because it takes too much effort to think through problems themselves.” Just like anyone in the general population suffering from burnout, doctors who suffer burnout stop communicating well, are more likely to abuse drugs and alcohol, and often slip into less ethical behaviors like shady business practices or violating confidentiality. Even worse, a study in 1996 reported that doctors are more likely to commit suicide than the general population and among other academic occupational groups. And remember, this is over 50% of the doctors practicing today. (1)
And like anyone suffering from the distress of burnout, physicians often want out. Many of them retire early or stop practicing altogether. With fewer and fewer students entering the medicine field as it is, it is easy to see that we will soon be facing a physician shortage in the years to come.
Epstein refers to a psychologist named Dr. Christina Maslach who describes physician burnout as “an erosion of the soul.” Epstein explains that the problem isn’t only overwork, he believes “it’s a crisis of meaning, resiliency, and community. The toxic combination of high responsibility, low sense of control, and isolation sets the stage for a sense of exhaustion, powerlessness, and helplessness.” That is not good for anyone, let alone those we hope will help us heal.
Making matters worse, the expectation we all carry with us when we visit the doctor often adds to the problem. We want them to be knowledgeable, have excellent skills, be empathetic and caring, and never error. Yet that thinking alone is a near impossibility when realizing that we are asking our doctors to be omniscient, omnipotent and never make a mistake. After all, health and healing are less straightforward than fixing a computer or a car. As Epstein says, “A patient’s outcome is not only completely attributable to a doctor’s skill; so much depends on the particulars of each patient that are out of a physician’s control.” We may want our doctor to be perfect, but we must remember they are human too.
Is Mindfulness Training The Solution?
As a young doctor, Epstein experienced a dramatic surgical lesson that showed him that even with his superior education, “competence is fragile and takes mindful vigilance to maintain.” With a goal to “capture the habits of master clinicians,” Epstein set out to study those who were able to maintain awareness, attention, and professionalism—no matter what they faced. He also felt drawn to what is called a “biopsychosocial” approach to care, which includes “how patient’s psychological makeup and social relationships were as important to illness and health as the biological, genetic, and molecular aspects of disease.” That study also recognized that doctors are people too, and that “their emotional responses to uncertainty, tragedy, grief and loss would affect the care they provided.”
Up until reading this book I had never considered how my doctor thought about her work or me. Now I am completely convinced that a doctor who practices mindfulness is nearly as important as the grades she received in school or her experience. But just what are the benefits of mindfulness that help a doctor to achieve balance, self-awareness, resilience, and quality care for those they serve? Here are the four elements Epstein believes are necessary for a mindful doctor:
- Attention. When doctors are extremely busy or burnt out they not only miss some of the questions asked by their patients, they also don’t hear the subtleties of what is being communicated. None of us can pay attention to everything all the time, but doctors are particularly hindered by the millions of distractions offered in the clinical setting. Mindfulness allows us to train our “inner manager” and become more sensitive to what we notice, see, and hear—and helps each of us recognize when something is important and when it isn’t.
- Curiosity. Maintaining a sense of curiosity is a vital tool to keep doctors (and all of us) from ever being too certain. If you already think you know the answer to everything, you become rigid, inflexible and arrive at premature conclusions and tunnel vision. Mindfulness allows a person to be more comfortable with uncertainty and to hold what Epstein calls a “soft vigilance” about what needs to happen next.
- Beginner’s Mind. Anytime we think we know everything, we limit our understanding. As Epstein says, “experts know the answers, but only masters know the important questions.” Unfortunately, most doctors consider changing one’s mind to be a source of shame, rather than a source of wonder. Epstein believes, “The ability to tolerate—and even embrace—ambiguity is central to being a good diagnostician.” And as most of us know but don’t always practice, “It’s dangerous when you feel that it’s better to appear certain even if you’re wrong than to appear in doubt.”
- Presence. According to Epstein, presence depends on “getting yourself out of the way, setting aside chatter—what the Buddha called ‘monkey mind’—to connect more directly with a person, a task, or part of yourself.” But many doctors are concerned that if they connect too deeply with a patient they will possibly be taken advantage of, or perhaps worse, feel too connected and vulnerable. That is why practicing stillness and making space within oneself allows one to connect without being consumed or paralyzed by the feelings generated within.
Obviously, there are many more gems in this book that I don’t have time to cover. Fortunately, more and more medical school and hospitals are recognizing the value of attention training, mindfulness, and heartfelt communication. Surely this training will ensure better outcomes for patients and the doctors who serve them in the years to come.
It has been some time since I’ve read a book that captivated me as much as this one did. Of course, I’ve written about mindfulness before so that obviously helped to hold my interest. But as I mentioned in the beginning, who among us hasn’t visited a doctor, either as a patient or as a companion, and wondered about the quality of the care? Now I have a renewed understanding of how the doctor might be viewing me as a patient and a better understanding of what might lie behind their eyes if they look me in the eye. And because a big part of SMART Living is becoming more aware of what is going on inside our own minds, the practice of mindfulness is something that benefits us all regardless of our health.
I have often wondered why so few doctors have truly warm personalities. I would have thought that compassion for others had prompted them to enter the profession, but that doesn’t always seem to be the case. Perhaps they are burned out. Perhaps Mindfulness would help them gain a better perspective of their patient’s needs.
When I was growing up in Belgium, we had our own “family doctor”, who knew all his patients by name and personality and who still made house calls. My parents told me he finally retired last year at age 80 or so. For the first time in 30 years, they had to find a new doctor. As an adult in Belgium, I had the same doctor for over ten years. She knew me and my adventurous life and made sure that all my questions were answered and that I was in tip-top shape. In the US, my first experiences with the medical world were shocking, unpersonable and you only saw the real doctor for a few moments. I have a primary physician now and will see her for the second time in two years soon… I’m curious about what we will talk.
Kathy Gottberg says
Hi Liesbet! Thank you for sharing your personal experience with us. I agree that our medical system lags far behind other countries in so many ways. Hopefully you can get your GPs attention next time you see her. If not, maybe it’s time to keep looking. I think we all need to be asking ourselves that if we aren’t pleased with what we are getting. ~Kathy
Mindfulness was one of the reasons I was drawn to Dr Andrew Weil so many years ago. I’ve used his mindfulness meditation audios and his breathing techniques on a daily basis for years. I would imagine he’s an awesome physician. Brenda
Kathy Gottberg says
Hi Brenda! Yes! Thank you for mentioned Dr. Weil and his work as a doctor and for mindfulness and meditation too. He is certainly an awesome example of someone who we would LOVE to have as our personal GP. And good or you for using his work to help your own practice. It’s always nice to find someone who resonates well with us–that definitely helps to keep us on track. ~Kathy
Still the Lucky Few says
I struggled with a doctor who held old stereotypical ideas about women, and hated his smug assumptions about our tendencies to exaggerate our problems. But doctors were scarce here, although accessibility has improved. Two years ago I found, after months of searching, a young female doctor, and have nothing but praise for her! Yes, her time with each patient is limited, but she has a talent for using every minute well, and knows when to give a patient more time, while limiting time with others. I know this, because I take only a few moments, usually to refill a prescription, but my daughter has more serious issues, and is always given exactly the time she needs.
Kathy Gottberg says
Hi Diane! So glad to hear that you’ve found a doctor that you feel takes time with you. I think that is more important than we know. I also know it isn’t fun to keep searching to find one but the alternative is to not have one you can trust or rely on when the time comes. Hope your daughter is getting all her needs met and is on the recovery. Thanks for sharing your personal experience with us. ~Kathy
We have a notable shortage of family practice doctors where I live (Vancouver Island, BC). It took my husband and me one full year to find a doctor who was accepting new patients. With all that doctors need to go through, shortages are not a surprise. Thank you for sharing a review of this book — it was extremely enlightening.
Kathy Gottberg says
Hi Donna! So sorry to hear that you had such a difficult time finding a new doctor. Dr. Eptstein even said “he” had a hard time finding a new GP because his last one burned out after 2 years. As more and more doctors and hospitals acknowledge that the current system is flawed they are making changes. None too soon as far as I can tell. Hospitals realize that it costs them LOTS of money to have such a high turnover too…so they are trying new things…even new things like mindfulness…to help remedy that. It’s all good news for us for sure. Thanks for your input! ~Kathy
What an interesting glimpse into what doctors are faced with every day and how both they and patients can work together for better results. My dermatologist (another Dr. Epstein, by the way) always made me feel that he was really listening to me. He was notoriously late for each appointment, but all of his patients understood that he would spend the time with them that was necessary to take care of their issues. Sadly he has retired and I will have to find another mindful doctor to take his place.
Kathy Gottberg says
Hi Janis! How nice that you’ve had the experience with a good doctor. And yes, hopefully the next one will be good as well. I now believe that we do ourselves a disservice to stick it out with any doctor who is too preoccupied to look at us when we visit them. And I think the more any of us are mindful ourselves, the more we know what to look for right? The healthcare system in general is a mess and let’s hope that in the future things will work themselves out before any of us are in the position of really, really needing a mindful and caring doctor. Thanks for your thoughts! ~Kahty
Craig Kidwell says
My last doctor said little and ordered medicine and test without even telling me.
My current one who younger is able to do the documentation and never misses a beat! We have q&a and I get real feedback
Kathy Gottberg says
Hi Craig. Good for you for finding a doctor that you are happy with. And hopefully he will stay eager and enthusiastic. Burnout can happen to anyone, in any occupation but we always hope it won’t happen to someone who holds our life in their hands. Thanks for sharing your experience. ~Kathy
I will have to read this book! I spent decades as a pharmaceutical sales rep calling on doctors. I know too well the burn out types, the mightier than thou types and the really good ones.
In the last 5 years the use of Scribes has become more common. These folks come into the room with the doctor and type into the patient’s file all that is being discussed so the physician can spend time being mindful. Both my oncologist and dermatologist use scribes. My Derm pays for it out of her own pocket. My oncologist uses students in physician assistants program because they need about a years worth of patient interaction for their course and being a scribe fulfills that requirement, at least in this state.
Kathy Gottberg says
Hi Haralee! I didn’t know you used to be a sales rep! Then you have certainly seen the good, the bad and the ugly from a doctor and/or hospital. I am glad that the use of Scribes is helping but it is just one step in the right direction. The book also shares how the entire system is set up to keep doctors to learning from mistakes and sharing support and wisdom because, after all, to learn from your mistake you have to be willing to even admit you don’t know. And who wants a doctor that is willing to say he doesn’t always know? Patients can be a problem too right? One of the many facts shared in the book is that patients who don’t feel they are heard by their doctor, often don’t tell the truth (or at least the complete truth) and also don’t take medications as recommended. It is a huge problem that has effects both doctors and patients. Glad to see there is motion to help correct the problem. Thanks for sharing your personal experience. ~Kathy
Lynne Spreen says
Mindfulness is great, but even a mindful doctor can’t do much in ten minutes. I feel sorry for them, and worried for my own care!
To me, the solution is to get rid of insurance companies and apply those dollars to hiring more staff.
Kathy Gottberg says
Hi Lynne! Oh yes i agree that a big part of the problem is the insurance companies. For efficiency purposes, doctors are required hours of paperwork on everything from claims to reporting. Instead of spending time with us and for us, they are having to pander to the insurance companies. Dreadful IMHO. I’m all for single-payer system but don’t see that happening until the general public demands it. Thanks for checking in! ~Kathy
Mona McGinnis says
Yes, I’ve been to a medical appointment where the doctor didn’t take his hand off the door knob. And when I don’t hear the results of a test result, I wonder if it means all is well or has the test result even been seen by the doctor? I know doctors are only human. It takes a certain personality that can separate emotionally from the vagaries of health care and humanity. At the same time, as health care consumers, we do expect a certain level of competency. The practice of health care is as much an art as it is a science. Sometimes one is required more than the other. I practiced as a nurse for >34yrs and have worked with all kinds of doctors. Some worked so independently while others practiced team work. And I saw outcomes that could not be explained, i.e. people lived and died when the clinical evidence would have suggested otherwise.
Kathy Gottberg says
Hi Mona! Yes I’ll bet with your experience you could share a LOT of stories. One of the illustrations in the book was when a doctor confessed that he didn’t even see the patient leave the room to go to the bathroom because he was so engrossed in typing his thoughts into the computer. And as your also proves, there are so many variables to healing that it is good when we have an aware and mindful doctor, nurses and all clinicians on our side, right? The statistics about how rare that is are certainly a reason for concern. Thanks for your thoughts on this! ~Kathy
Susan Mary Malone says
Now this books does sound captivating, Kathy. And yes, we all wish for mindful doctors.
I come from a family of doctors, so I’ve heard the “other side” all of my life. And, what docs have to wade through just to practice medicine is atrocious. It wasn’t that way when I was a child–it was so much more of a “people” world. Now, it’s filled with bureaucracy and paperwork and dealing with insurance companies that won’t pay, and medicare regulations (even per how many patients you have to see, whether they fit the time slot or not). And that doesn’t even take into account bad hospital practices and all the red tape that comes with that.
It’s not pretty. And no wonder young men and women now think twice about going to medical school. For so many, it’s just no longer worth it.
From this side of the issue, things are scary indeed.
Kathy Gottberg says
Hi Susan! I think you would enjoy it as much as I did for many reasons. I know the post is geared more to how doctors are viewed but I believe just reading about all the scientific studies that show how mindfulness is beneficial on so many levels for all of us is also important. The book blends lots of studies along with stories about how patients are routinely treated (both good and bad stories) so it is really an enjoyable read. Thankfully there are doctors AND hospitals who recognize why this is important. ~Kathy