Physician Be Mindful—Bring Awareness and Self-Compassion to Work and Life

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Are there times when your mind feels too full? Striving to meet busy clinic demands, your mind may be racing or bouncing from dis­traction to distraction. Working in this distracted state contributes to stress.

The downsides of stress. Stress can result in your becoming impatient and irritable with others. Stress also can be a factor in physical tension and pain, especially when performing surgery and other medical procedures. Unrelieved stress also can lead to exhaustion and burnout.

Mindfulness can help. Learning basic mindfulness can help you to do the following:

• Enhance awareness of your actions, thoughts, and emotions. As you develop the ability to stay in the present, you can let go of unrealistic demands to “get it all done.” You can stop rushing through work and life.
• Recognize tension in your body and understand how to release it. You can learn to avoid, reduce, and relieve phys­ical discomfort. 

So What Is Mindfulness?

Jon Kabat-Zinn, PhD, the founder of Mindfulness-Based Stress Reduction, describes mindfulness as “awareness that arises through paying attention, on purpose, in the present moment.” In his teaching and books, he emphasizes that mindfulness doesn’t include judgment or criticism of oneself, other people, or one’s experiences. Another way to say this is, mindfulness is being with things, just as they are.

Traditionally, mindfulness encom­passes many practices. Two common mindful movement practices are yoga and qigong, which originated in India and China, respectively.

Three Physicians Who Have Embraced Mindfulness

Retina specialists Marion R. Munk, MD, PhD, and Camille V. Palma, MD, and comprehensive ophthalmologist Ravi D. Goel, MD, have practiced mindful­ness and related methods for years. They provide some examples of how this has enhanced their working lives.

Dr. Munk takes time to slow down. “If I’m getting behind in clinic, I inten­tionally slow down,” said Dr. Munk. “I give full attention to each thing I do. This significantly decreases my stress. Interestingly, I get just as much done as when I constantly pushed myself.” She added, “residents and patients have asked me, ‘What did you do? You’re much nicer and calmer than you were.’ At times I’m still stressed, of course, but nothing like before. Work and life are more satisfying because I’m living them.”

Dr. Palma applies her yoga aware­ness to her working day. Dr. Palma said that her years of practicing and teaching yoga have affected her awareness of her positions and movement throughout the workday, even just rising from a chair to standing. Dr. Palma is a certi­fied yoga teacher (https://yogaeyedoc.com) and has created yoga movement sequences that are specifically designed for ophthalmologists.

Dr. Goel will pause a procedure to release tension. “During a procedure, I’m aware when tension starts to build in my back,” said Dr. Goel. “I know if I don’t release it, I’ll pay for it later. So, at an appropriate time, I pause. I take a few deep breaths while focusing, releasing the tension.” He said that habits such as this—along with a vari­ety of meditation, yoga, and stretching practices—have been key for staying well and being “mentally prepared to provide high-quality vision care.”

An Easy Way to Get Started

One breath is a basic awareness practice that can be used throughout the day and is easy to learn—in fact, you can try it right now.

Try the one breath practice. This “is also called ‘belly breathing’ or ‘dia­phragmatic breathing,’” said Dr. Palma. “I intentionally take a slow breath in through the nose, aware of my ribcage expanding out and down and my dia­phragm engaging. Then I exhale slowly and gently through the mouth, as if there’s a candle in front of me and I don’t want to blow it out. For enhanced relaxation, extend your exhalation, so that it’s longer than your inhalation.”

How it works. Slowing down the breath engages the Vagus nerve and the parasympathetic nervous system. The body receives the message to relax and let go, said Dr. Palma.

When Dr. Palma uses one breath. Dr. Palma uses one breath several times a day, usually at a transition point, such as before entering a patient exam room. She intentionally releases whatever she’d been doing. Feeling re-energized, she’s ready to give full attention to her pa­tient. She also teaches the practice to residents, many of whom have said it is helpful.

Mindful Meditation—Four Effective Practices

A 2017 study compared four mindful­ness meditation practices: awareness of breath, awareness of the body, loving-kindness, and observing thoughts. Re­searchers found that each practice had some unique benefits, but performing any of the four practices left partici­pants “feeling happier, more energized, more present in the moment, more aware of their bodies, and better able to disengage from distracting thoughts.”¹

1: Awareness of the breath is a basic, yet powerful, practice. Breath awareness is a foundational practice in classic mindfulness meditation. You bring your full attention to your breath, experiencing each subtle sensation of flow into and out of the body. This is done again and again, breath-by-breath, for the practice session.

At first, many people find it chal­lenging to stay focused. Distracting thoughts, worries, and irritating sen­sations come up. Meditation teachers advise that you learn to recognize distractions and then choose to return awareness to the breath. This active returning is key to strengthening mind­fulness and avoiding distractions.

Dr. Munk advises that new medita­tors avoid being discouraged by their wandering mind. “There’s no need to struggle to stop your thoughts,” she said. “Having thoughts doesn’t mean you’re doing it wrong or failing at meditation. We physicians are trained that doing it right is crucial. But when learning breath awareness, the key is patience. Recognizing a thought and watching it disappear is a success and an important part of the practice.”

Benefits. With consistent practice, meditators can catch distractions as soon as they occur. Eventually, distrac­tions fade into the background and aren’t experienced as annoying. The meditator becomes able to direct their awareness and attention.

2: Awareness of the body—also known as the body scan—can help release physical tension. The meditator directs awareness sequentially to each area of the body. First, bring awareness to the sole of one foot, then move up the leg to the hip. Next, move awareness through the other leg. Then the hands and arms, lower torso, and so on up through the crown of the head. Simply be with any sensations in each area, without judgment or trying to change anything. This close attention strength­ens respect for and sensitivity to the body. After learning the longer practice, a brief body sweep can be done when needed.

Benefits. Benefits include increased body awareness and reduction of nega­tive attitudes and thoughts.¹

3 and 4: Loving-kindness and ob­serving thoughts to enhance relation­ships and increase empathy. Although the effects of loving-kindness medita­tion and observing thoughts medita­tion overlap, they are two distinct types of meditation:

• True to its name, loving-kindness meditation increases kindness while reducing conflict within oneself and with others.
• Learning to observe thoughts during meditation can reduce judgmental, negative thoughts as well as repetitive worrying.

Learning loving-kindness meditation. You can learn guided loving-kindness meditation from an app or other format (see “Recommended Re­sources”). The meditators learn to offer kind, caring wishes first to themselves, then to those they care about. As their capacity for loving-kindness strength­ens over time, the meditators can offer loving-kindness to difficult people in their lives. They can expand their sense of caring and generosity outward, to people in their neighborhood or even the world.

The challenge of offering loving-kindness to yourself. Dr. Munk said that offering loving-kindness to herself was not easy, at first. A guided medi­tation (Waking Up app) encouraged her to remember herself as a young child. It felt natural to care for this little one. “This works really well as a way to become compassionate and kind to oneself,” she said.

Benefit of using loving-kindness in the clinic. The practice of offering loving-kindness to difficult people has helped Dr. Munk when interacting with challenging patients. “I now see their behavior as coming from their suffer­ing, so I’m able to respond with calm and compassion,” she said.

Learning observing thoughts meditation. Most mindfulness teachers advise learning awareness of breath and the body scan before starting thought-observation.

Find a qualified teacher. “There are numerous low-cost ways to learn from expert teachers and find approaches that appeal to you,” said Dr. Goel. Options are available online, via apps, and locally. But learning from a respect­ed teacher is key. They can inspire and motivate you, explain the practices and benefits clearly, and guide you in bring­ing mindfulness to daily life.

You can start by investing a little time each day. “Commit to practicing every day for 10 to 15 minutes,” said Dr. Goel. “Practice consistently for at least 30 days. This will give you a sense of how and whether meditation is work­ing for you.”

Recommended Resources

Drs. Munk, Goel, and Palma encourage ophthalmologists to use apps, videos, and online courses guided by trust­worthy, authentic teachers and based on time-tested methods.

Dr. Munk recommends the following resources:

• Waking Up app. This was created by Sam Harris, PhD. It includes a four-week introductory course, practical and theoretical courses, and daily medita­tions
• Mindvalley.com. This is an online learning platform that offers a free six-phase guided meditation, as well as daily meditations that are free and short relaxation exercises.
• How to Change Your Mind: What the New Science of Psychedelics Tells Us About Consciousness, Dying, Addiction, Depression, and Transcendence, by Mi­chael Pollan (Penguin Press, 2018). The book, which Netflix recently turned into a four-part docuseries, includes sections on mindfulness meditation.

Dr. Goel recommends the following:

• Headspace app. Main topics: med­itation, sleep, movement, and focus. This is free for two years to members of the American Medical Association.
• YouTube.com. For mindfulness meditation videos, Dr Goel’s current go-to is “Mindfulness Meditation–Guided 10 Minutes,” posted by The Honest Guys (https://youtu.be/6p_yaNFSYao); for yoga, he uses a 15-minute daily stretch video posted by Mady Morrison (https://youtu.be/g_tea8ZNk5A) and a 20-minute work-out posted by Yoga With Adriene (https://youtu.be/v7AYKMP6rOE).

Dr. Palma also recommends the Headspace app, plus:

• 10 Percent Happier app. This is based on a book by journalist Dan Harris. It includes brief guided medita­tions (awareness of breath, body scan, and loving-kindness), guided relax­ation, and restful sleep programs, the 10 Percent Happier Podcast, and related courses.

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1 Kok BE, Singer T. Mindfulness. 2017;8(1):218-231.

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Dr. Goel is a comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, N.J. Relevant financial disclosures: None.

Dr. Munk is professor and uveitis and medical retina specialist at the University Clinic Bern in Switzerland. She is also an adjunct professor at the Northwestern University, Chicago. Relevant financial disclosures: None.

Dr. Palma is a vitreoretinal surgeon at John H. Stroger, Jr. Hospital of Cook County and a yoga teacher, both in Chicago. Relevant financial disclosures: None.

About the author: Ms. Wade is an educator, program guide, and practitioner of mindfulness meditation and Insight Yoga. Her 35 years of teaching and training integrate methods based on these programs: Mindfulness-Based Stress Reduc­tion, founded by Jon Kabat-Zinn, PhD; Finding Meaning in Medicine, founded by Rachel Remen, MD; and Insight Yoga, founded by Sarah and Ty Powers. Relevant financial disclosures: None.

For full disclosures and the disclosure key, see below.