According to the nurse's note, the patient had received a clean bill of health from his regular doctor only a few days before, so I was surprised to see his request for a second opinion. He stared intently at my name badge as I walked into the room, then nodded his head at each syllable of my name as I introduced myself.
Shifting his gaze upward to my face, he said, "I'm here, Doc, to make sure I don't have anything serious. I'm not sure my regular doctor was listening to everything I was trying to tell him."
I smiled. To hide my embarrassment.
I had walked into the exam room to listen to this patient; but my mind was a few steps behind, as I struggled with thoughts about the colleague who'd just snapped at me over the phone because she was in no mood to get another new consult, my mounting piles of unfinished paperwork, and the young patient with widespread cancer whom I'd seen earlier in the day. Thoughts about my new patient jumbled in the mix, too, but they came into focus only after I had pushed away the fears that I might have neglected to order a key test on my last patient, that I'd forgotten to call another patient and that I was already running behind schedule.
That relentless inner conversation came to mind this past week when I read two studies on physician burnout and mindfulness in the current issue of The Annals of Family Medicine.
Research over the last few years has revealed that unrelenting job pressures cause two-thirds of fully trained doctors to experience the emotional, mental and physical exhaustion characteristic of burnout. Health care workers who are burned out are at higher risk for substance abuse, lying, cheating and even suicide. They tend to make more errors and lose their sense of empathy for others. And they are more prone to leave clinical practice.
Unfortunately, relatively little is known about treating burnout. Butpromising research points to mindfulness, the ability to be fully present and attentive in the moment, as a possible remedy. A few small studies indicate that mindfulness training courses can help doctors become more focused, more empathetic and less emotionally exhausted.
But two important questions remain unanswered. How does mindfulness affect patients? And who really has the time to enroll in training courses that can take several weeks or longer?
The studies in The Annals of Family Medicine attempt to answer those questions.
In one study, researchers first assessed the baseline mindfulness of 45 doctors, nurses and physician assistants by asking them to respond to statements like, "I tend to walk quickly to where I am going without paying attention to what I experience along the way," "I find myself listening to someone with one ear, doing something else at the same time," and "I forget a person's name almost as soon as I've been told it for the first time." Then the investigators recorded the clinicians' interactions with more than 400 patients and interviewed the patients to gauge their level of satisfaction.
After analyzing the audio recordings and the patients' responses, the researchers found that patients were more satisfied and more open with the more mindful clinicians. They also discovered that more mindful clinicians tended to be more upbeat during patient interactions, more focused on the conversation and more likely to make attempts to strengthen the relationship or ferret out details of the patient's feelings.
The less mindful clinicians, on the other hand, more frequently missed opportunities to be empathic and, in the most extreme cases, failed to pay attention at all, responding, for example, to a patient's description of waking up in the middle of the night crying in pain with a question about a flu shot.
Significantly, the most mindful doctors remained efficient. They accomplished just as much medically for their patients as their least mindful colleagues, despite all the extra conversation with patients about experiences and relationships.
"We clinicians are not always fully present for patients because our minds are always working," said Dr. Mary Catherine Beach, lead author of the study and an associate professor of medicine at Johns Hopkins University. "But when we don't listen," failing to let patients say what they need to say or ask what they need to ask, "we end up giving explanations that are too long and complicated and responses that they don't need or want."
For many doctors, it's not the lack of interest that prevents them from incorporating mindfulness into their clinical practices; it's the time required to complete a standard training course. The courses require a significant commitment, ranging from a full week, to a full day once a week for eight weeks.
In the second study, another group of investigators looked at the effects on 30 physicians of a mindfulness course that required only one weekend and two follow-up evening sessions a couple of weeks apart. Even after such an abbreviated course, the researchers found decreased levels of burnout, anxiety, depression and distress among the doctors. And nearly a year later, those salutary effects persisted, even without any mindfulness training "booster" sessions.
"We tried to get the training down to the bare minimum and as user-friendly as possible," said Dr. Luke Fortney, lead author of the study and an integrative and family medicine physician who is part of the Meriter Medical Group at the McKee Clinic in Madison, Wis. "We didn't want to exhaust the doctors with another burden."
Dr. Fortney and his colleagues filled the condensed course with techniques adapted for busy clinicians, like the "two feet one breath" technique in which a doctor, just before entering an exam room, stands in front of the door and concentrates on breathing and the feeling of his or her feet on the ground as a way to help focus on the moment. They also created a practical and accessible Web site that reinforces key points and offers helpful advice in the form of short videos, brief audio recordings and easy-to-digest tables.
