Mindfulness in medicine

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Spend five (5) minutes gazing at the horizon ...
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Contents

Introduction

See also Bibliotherapy‎ | Complementary & alternative medicine (CAM) | Information prescriptions | Information therapy | Integrative medical care

"Mindful practitioners attend in a nonjudgmental way to their own physical and mental processes during ordinary, everyday tasks. This critical self reflection enables physicians to listen attentively to patients’ distress, recognize their own errors, refine their technical skills, make evidence-based decisions, and clarify their values so that they can act with compassion, technical competence, presence and insight." — Epstein RM. Mindful Practice. JAMA. 1999;282;(9):833-39.

Mindfulness in medicine refers to a certain mindset where health practitioners can bring their complete focus and attention to what they are doing in the moment. Mindfulness is a Sanskrit word meaning awareness in Buddhist meditation. In medicine, the idea of mindfulness is a form of reflection and deriving a renewed sense of one's body and feelings. Mindfulness – being focused and fully present in the here and now – is part of many meditation practices where the "correct" or "right" frame of mind puts one on a path of enlightenment. According to Langer (2000), "...being mindful is the simple act of drawing novel distinctions; it leads to greater sensitivity to context and perspective and greater control over our lives. When we engage in mindful learning, we avoid forming mind-sets that limit us. Many of our beliefs about learning are mind-sets that have been mindlessly accepted to be true. Consideration is given to consequences that result from mindful reconsideration of these myths of learning."

Incidentally, "being mindful" is also the seventh element on the path of Buddhism, a practice which supports the development of wisdom. The Buddhist concept of mindfulness means to put all of your mental attention to the task at hand and to be in the moment. Mindfulness practice involves cultivating focus, attention, and awareness. In daily life, the practice also encourages simplicity, trust, and generosity. A key innovative teaching of Buddhism is that meditative absorption can be combined with contemplative insight.

In medicine, mindfulness techniques are used to help alleviate a variety of mental and physical ailments but also to focus the mind on tasks at hand. The notion of mindfulness is linked to narratives and patient histories in medicine. It acknowledges the often complex stories and narratives that arise between doctors, their peers and patients. Narrative medicine aims to validate the subjective experience of the patient, and encourages creativity and self-reflection in the physician.

In health librarianship, mindfulness is a focus on listening and awareness, both key to providing effective reference services or assistance to users in the library. When health librarians focus on the present, unencumbered by assumptions, judgments, thoughts of past or future events, they are more likely to listen attentively to and meet the needs of their users.

Mindfulness activities

The physiological benefits of clearing away distractions and noise have been documented in many scientific and medical studies. Practicing mindfulness, whether taking deep breaths, meditating or doing yoga, helps to alter the structure and function of the brain. This, in turn, allows us to learn, acquire new abilities and improve memory. "...advances in neuroimaging techniques have taught us how these mindfulness-based techniques affect neuroplasticity." On the other hand, multitasking depresses the brain’s memory and analytical functions, and reduces blood flow to the right temporal lobe, which contributes to creative thinking. In today’s workplace, creativity is an important part of sustaining energy levels and happiness. Here are some tips for practicing mindfulness at work:

  • Focus on one task at a time, for an allotted period of time. For 15 minutes, read your email and then make your phone calls
  • If your job has constant interruptions that demand your attention, take several deep breaths and prioritize them; resist the urge to answer the phone every time it rings unless it’s a boss. If someone asks you to drop what you’re doing to help with a problem, it’s OK to say " ...I’ll be finished with what I’m doing in 10 minutes, then I’m all yours."
  • When you are stuck doing one task, change your physical environment to stimulate your senses. Sometimes we bounce from one job (or task) to another job because we don’t have the words to write that strategic plan or we’re staring at a problem (and a computer screen) and have no ideas. That’s the time to get up, take a walk, look at the flowers and the birds – change what you’re seeing. Turn on some relaxing music that makes you happy.
  • Offering your senses pleasant and different stimulation rewires your brain for relaxation, and reduces the effects of stress hormones.
  • Delegate tasks. If you do not have control over external stresses in your life, take control of what you can control. Most importantly, have compassion for yourself, and reach out. Assign tasks to someone else who’s capable of it. Ask a colleague to help you which will not only allow you to focus on the tasks that need your attention, it will reduce stress.

Other mindfulness suggestions

  • For every hour of practice, try to integrate at least five (5) minutes of mindfulness
  • Sit and breathe slowly for a few moments; take this time, even for a few minutes in your office or at lunch, and sit and breathe; count your breaths to ten and start over
  • Physicians and medical librarians are notorious for multitasking over lunch, fork in one hand and book in the other
  • A psychologist once told me to take fifteen minutes twice a day to unfocus my eyes by looking off to the horizon
  • We can do something similar with our minds, given the constant attention we pay to others
  • Drop it all for a few minutes, close your eyes and spend time with yourself

The value of narrative medicine

Mindfulness.jpg

Narrative medicine is summarized in Greenhalgh T, Hurwitz B. Narrative based medicine: Why study narrative? BMJ. 1999;318:48-50.

  • In the diagnostic encounter, narratives:
  • Are the phenomenal form in which patients experience health or its absence
  • Encourage empathy and understanding between clinicians and patients
  • Allow for the construction of meaning, and encourage being present in the moment
  • May supply useful analytical clues and categories
  • In the therapeutic process, narratives:
  • Encourage a holistic approach to management
  • Are intrinsically therapeutic or palliative
  • May suggest or precipitate additional therapeutic options
  • In the education of patients and health professionals, narratives:
  • Are often memorable
  • Are grounded in experience
  • Encourage reflection
  • In research, narratives:
  • Help to set a patient-centered agenda
  • Give distinct voice to participants of research
  • May challenge received wisdom
  • May generate new hypotheses

Medical programs in narrative medicine

Key mindfulness websites

Roles for health information professionals

  • As a health librarian, are you a mindful practitioner?
  • Do you listen to patients and physicians' narratives in a non-judgmental way?
  • Are you attuned to the developing narratives of those encounters?
  • Are you a supportive positive presence in your organization? library? clinical team?
  • Are you able to assume mindfulness with others including your colleagues and staff?
  • For some, the aim of mindfulness is to make it recursive (or continuous) throughout the day

Mindfulness in health librarianship can be practiced by paying attention to what we are doing throughout the day. What this entails is giving ourselves over completely to the moment, whether it's during the reference interview, questions being asked, catalogue searches or interactions with staff. Even though health librarians are trained to multitask, given the nature of our work, it's extremely important to be present during each task. Multitasking can lead to doing things poorly if we are not fully in the moment.

Mindfulness-based stress reduction program

Kabat-Zinn developed the mindfulness-based stress reduction program over a ten-year period at the University of Massachusetts Medical School. He defines it as "...the regular, disciplined practice of moment-to-moment awareness or mindfulness, the complete "owning" of each moment of your experience, good, bad or ugly." Kabat-Zinn explains the non-Buddhist universality of this practice. Mindfulness meditation is most-commonly practiced within the context of Buddhism, and its essence is universal. Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concern the relief of suffering and dispelling of illusions. MBSR has been shown to provide clinical benefits for people with depression and anxiety. Mindfulness-based psychotherapy is practiced as a form of complementary medicine in many hospitals. It is currently the focus of numerous research studies funded by the National Center for Complementary and Alternative Medicine. see http://clinicaltrials.gov/ct2/results?recr=open&no_unk=Y&spons=NCCAM&term=MBSR

YouTube video on mindfulness

References

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