Mindfulness in Medicine by Dr Iraniha
After having an uncomplicated laparoscopic gallbladder surgery, a 90 year old cachectic, fragile but extremely sharp and pleasant female was recuperating at the surgical floor. She reported some abdominal pain and lack of urination several times to the night nurse and received multiple doses of pain medication overnight. Next morning, when she was visited by her surgeon and asked how she was doing, she said “I`m miserable. I have been miserable all night”. The surgeon noticed her lower abdomen was as distended as a 6 month pregnant female, extremely tense and tender. It was her bladder which was extremely distended due to urinary retention and instead of pain medication she just needed a catheter to decompress her bladder overnight! The surgeon asked her night nurse who was signing out to the new shift in front of the computer to bring the catheter into the room and went into the room to console the patient. Ten minutes later when no one came to the room the surgeon went out and saw the nurse was still standing in the same place and giving the sign out report to the new shift! Finally the surgeon fetched the catheter and decompressed the patient`s bladder. There was 1200 cc of retained urine!
So many similar stories occur in a daily basis in our health care system. Some might call this just an error or lack of experience, some might call this lack of care and compassion, and some might blame the system which has created super busy, overworked and exhausted health professionals that make them prone to mistakes. However, I`d like to blame the culture in our health care system where we have lost “our priorities”. Many factors including the new changes in health care system, infusion of demanding technology, the ongoing war between hospitals and insurance companies over the reimbursement, more strict rules and regulations to comply and robotic way of how we deliver our medical care to patients have created a culture of “indifference” in our health care system. It seems like we have lost our “attention” to the supreme goal of our profession and act indifferent with little or no sense of compassion and kindness. These elements have resulted not only an escalating stress, frustration, exhaustion and burnout among health professionals but also a lower efficiency, productivity and performance, and higher medical errors and patient dissatisfaction. There is no doubt that the organizations have a critical role in improving the culture in our health care system by improving the well-being of health professionals and patient experience, but as individual we also have a major personal responsibility to create a change. First and foremost we need to recognize and promote the sacred value of health profession as the main purpose and embrace this remarkable opportunity to engage in care of others, create connections and practice the essence of humanity. Then we also require to change our mindset, recognize our principal priorities in health care, be mindful and re-direct our attention to the vital goal.
Today I’m not here to teach you mindfulness meditation. I am here to offer you to be mindful at all times. Being mindful as a way of life, a discipline to follow in every aspects of your lives including at home, in your relationships and at work. Mindfulness is a life skill that requires dedication and practice and meditation is just a tool to remind you to be mindful and help you to cultivate the mindfulness in your life. Mindfulness requires “attention” as the fundamental element which is also extremely critical in our mental, physical and social wellbeing.
Attention is a cognitive feature of the brain of selective concentration to the events or objects that are deemed relevant or important. We receive significant number of sensory input into our brain and the attention system is responsible to modulate and regulate the information, filter out the irrelevant data and amplify the relevant ones. We think that we are aware of everything around us and paying attention at all times. What an illusion!
Our attention has a tendency to be diverted with external and internal stimuli at all times. We live in an era of gigantic external distractors, responsible to divert our attention. The technology has brought us the means of faster processing, transaction and communication but it seems that it is dominating our lives and our relationships and creating more distractions. Devices and agencies including our phones, internet, social media and television are the main culprits. But distractions do not stop there. We also have constant internal intrusions. Ruminating about the past and worrying about the future called mind wandering is the characteristic of our internal narrative, the little voice inside of us that invades our attention constantly. Among the past experiences and future planning, our mind has the affinity towards the negative ones. The negative thoughts and experiences are extremely gluey and sticky and positive ones are oily and slippery in our mind. This way of thinking make us more distracted, depressed and stressed out. It will also divert our attention away from the main tasks. Even though our brain has the capacity to perform parallel processing, but in order to perform a complex task it requires to fully attend on the target and limit or eliminate the distractors. The attention system allows the brain to boost the relevant information and minimize the other signals. This process is handled in our executive region of our brain, the location which makes us “human” and separate us from other species.
What is Mindfulness in Medicine?
Mindfulness is the ability to recognize the mind wandering and re-direct our attention back on the target. However, attention is not the only necessary element of mindfulness. To be mindful, it requires passion and desire to be present fully and pay attention entirely in the present moment. It also requires a new mindset, the attitude of curiosity and acceptance with no judgment.
Mindfulness in medicine is awareness and compassion towards ourselves and our patients. It enables us to see the world from different point of view, have intense desire to engage, understand and accept the stress, struggle, pain and suffering of us and our patients with open heartedness without judgement. This way of being allows us to see our thoughts and behaviors more clearly, to pause and act wisely, to shape an amazing quality within us to cope and establish peace with our pains and struggles and to foster more compassion, care and kindness within us and our patients.
It is just astonishing to know that there is an opportunity and capacity to change our attitude, our behavior or even our brain. It is our choice to take the first step.