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Why physician mindfulness could improve patient care and prevent health care disparities.
One night several years ago, I was the sole physician seeing patients at a busy urgent care clinic in East Baltimore. That night was particularly busy, and as each patient’s needs expanded beyond the time I had allotted to see them, I got further behind.
I walked into an exam room and saw a young, healthy man. I breathed a sigh of relief, thinking that I might start to catch up, as I assumed it would be a pretty quick encounter. He told me that he had a spot on his lip that he wanted me to check out. I looked carefully, did not see any spot and told him so. He was unsatisfied and concerned, so I looked more carefully. I mentioned to him that his lips were dry and suggested some moisturizer. Still, the man seemed unsatisfied, and the encounter ended with both of us a little frustrated.
At night’s end, our medical assistant asked me, “Hey, what was wrong with that guy’s lip?” “Nothing,” I told her, “But why do you ask?” She answered, “Oh, nothing? Really? Because, in my culture, if a guy has a spot on his lip, it means he’s an alcoholic.”
Walking out of clinic that night, I was disappointed with myself for dismissing the patient’s concern. Of course there must be a reason why a healthy young man would come to the doctor for a seemingly small issue. If I’d been less rushed and more aware, there was one simple question I could have asked: “Is there anything in particular that you’re worried about?” But I didn’t, and I may have missed an opportunity to talk to him about his alcohol use.
Mindfulness is defined as a mode of awareness, a “metacognitive” skill that involves attentional control, emotional regulation, self-awareness, and a nonjudgmental and curious orientation toward one’s experiences. Mindfulness has been popularized in the form of mindfulness-based stress reduction programs, which have been shown to improve quality of life for patients with numerous medical problems, especially chronic conditions.
Until recently, there hasn’t been much focus on the mindfulness of clinicians. Ron Epstein, at the University of Rochester Medical Center, first promoted the theoretical advantages of clinician mindfulness in terms of preventing burnout and improving the quality of patient care. Following his seminal article, there were several research studies done demonstrating that mindfulness programs do improve physician and nurse well-being and prevent burnout.
Yet the benefits of clinician mindfulness on improving patient care are less well-studied. A few years ago, my colleagues and I looked at this issue. First, we asked physicians to rate themselves on a scale of mindfulness, which includes things like assessing how often we might walk somewhere without noticing where we’re going or forget someone’s name right after we hear it. Then, we recorded the physicians interacting with their patients. We found that those who rated themselves higher on the mindfulness scale communicated better—they were less verbally dominant with their patients, and their patients rated them higher in terms of satisfaction.
I think back to the young man worried about his lip. If I’d been less distracted, I would have heard more of his voice in the encounter. Considering how busy all of us are in medicine, the ability to tune out distractions and focus on the present moment is increasingly important.
Most recently, we hypothesized that mindfulness might have even further benefits for patients, in terms of reducing racial and ethnic inequalities in care. Studies have shown health care providers hold implicit racial and ethnic biases that may contribute to unequal care, yet little progress has been made in addressing these unconscious cognitive processes. We think that meditation training designed to increase health care providers’ mindfulness skills may be one promising solution.
We don’t know for sure what all the benefits of mindfulness might be or how to achieve them. But for now, it seems like a promising strategy to improve the equity and overall quality of care. As many experienced physicians have told me, it might be enough to pause, take a deep breath and clear our minds, as well as we can, before we greet each new patient. It might improve the way we communicate with, diagnose and treat patients—and it will probably make our days less stressful.?
Mary Catherine Beach is a core faculty member in the Johns Hopkins Berman Institute of Bioethics.