Mrs. Johnson, 45 years old, has been under care of Dr. X for many years for a nonspecific autoimmune disease. In addition to the relentless physical symptoms of her condition (aches, pains, and fatigue), Mrs. Johnson has a hard home life: struggling with financial troubles, divorce and uneasy relationships with her children. At her last visit, Dr. X began the appointment feeling dismissive and unhopeful, but noted Mrs. Johnson’s newest symptoms (pelvic swelling, muscle weakness, skin lesions) and listened to her concerns. His thoughtful reflection led to a diagnosis of dermatomyositis and uterine cancer. To Dr. X’s surprise, instead of devastation over the news, Mrs. Johnson expressed relief that she finally understood what had been making her sick.
Dr. C. Ronald MacKenzie, rheumatologist and recently named holder of the C. Ronald MacKenzie, M.D. Chair in Ethics and Medicine, presented this case at the annual HSS Spirituality and Health Forum in his presentation “Mindful Practice.” The Forum is sponsored by the HSS Pastoral Care and Education Committee. Mrs. Johnson and Dr. X approached symptoms and diagnosis through a wide lens, without bias and with reflection. They demonstrated a mindful approach to medicine, which HSS staff strive to practice for improved patient care and outcomes.
Despite the comprehensive topics taught in a medical education, mindful practice is not a subject often found in the curriculum. Mindful practice, also sometimes called reflective practice, is a wholesome and sympathetic approach to medical care that can be applied across a spectrum of health care professions. Through heightening consciousness and promoting personal reflection, mindful practice provides an opportunity to reflect on deeper, but often unattended, aspects of patient care that can supplement traditional treatments and promote healing.
While spirituality, mediation or religion can all be a part of mindful medicine for an individual, these tenets do not define mindfulness. Instead, the word mindful stems from the Pali word “Sati,” meaning attention and awareness. Mindful practice has been described as “paying attention on purpose.”
Mindful medicine has benefits for both health care providers and their patients. When coupling traditional methods of treatment with mindful exercises, patients demonstrated a lower perception of pain (or raised ability to tolerate pain); lower stress, anxiety and depression; enhanced motivation to improve lifestyle (e.g., quit smoking); improvements to interpersonal relationships; and positive impacts to the immune system. For hospitals, mindful medicine has put in motion what is called the “Quality Movement.” In more than 60 percent of quality cases, mistakes are made because of individual errors. Many of these errors can be attributed to mindlessness. By implementing steps to incorporate reflective practices, health care providers can dramatically lower the number of careless individual mistakes.
It is unclear whether mindfulness can truly be learned, however there are steps that health care providers can take when seeing patients to be more reflective about the visit. Before seeing a patient, the clinician should “prime.” Pause before seeing the patient, reflect on prior experience with that patient, create a mental task list, and take a deep breath. After seeing the patient, mindful clinicians ask reflective questions about the visit: Were there any assumptions you made about the patient that may not be true? Were you surprised by anything during the visit? How did you respond to that surprise? Taking the time out to reflect promotes clear thinking and an open mind toward the specific case.
For Mrs. Johnson, a mindful approach to her condition was essential. Although it would seem that a severe diagnosis is a bad thing, that same diagnosis gave Mrs. Johnson a freedom and reassurance in her feelings. Patients are more than symptoms and diagnoses, and all aspects of mental and physical life contribute to their health. Every patient and physician has the ability to assess and reflect, and this reflective practice can have positive impacts on healing.
Dr. MacKenzie’s presentation drew from the work of Dr. Ronald Epstein of the University of Rochester, who has been widely published on mindful practice.
C. Ronald MacKenzie, M.D., is a rheumatologist at the Hospital for Special Surgery and recently named holder of the C. Ronald MacKenzie, M.D. Chair in Ethics and Medicine, Dr. MacKenzie is also Director of Perioperative Medicine with the HSS Spine Care Institute. He is Chair of the American College of Rheumatology Ethics and Conflicts of Interest Committee. Dr. MacKenzie’s interest in bioethics grew out of a melding of his former role as Chairman of the HSS Institutional Review Board and his affinity for the humanistic aspects of medical practice.