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Mindful : October 2014
themselves to practice mindfulness,” said Dr. Krasner, an easygoing primary care doctor in his late 50s, and an associate professor of clinical medicine at Roches- ter. “Even though we documented many improvements, it’s ha rd in the culture of medicine for practitioners to spend time on self-care.” Many physicians have a hard time appreciating the powerful connection between ca ring for themselves and their ability to care for others. But the evidence is clear that you can’t really be compassionate towa rd your patients unless you’re kind to yourself. “There are direct correlations between physical and emotiona l well-being and cognitive func- tioning, number of errors, and patient safety,” Dr. Krasner explained. “Our work suggests that self-care, although a challenge, may improve patient-centered qualities of physicians, hence quality of caring.” An overwhelmingly positive response to their mindfulness study inspired Dr. Krasner and Dr. Epstein to teach their first course to doctors in 2010. Since then, they’ve trained nearly 500 medical professionals, including psychologists and nurse practitioners, and their course is now taught in dozens of medical set- tings, including Georgetown, Ha rvard, and Hong Kong University. Mindfulness education is catching on in some large health-care systems as well. Robert McClure, manager for the SharpHealth- Care Employee Assistance Program in Sa n Diego, California, teaches a nine- week course in compassion cultivation training for medical professionals. “I’ve never done anything in my 40 years as a therapist where I saw people change more,” said McClure, a licensed social worker. A physicia n recently told him that the course had transformed her practice from illness-centered to patient-centered. “She now pays atten- tion to people in front of her in a more profound way than she ever has.” Another doctor he knows takes three deep breaths before she sees her next patient, said McClure. “She’s not bringing the previous patient into the room with her. She spends no more time, but her own experience of the time has changed. In short, she’s not burned out.” Three yea rs ago, Dr. Ellen Brow n was exhausted. Her job had wreaked havoc on her emotions. As medical director of Pathways Home Health & Hospice, a non-profit group with three facilities in the Sa n Fra ncisco Bay Area, she’d been caring for dying patients for 13 years. “I view myself as a n empathetic person,” Brown told me, “But it was, ‘Oh my god! How can I continue to do this?’” A colleague told her about a course at the Metta Institute. Brown, a specialist in geriatrics a nd oncology attended a five-day retreat on “Cultivating Pres- ence at The End of Life,” and realized how helpful being aware of right where you are could be. “It would be so good for many more physicians to talk about what ’s going on emotionally, to grieve openly, and not be consumed by every- thing that ’s going on around them.” “ When they spend time with us, they get real practical support,” said Osta- seski. “ We show them how they can build more resilience, more balance in their lives, how they can work in a really tough environment without getting over- whelmed. When you talk to the doctors, they care. They want to do the very best job, but they can’t.” After the course, Dr. Brown started using the skills she learned with her col- leag ues and patients. One of her patients, a woman in her 50s, was succumbing to 300 to 400 U.S. doctors commit suicide every year Death by suicide in male physicians is 70% higher than among men in other professions, and up to 400% higher among female physicians than woman in other professions. ovarian cancer. She wasn’t eating, but was still vomiting. Although she was in terrible pain, she didn’t want to take pain medication. “I don’t want to be here any- more,” she would say. Her husband was falling apart. “ It was very difficult seeing her in that situation,” recalled Dr. Brown. One afternoon, as Dr. Brown was visiting the woman’s home, she did some- thing she’d never done before. She asked the woman to breathe with her. She said, “‘ I’m here with you. A lot’s going on right now. I just want you to close your eyes and think of a place that makes you happy. We’re going to breathe together and think of that place.’” A feeling of calm suff used the room. A big issue that doctors like Brown confront is their inability to “fix” people, a reality that contradicts their medical training. Mindfulness has freed Dr. Brown from that burden. “It’s more about my connection person to person, as opposed to the fixed role of the doctor,” she said. “Sometimes people will say to me, ‘You were so helpful.’ But all I may have done is listen to them talk. I get goose bumps when I think about these intimate interactions. It’s a privilege for me to hear their stories.” Several of her colleagues have also been through mindfulness tra ining, → October 2014 mindful 55