Mindfulness in the clinical visit

Mindfulness Collectives Mindfulness in Medicine
#1

I can’t remember the last time a colleague told me “wow, clinic was easy and ahead of schedule today!”. My experience has been that its hectic, there’s never enough time to be with my patients, and I’m left with way too many charts to fill out at the end of the day. And there’s lots of data showing that physicians are burnt out etc.

At UMASS, we’re starting to pilot out simple ways to bring mindfulness into the clinic (stay tuned for more on this!). Do you have a story or anecdote to share about how you brought your mindfulness practice to the bedside or clinic encounter? And how did this affect you (and the encounter)?

For example, I noticed I was frazzled, stopped at the door before entering my patient’s room, and just dropped into noticing my body sensations for 10 seconds and then…

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#2

As a counselor on a palliative care team at a local hospital, I try to offer a mindfulness practice experience to some patients in their rooms. Often surprised by there persons who show an interest in mindfulness and who say it helped reduce their sense of pain a little bit. But hospital rooms are tough places to practice mindfulness because of the constant, or seemingly constant flow of persons into and out of the room. Wonder if putting a small sign on the door might work, saying a brief mindfulness session was in progress. Anyone have any experience doing that?

Best,
Michael Knapik

#3

Just as doctors didn’t talk about sexuality until there were sex therapists(and Viagra) I find myself more and more often bringing up mindfulness because I increasingly feel I have something to offer. I have realized most people won’t be able to manage an MBSR class due to transportation and child care and other challenges but my patients are still interested being in this moment. Now I offer them my CD’s and they actually often do them. It feels wonderful to be able to offer something tangible.

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#4

I have been using breath / body awareness practice with my primary care patients in the exam room, and in particular with acutely anxious and hypertensive patients. It has been exciting for me to see what can happen when patients and I become more present in the clinical encounter. I have had several patients with intense “white coat” syndrome and extremely elevated blood pressures (200/100 or so), just sit with me and become aware of their bodies sitting on exam table and breathing in the present moment. I have been seeing big drops of blood pressure (50 mm hg or more) coupled with calm. One elderly man, who has always feared coming in for visits and has severe white coat syndrome, was so moved by the intervention that he now routinely practices breath meditation in my waiting room before visits!

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#5

Hello,
I have now had some wonderful experience with teaching ( or rather introducing ) mindfulness to my patients.in my clinic, we have 3-4 exam rooms going at one time.We have placed white boards on the door which we use for different things but one of them is I will write MIP (meditation in practice ).This is so the medical assistant knows. I also add how many min and the MA knows that way they should go in after that time to check in with the patient and often repeating the BP is indicated at those times.

We also bought some inexpensive noise cancelling type headphones do the patients don’t het disturbed very much.My patients are using an app (Insight timer.). I play it on an iPad.

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#6

I practice pairing mindfulness with closing my office door. As I enter my office with each client, I pause and turn the body, take a deep breath, place my hand on the door, observing the hand, feeling the door and movement of it entering the doorway, noticing the tightening and being right there as it catches and becomes “closed.” Then, another breath as I turn and face the client with fresh eyes, observing as if I don’t “already know” this person or situation. Thank you, Mindfulness.

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#7

Whenever there is a painful procedure I need to preform i.e. a cortisone injection. I notice the patients body language. Most cases there is a person grabbing the arms of the chair, palpable tension all over their face.

I suggest we try something. I ask them to try to sit comfortably, breath slowly, concentrate on their breath. I tell them they have a power to feel this breath, to focus away from anything unpleasant… I talk calmly , tell them it will be over in a few seconds. I show them the Ethyl Chloride spray which I assure them will limit their discomfort. I never say pain.
After a few minutes, I see the patient focusing on their breath, relaxing. I continue to talk to them about their breathing. The injection is much easier, for them and me.

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#8

It is about 10 meters between my office and the clinic waiting room. I’m getting in the habit of using the stepping out of my office door as a mindfulness bell, and dropping into my body as I walk to greet my next patient. I’ve noticed it helps drop anything that I might have carried from my last patient, and bring some freshness into that moment when I great my next patient.

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#9

What a great topic! Am excited to read more! In my practice as an anesthesiologist, I have started sitting down with every patient I interview, even if for only 4-5 minutes. I think it has helped me to stop and focus and be in the moment. I also believe, as the literature would suggest, that my patients feel more involved and perhaps “cared for” in the perioperative process.

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#10

Hello everyone!

Grateful for this topic. Small-town Missouri family medicine here. I too use the steps I take to get to my office, and to the exam rooms, for grounding in my body. I find the small doses of mindfulness, repeated frequently throughout the day, to be very useful in keeping my awareness open and myself available to my patients. Since the Mount Madonna retreat, I have really been working on noticing where my awareness is during the office visit. I’m finding that if I keep about 20% of my attention in my body during the visit, I am able to notice more quickly when I contract or move away and can bring myself back to the patient. Doing this, I have noticed a very subtle pulling away if I perceive that I am not meeting the patient’s expectations. I can feel it before I notice it cognitively. My shoulders tense and my breathing becomes shallow, and I start messing with my computer. Noticing, I breath into my body and smile. This has undoubtedly changed the trajectory of many office visits.
Thanks for reading! Thoughts are appreciated!

#11

This is an important topic, so thank you. When I sit down with a patient, I notice myself sitting on the chair, feeling my feet on the floor, connect with my breath. Seeing my patient and being open and receptive to who they are in this moment.
The other day I had an experience where I was listening to my patient, and instead of feeling compassion I felt angry and impatient. It caught me off guard. I took my attention back to my own breath, my bodily sensations, and just “noticed” my feelings. I was able to stay present with her, in spite of these feelings that came up. Not sure where they came from, maybe my own fatigue perhaps (it had been a long day). But the mindfulness practices helped my stay in the present and not close myself off because of them.
Thanks for listening.