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Are you present in body and mind?

See the difference mindfulness and presence can make in a therapeutic relationship.

Q&A with Eric Dinenberg, MD, MPH, eric.dinenberg@xpeditionhealth.com

Eric Dinenberg, MD, MPH, a member of The IHE faculty, has conducted research and training on mindfulness for physicians, allied health and patients. His interests include resiliency for healthcare providers, mindfulness applied to population health, mindfulness for veterans affected by PTSD, and mindfulness for wellness. Read his full bio.

Dr. Dinenberg took a few minutes to answer our questions on mindfulness for healthcare professionals. Here’s what we learned:

1) How do you introduce mindfulness to other doctors and medical professionals?

I let doctors know that mindfulness is a practice that will help them toward (1) their own peak performance, (2) their own way to address or prevent burnout, and (3) their own way to provide excellent care.  A busy doctor can practice mindfulness formally in one 5-minute practice session per day (See Dr. Dinenberg’s 5-minute practice session on YouTube). Once formal practice is established, informal practice can be integrated seamlessly into a day of seeing patients. This means practicing a 5-second version of your 5-minute mindfulness practice while washing hands or just prior to knocking on the patient’s door.

2) Presence vs. Multitasking; is it one or the other?

On the one hand I feel it is impossible to be 100 percent present with a patient if the patient interaction includes seeing the patient and, at the same time, doing anything else. On the other hand, many doctors are present with their patients, while, at the same time, documenting in the medical record. Depending on how the patient interaction goes, a doctor who is charting while talking can, for a moment, put the electronic medical record aside and dive into being 100 percent present for the patient. I would want my doctor to be 100 percent present for me or my loved ones. That non-multitasking presence is part of the sacredness of the doctor-patient relationship.

3) Can Presence make a difference to the patient? How?

Presence makes all the difference for patients. When I was a medical student I fell off a balcony and broke my neck.  I remember being rolled into emergency surgery feeling absolutely terrified. A physician leaned over my gurney, made eye contact, put his hand on my shoulder, and said, “I am here.” My terror melted away at that moment. The presence of that physician made all the difference for me.

On the other hand, lack of presence not only puts patient safety in jeopardy, but erodes that all-important therapeutic relationship. I heard a patient tearfully recount how her doctor took a phone call during a conversation where he was breaking bad news to her about her medical condition. Here we have a glaring example of how patients can perceive physician multitasking not only as a lack of presence, but as severe disrespect.

4) What if the patient is not “all there” – is the effort less effective if it’s one sided?

People are suffering when they come see doctors. Depending on the severity of their medical condition, feelings of vulnerability and the sense of being overwhelmed are common. Add to that anxiety over insurance coverage, medical billing, and co-pays and you can understand why patients may not be at their best when seeing a doctor. Being there for someone who needs help is why many doctors dedicated ourselves to the practice of medicine in the first place. A doctor who is mindful effectively holds the space of the present moment for a patient who may be half distracted. Recall my story of when I was being rolled in to surgery (I was not half, but all distracted by fear), and how I felt held, safeguarded by the presence of my doctor and you will see that yes, a mindful physician can hold the space for the therapeutic relationship even when the patient is not “all there.”

See Dr. Dinenberg’s bio. | Register for the Excellence in Healthcare Conference.