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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, 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.”

Learn how you can open your practice to mindfulness and be more present for your patients and your team by attending Dr. Dinenberg’s talk at The IHE Regional Summit in San Diego on April 30, 2018. Get more details and register here.

The clarifying lens of empathy

What empathy adds to your daily interactions with patients and team

Empathy enables you to put yourself in your patient’s shoes. Your ability to see and feel the situation from another person’s perspective can help you grow as a caregiver.

Some are concerned that it can also make you feel drained and perhaps even compromise objectivity. How do you allow empathy to inform your work and do your job effectively?

First, what is empathy? Amid the many academic interpretations and debates regarding what empathy really is, Patrick Kneeland, M.D., Executive Medical Director for Patient and Provider Experience at University of Colorado Health and consulting faculty at The Institute for Healthcare Excellence (The IHE), prefers to keep it simple: “Empathy is connecting without judgment with another person around the shared experience of being human.”

Empathy brings connectivity and a new dimension to caregiving. Read Pierce, M.D., from the Institute for Healthcare Quality, Safety, and Efficiency at University of Colorado Denver, and consulting faculty at The IHE, sees empathy as a driver of change.

“Change is not possible without deep respect for the human experience of what we strive to do for and with others,” Dr. Pierce says. He sees the connections between patient care and empathy/quality as the same pursuit: “a respectful, deliberate connection between people on the journey to improve, together, our current state.”

Born or made?
In that mode of collaboration, how do you encourage empathy in yourself and others? Are you born with empathy or do you cultivate it?

“Our best role models and highest performing teams ‘do’ empathy all the time,” says Dr. Pierce. “People with empathy not only model — they also practice cultivating empathy for their own benefit and to support sustainable performance in the pursuits that matter most to them.”

Dr. Pierce views empathy as part of what we explore and experience in pursuit of our own humanity. He places resilience, engagement with challenging work that brings joy (flow), compassion, and other feelings and behaviors we consider virtues, on the same plane.

Either and both
Within our human constraints, is there a need to balance our own well-being and empathy for others? “I think of well-being and empathy less as competitors — one at the expense of the other — and more as interdependent aspects of what it means to be human,” says Dr. Pierce. “Most often, building your well-being allows for greater access to empathy, and the opposite is also true.”

At some point, empathy is internalized, not as a competition (privileging empathy over other attributes) but as a sort of default setting. “Empathy of its own accord is not something to do less of, just as asking the brain to think fewer thoughts misses the mark,” Dr. Pierce explains. “Rather, the question is how we focus and harness this remarkable power more effectively.”

The clarifying lens
Dr. Kneeland adds an interesting metaphor — picture yourself choosing between lenses during an eye exam.

“I like to think of empathy as a clarifying lens, rather than something that clouds objectivity. Seeking to understand in more depth how other people are experiencing a particular situation can add incredible insight into the nature of a problem, and also offer surprising paths forward for improvement or healing. The best clinicians I know demonstrate empathy in all that they do. Same with the best leaders.”

From this point of view, your capacity for empathy and your capacity for objectivity are not mutually exclusive. They can go hand in hand. In the words of Dr. Kneeland: “There are multiple things that limit our empathy. One is certainly the myth that empathy somehow clouds objective judgment or impedes getting the ‘real work’ done. There are both intrinsic and extrinsic reward systems in our workplaces that reinforce that myth. In such environments, it takes considerable energy to maintain an empathic stance. Empathy begets empathy — and the opposite is also true. The healthcare world is no exception.”

Learn how you can expand your capacity for empathy with Dr. Pierce and Dr. Kneeland at The IHE Regional Summit in San Diego on April 30, 2018. Get more details and register here.