Stethoscope

#41 An orthopod teaching mindfulness: Is it an oxymoron?

 

7 December 2018

A busy orthopaedic surgeon is probably the last person that you would expect to become involved in something fluffy like mindfulness meditation. Several years ago I realised that things weren’t quite right with my life despite having a successful career as an orthopaedic surgeon. I became aware that work was becoming overwhelming and I realised that I had several of the features of burnout, including emotional exhaustion and a loss of confidence in myself, particularly when things didn’t go smoothly. I would often ruminate about complications and this was exhausting.

I was fortunate to find the Mindfulness Based Stress Reduction (MBSR) course over 10 years ago and this was a real game changer for me. This eight week semi-structured mindfulness program was brought into mainstream medicine at Massachusetts Medical School in 1979 by Dr Jon Kabat-Zinn. A molecular biologist by training, Dr Kabat-Zinn had spent several years training in Zen and Theravada Buddhist meditation in Asia. He incorporated the wisdom of these traditions into the secular MBSR program making it accessible to western medicine. This course is now available all over the world and has been subject to the scrutiny of many scientific studies demonstrating its efficacy in treating conditions such as chronic pain, anxiety and depression, as well as offering improved general wellbeing to all participants.

After completing this course, I continued meditating regularly. I went from being a person who was simply existing to one who is now flourishing and enthusiastic about life and work. Some of you might say that this is simply an anecdotal report. However, there is now very strong evidence that mindfulness meditation improves the quality of doctors’ personal and professional lives. 

I hoped that one day I might be able to teach the MBSR program. I was fortunate to attend a workshop for health professionals with Jon Kabat-Zinn in Sydney. Following this, my wife Jo and I completed our MBSR teacher training. We were both involved in a randomised control trial looking into the efficacy of this program for patients undergoing joint replacement surgery. This study was done at St Vincent’s Public Hospital in Melbourne and is about to be published. It has demonstrated a significant improvement in pain and function in those patients who did the MBSR course prior to surgery. 

Jo and I have now been teaching mindfulness courses for staff at St Vincent’s Hospital and the feedback has been overwhelmingly positive. In the last two years we have also commenced our Mindfulness in Medicine course specifically designed for doctors. Burnout in our medical workplace and in hospitals is receiving increasing publicity; which is a good thing. We are constantly dealing with patients who bring pain and suffering to the consultation. Empathy is an automatic response in dealing with another person’s suffering. Constant exposure to the suffering of others can lead us to distance ourselves emotionally in order to cope. A great deal of emotional effort is necessary to block our natural empathic response and this often leads to emotional exhaustion. 

Alternatively, we may over identify with the person suffering and this can result in feelings of overwhelm and empathic distress. Mindfulness helps reduce personal distress for doctors and leads to improved wellbeing. We are more able to shift our appraisals and recognise whose feelings belong to whom. Mindfulness assists us in developing sustained attention for managing emotional resonance to suffering, particularly when we are under pressure or in stressful situations. Mindfulness invites us to cultivate a sense of compassion for one’s self as well as compassion for others. It has been demonstrated that compassion is one of the best antidotes to burnout. 

Some doctors have suggested that providing mindfulness or resilience training in our workplace is simply a cop out in the face of a widespread dysfunctional culture in our health system. There is a view that administrators have not done enough to address this problem and that this is what needs fixing, rather than doctors taking ownership of their own behaviours. I agree that there is a need for major structural and cultural change to reduce the emotional distress of being a doctor today. However, it doesn't have to be one or the other. If we can bring mindfulness into the medical workplace then I believe that this will enhance the possibility of cultural and structural changes. It is worth noting that medical workplaces that have prioritised a culture of civility and respect have noted a diminished burnout rate among their staff.

There is good evidence that mindful doctors experience fewer medical and surgical errors and respond with more wisdom and care for their patients when things do not go as planned. Patient compliance and satisfaction are further benefits of improved quality of care.

Over time I had come to dread consultations, seeing them as just another patient with hip or knee pain. I now see the person who comes into the consulting room as unique, with their own story. I am there to do the best I can for each of them. That is so much more rewarding and fulfilling.

For further information about our program for doctors see www.mcfm.com.au

 

Mr Tony Dunin

Orthopaedic surgeon

MBSR teacher

 

This article appears in the December 2018 edition of Vicdoc.

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