Other qualities of mind, in Dr. Ferguson’s view, include the whole spectrum of empathy and compassion, being personable in the sense of being open to what patients and families have to say, and being patient. She also believes the quality of mind necessary to express a human touch is sometimes missing.
Valerie Lang, MD, is also a hospitalist at URMC and has studied mindfulness with Dr. Epstein. She is enrolled in Dr. Krasner’s class for healthcare providers on being mindful. What qualities of mind does she think are important for a hospitalist to have?
“I want to say an open mind, but that’s such a broad term,” she says. “Dr. Epstein uses the term ‘beginner’s mind’ [to refer to] when you’re willing to consider many alternatives, where you don’t necessarily jump to a conclusion and then just stick with it. As a hospitalist, you start making those conclusions as soon as you hear what the patient’s chief complaint is. I think that having [a] beginner’s mind … is so important because we don’t know these patients, and it’s easy to jump to conclusions because we have to make decisions very quickly and … repeatedly.” She also believes that “being able to reflect on how you are communicating with another person is incredibly important to their care.”
—Valerie Lang, MD, hospitalist, University of Rochester Medical Center
Operationalizing Mindfulness
In 2004, after the publication of two of Dr. Epstein’s articles on mindful practice in action, the Arthur Vining Davis Foundation approached him and requested a proposal.5,6 At that time, he was in the process of writing an article on reflection and mindfulness in the context of preventing errors.1 (See Table 3, left.)
“This [proposal] was an intriguing possibility,” says Dr. Epstein, “and galvanized my putting together a curriculum that would not just be elective experiences for preclinical students, which is what the offerings related to mindfulness currently are, but something that was really going to influence clinical training.”
In Dr. Epstein’s view, placing educational reform in the first two years of medical school is teaching it when it matters the least. “Where it matters the most is when students are interacting with patients and using the knowledge and skills and doing work that they’ll ultimately end up doing for the next 30 or 40 years,” says Dr. Epstein.
One project plan is to train practicing primary care physicians to communicate more mindfully with their patients. Outcomes of the intervention will be measured by how it has affected the physicians as well as the patients’ ratings of their physicians and their practice styles.
The second project is a series of annual workshops for 100 third-year medical students and about 250 residents in the nine largest programs at the medical center. All participants will take five seminars that include mindfulness techniques to improve the capacity for paying attention and observing, and narrative exercises, whose themes will include, for instance, suffering, meaningful experience, professionalism, physician self-care, and avoiding burnout. The coursework, which will include both cognitive and experiential content, will also involve training a cadre of about 20 faculty members to teach these sessions, and educational outcomes will ultimately be measured for all participants.