I teach mindfulness as a method to help combat the growth of burnout in physicians, especially surgeons. However, I do not believe that sustained improvement can occur without real change in the system in which we currently practice; without it, we will continue to see large numbers of our best and brightest drop out of surgery and medicine – or refuse to sign on in the first place. Part of the work I do is to help institutions partner with surgeons to align goals and priorities in a manner that promotes sustainable growth alongside physician satisfaction.
Yet, while we attempt to redesign how health care is delivered, it is wise to take steps to maintain our own sanity and wellness. One good method is mindful awareness, or “mindfulness,” which originated 2,700 years ago as a Buddhist teaching, but is now widely available in secular format.
The Basics
The beginning of mindfulness practice is awareness of the breath. While there are a lot of ways to refine and deepen this practice, the basics are remarkably simple to learn. The following “two-minute meditation” can provide a taste of what the practice offers.
To start — sit comfortably, preferably in a chair with a straight back. Meditation is intended to eventually lead to a natural, effortless awareness in all postures – standing, walking, lying down – but for a beginner, sitting down is easiest by far. Shrug your shoulders and wiggle them a little to ease any tension that has been building up through the day. Close your eyes, and take a deep breath. Now exhale, and do this a few times before settling down to a “natural” unforced breath.
Focus on Your Breath, Reconnect to Your Body
When breathing, focus on the physical sensation of the movement of the anterior abdominal wall just below the umbilicus. The goal is to notice the felt sensation of the movement, rather than any ideas or concepts about breathing. Try to be aware of the sensations in both inhalation and exhalation. It is not uncommon for the movement to only become perceptible after several breaths; many of us are habitually disconnected from everything below our neck, and wander around like Mr. Duffy in James Joyce’s Ulysses “…who lived a short distance from his body.”
It can be helpful to silently label the breath “in, out” or “1, 2” as a way to improve focus. Eventually, it is possible to let this go and simply be aware of the physical sensation alone, without the need for a mental label.
As you focus your attention on the movement of the abdomen and your mind starts to grow calm, a stream of thought will inevitably pop up. For many of us, it takes 10 seconds or less for this intrusion to interrupt your well-intentioned efforts to concentrate on the breath. When this occurs, your job is neither to prevent nor get rid of the thoughts. Instead, simply notice that thoughts have occurred — and then let them go — bringing your attention back to the abdominal wall.
When another thought pops in almost immediately, rinse, lather and repeat. It is often disheartening for beginners to see how persistently and incessantly our mind generates thoughts that seem to have very little substantive value or even coherence — the randomness of thoughts is what led to the Zen term “monkey mind.” Surgeons, as highly trained professionals, often hold the assumption that our thoughts must be preponderantly valuable or at least intelligent; observing the nonsense that our brains generate in a short period of sitting meditation is both eye-opening and depressing. I find the attitude that “the brain generates thoughts like the colon generates stool” a useful way to accept the situation for what it is — a natural function, something that warrants neither elation nor deflation.
Temporarily Remove Time-wasting Distractions
Before you begin, it is useful to set the timer on your phone for two minutes — this will prevent you from peeking at it every 10 seconds to see if you are done. Scheduling two-minute sessions at the beginning and end of the day is a good way to assess whether this practice might provide you with some calm and respite. If this is helpful, you can add more sessions during the day.
A useful adjunct to this practice is to, at least temporarily, remove Facebook, Twitter, Flipboard and other apps designed specifically for the purpose of wasting time from your phone. The problem with constantly checking in on your smartphone is that your brain quickly becomes habituated to perpetual stimulation, where every bit of peace and quiet and empty space is quickly filled with “infotainment.”
Every grocery store checkout line and airport terminal in America currently bears witness to this phenomenon. If you find it difficult to go for any period of time in complete silence, then your brain is likely as addicted to stimulation as you would be to caffeine, nicotine or other addiction – and the long term consequence is a sense of chronic stress and fatigue
No Substitute for Sleep
Finally, get enough sleep. There is no substitute for this one. While we may have borrowed heavily from the bank while in medical school and residency, there comes a time when it is necessary to repay that debt. Nobody works well sleep deprived, especially in the long term.
If the mindfulness approach described here resonates with you and seems useful, then please explore further — there are now myriad courses, books, retreats and other options for exploring mindfulness, meditation and other body-mind techniques in the context of stress reduction and burnout prevention. Teachers and courses are available throughout the country, and mindfulness-related techniques are no longer outside the mainstream. If you wish to contact me or for further information, please email me at [email protected].
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