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AANS Neurosurgeon | Volume 28, Number 3, 2019

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The Case for Mindfulness and Compassion

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The hospital gown makes the 5-year-old boy look even smaller as he waits for surgery. He has a cancer (medulloblastoma) located in the posterior fossa (back of his brain). My assistant is a senior surgery resident in training. We both are laser-focused on removing the tumor. We cannot think about anything else during surgery. It is a form of single-pointed concentration almost like meditation.

Focus Lost

While I am removing the last piece of the tumor, my assistant lets his eyes wander for a second and in that second his suction tears the vein – for the briefest moment everything stops. The blood fills the resection cavity and begins to pour out of the wound. The anesthesiologist starts yelling that the child’s blood pressure is rapidly dropping. I need to clamp the vein and stop the bleeding, but it has retracted into a pool of blood – I can’t see it. We might lose this child.

Focus Regained

I am working blind, so I open my heart to a possibility beyond reason, beyond skill and I begin to do what I was taught decades ago, not in residency, not in medical school, but in the back room of a small magic shop in the California desert. I calm my mind. I relax my body. I visualize the retracted vessel. I see it in my mind’s eye. I reach in blindly into the pool of blood with the open clip, close it and slowly pull my hand away. The bleeding stops, and then, as if far away, I hear the blip of the heart monitor, faint at first, but soon getting stronger as all hearts do when we come to life.

The effects of stress in the workplace are well documented. The field of medicine is not immune. Only recently, the public perception of invincibility of surgeons started to change as burnout rates of physicians have had a dramatic rise. Whether at academic institutions or in private practice, stress is taking its toll with a number of physicians leaving the practice of medicine.  

The brain of a neurosurgeon is not immune to the effect of stress. In fact, neurosurgery might be the most stressful specialty of all. Two-thirds of neurosurgeons in the U.S. experience burnout at some point in their working years:

  • For some it manifests as forgetfulness.
  • Others experience compassion fatigue.
  • Some experience moral injury and completely lose their motivation to serve their patients.
  • In the worst cases, as defined by the ICD-10, physician’s burnout results in a state of vital exhaustion.

Mindfulness and Compassion

I am most often asked how I apply mindfulness and compassion to my job as a neurosurgeon. Being able to apply mindfulness training and a self-compassionate attitude to my profession gave me permission to attend to my own health and well-being. Additionally, this has allowed me to be a more attentive listener to my patients and to realize that often their major problem is not what is on the imaging study, but what is going on in their mind. So often, we forget that the interaction we have with a patient, while routine to us, is often profoundly stressful for them. Being a more compassionate listener often has a huge impact on how we ultimately treat the patient.

And this is not my personal or anecdotal experience. Promising research is pointing at mindfulness and compassion training as a possible remedy for burnout as they can help physicians increase their focus, become more empathetic and risk less emotional exhaustion. This can result not only in a less stressful experience for the patient, but in better outcomes.

Speaking as the founder and director of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford, we have developed a number of interventions that include a Compassion Cultivation Training (CCT) program that is being taught to medical students, residents and faculty. This program has a positive effect on various aspects of burnout and job satisfaction, such as:

  • Self-reported mindfulness
  • Self-compassion
  • Compassion toward others
  • Interpersonal conflict

The implications range from promoting mental health resilience in physicians to improving patient care, making compassion and mindfulness training a helpful tool in the armamentarium of physician self-care. 

References

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1. Doty, J. R. (2016). Into the magic shop: a neurosurgeons true story of the life-changing magic of compassion and mindfulness. New York: Penguin Random House.

2. Deligkaris, P., Panagopoulou, E., Montgomery, A. J., & Masoura, E. (2014). Job burnout and cognitive functioning: A systematic review. Work & Stress, 28, 107–123.

3. Gunderman, R. (2014, February 21). For the young doctor about to burn out. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/02/for-th0e-young-doctor-about-to-burn-out/284005/

4. Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12, 189–192.

5. Savic, I. (2015). Structural changes of the brain in relation to occupational stress. Cerebral Cortex, 25, 1554–1564.

6. Jazaieri, H., McGonigal, K., Lee, I. A., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. R. (2017). Altering the trajectory of affect and affect regulation: The impact of compassion training. Mindfulness. Advance online publication.

7. Seppala, E. M., Hutcherson, C. A., Nguyen, D. T. H., Doty, J. R., & Gross, J. J. (2014). Loving-kindness meditation: A tool to improve healthcare provider compassion, resilience, and patient care. Journal of Compassionate Healthcare. 

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