Think about mindfulness when seeing a new patient

I had a “wow” experience recently when I accompanied my wife to interview a new doctor for her.   As some reader may know she is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer.   She has not had a local oncologist for the past 6 years, but she does now.   And we both love this guy!

You need to understand that I have been very underwhelmed by the local oncologists I had met up till now.   I am sure they were clinically proficient, but as a group not a one could muster a smile or any sense of interest or curiosity in my wife’s medical condition.  I held out little hope that this new doctor would be any different.

After being ushered into the exam room, a physician assistant came into the room to get smart about my wife’s history and records (which she brought).   Three things surprised me about the PA.  1) She was incredibly thorough actually reading the radiology reports and reflecting with my wife on what she learned, 2) her empathy – as she read the reports she actually used terms like “bummer” when she read how my wife developed pneumonia during her treatment, and 3) she faithfully summarized the results of her review to the doctor before he came in.  In other words – the PA listened and heard what my wife shared with her.

Now enters the doctor.   He has a warm smile on his face while he extends a hand to my wife and me.  He says just enough for us to know that he has talked to the PA.  He asks my wife to sit on the exam table and does a physical exam (also a rare event these days).

He then got her down from the exam table into a chair and sat down himself facing us.  He asked my wife why she was there and what she wanted to accomplish.  After all she had world class docs back in Houston.   He asked her why she thought her docs in Texas had stopped her oral chemo for 3 months.   He asked why they suggested she start some of her care locally instead of continuing to go down to Texas.  If the point isn’t obvious, the doctor seemed to value her opinion of what was going on with her care.

He empathized about it is like to be treated in a world class academic medical center, often long on experience but sometimes short on bedside manner.    He volunteered that given my wife’s situation he saw his role as collaborator with her primary cancer care team in Houston.   He would take care of her needs locally and advocate on her behalf when needed with the “experts” at MD Anderson.   And I was worried that this guy’s nose would be out of joint given her continued relationship with her docs in Houston.    The visit ended with a hug between my wife and her new doctor.   Something my wife told the doctor she was used to from one of her Houston docs.

What we like about my wife’s new doctor is his “mindfulness.” Specifically we liked the doctor’s attentiveness, curiosity, flexibility, and presence – all qualities of mindfulness.

We have already established the doctor’s attentiveness to the details of my wife condition.   His curiosity was evident by his questioning of my wife’s opinions on how her case was being managed.   In addition, the doctor enjoyed working with lung cancer patients.  The doctor flexibility was evident from his willingness to play “second fiddle” to my wife’s doctors in Houston.   Finally this doctor was “present” at all times during her visit.   He listened, picked up on “cues” from my wife and I, anticipated my wife’s needs and never looked at his watch.

So the next time you visit your doctor, or you visit with a patient, you might think about “mindfulness.”

It doesn’t take any more time I suspect, but can make all the difference to patients and their caregivers.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • http://www.howtobesick.com Toni Bernhard

    I am so glad to see that you and your wife were treated by a doctor who had mindfulness skills. I’ve written about mindfulness in my book, How to Be Sick, but my focus is on the person who is sick, not on the doctor! 

    But, as I read this piece, I thought about the experiences that I share about doctors in the book and how what they were lacking was mindfulness. I used different terms for it — e.g., they were lacking in “good listening skills” — but I love thinking of it in terms of mindfulness: careful and bare attention to the matter at hand, without judgment.I wish you and your wife all the best. Warmly,Toni

  • http://www.andromeda-med.blogspot.com AndromedaMed

    First, I want to wish you and your wife every success in your ongoing battle! As I recently posted Courage Wolf says “Tell cancer it only has a few months to live.”

    This post is so uplifting, because it is great to hear that there physicians like this out there. My family has been having a rough time finding anyone like you describe. My dad has Wenckebach, and his bpm hovers at around 50. But for a few months, it went down to 38-40. When my dad went to his primary care, the doctor didn’t even look at what the nurse had written down for his vitals! When my dad pointed out that his pulse was only 40, the doctor looked stunned and stumbled all over himself trying to listen to his heart. My dad then told him, as he had told the nurse during his history, that he has Wenckebach, and had he read any of his medical history at all, he would have known that. *sigh*

    • Anonymous

      Actually, Wenckebacks syndrome, or Second degree AV block, type A, is usually rather benign, and, unless your father was suffering from giddiness or fatigue attributable to it, it warrants no treatment. 

      Besides, the doctor would have likely heard very little when he “stumbled all over himself trying to listen to his heart”. This is a cardiac rhythm problem, with no auscultatory findings

      • http://www.andromeda-med.blogspot.com AndromedaMed

        Yes, I’m aware that Wenckebacks doesn’t normally require treatment, but as I said, his bpm had fallen from a normal 50 to hovering just under 40. This was accompanied by a mental and physical slowness (which I didn’t add to the post), hence why he went in to see his doctor. 

        But ignoring this, I was under the impression that a heart rate of 38-40 in a non-athlete older man was something that should be at least noted in a physical and commented on by a physician. The nurse even commented his pulse was low when she took it. Why would the doctor not ask about it? I would expect my doctor to know my basic vital signs by the time he got into the room with me.  Is a heart rate of 40 common enough that it doesn’t warrant at least a basic question? 

  • http://www.facebook.com/people/Anne-Lawlor/1345196099 Anne Lawlor

    That my friend, is as good if not better than any medicine, it’s called loving kindness and it costs nothing. It makes THE difference to patients and their caregivers. Problem? humility and loving kindness are not taught in med school.

    Wishing the best of everything to your wife.
    Anne

  • http://www.stampandchase.com Burl Stamp

    My prayers and best wishes go out to you and your wife as you bravely battle this terrible disease.

    While my professional philosophy related to an exceptional patient experience has always been aligned with the thoughtful characteristics you’ve so eloquently described, I’ve become even more adamant about the need for more meaningful connections with patients over the past few weeks. My wife’s mom recently was diagnosed with stage IV cancer, and dealing with individuals who are the antithesis of mindfulness has been one our biggest challenges.

    But a bright ray of compassion and empathy has recently come into our lives during this difficult time; my wife and her mom’s physician together decided it was time to call in hospice. Perhaps we should find ways to allow the compassionate hospice professionals who help us die with grace and dignity share their skills and mindful approaches with their colleagues who take care of those struggling to live.

  • http://www.inflammes.com Fabio Sanchez, MD, MSc, PhD

    Thank you for the note on mindfulness during clinical practice. As a medical practitioner I very much appreciate that you support those who are trying to do their best for the patient. I hope that the damage that consumerism has inflicted on patient-doctor relationships can be reversed.
    Best wishes for you and your wife.

    Fabio Sánchez
    http://www.inflammes.com

  • Steve Wilkins

    Thanks to everyone for the kind, warm wishes for my wife’s health. She actually is doing very well contrary to the horrible outcomes normally associated with her condition.  A big part of the difference is finding the right physicians and of course a lot of help from her “maker.”    

  • http://www.facebook.com/john.burik John Burik

    First of all, best to you and your wife! Second, I applaud your getting to the core of mindfulness, “attentiveness, curiosity, flexibility, and presence,” rather than a 10′ relaxation exercise.

  • Anonymous

    I am so glad to hear you’ve found a wonderful doctor who really sounds like he understands the role he plays in allowing a mindful conversation to emerge with his patients. At CareCoach we read hundreds of physician/patient dialogues a month in order to supply our members with the latest information and advice about how to prepare and improve their conversations with their doctors. As you noticed, it is extremely important and beneficial for docs to be mindful as this one was -through how they structure their open-ended questions and prompt patients to tell their stories as well as his gestures, gaze and body language. Linguistically this changes the whole outcome of the conversation. The thing we want to encourage patients/caregivers to remember is that they have the same things to say whether or not they are seated before a “mindful” doc but because of the power those docs have in controlling the conversation, many patients cannot get fully engaged in the ways they would like to and docs, even though they try their best, do not always realize the ways in which they truncate patient/caregiver’s contributions. A helpful resource are such web-based tools like CareCoach which are set up to help families listen to real dialogues from other patient’s office appointments so that they can prepare ahead of time and learn how to better managed the conversation.

  • http://www.facebook.com/profile.php?id=621709336 Jared Waterman

    While I’m greatful to hear there are still compassionate physicians still out there today, and they perform physical exams instead of relying on CT, I picked up an even better insight in this article.  The role of PAs did not go unnoticed, and perhaps KevinMD should pick up on this as he has posted some less than acceptable posts in the past viewing them in a negative way.  

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    Wishing you and your wive all the best. Glad you found compassionate caring physicians.

  • http://www.facebook.com/abedashi Allan Bedashi

    This is a great model for PA-MD-Patient team practice. Loved reading this article.

    Allan M. Bedashi, DHSc, PA-C
    PA Program Director/Associate Professor of PA Eduation