It is easy to lose oneself while swimming in a sea of medical facts surrounded by overburdened physicians and high-acuity cases. Initially, it is difficult taking care of one patient, much less a whole service. The transition from student to student-doctor is not as homophonic as the semantics would suggest — and this transition affects the mental health of thousands of medical students each year.
Medicine is less a profession and more a way of life, and physicians, arguably, take their work home more than any other professional. In a literal sense, home call is doing exactly that, and this prevents physicians from leading lives in which they are satisfied by their work-life balance. Surveys of over seven thousand physicians have found almost half of all physicians to suffer from at least one symptom of burnout and a similar percentage to be dissatisfied with work-life balance. Job dissatisfaction has been shown to be significantly associated with the estimated 300 to 400 annual physician suicides. We have known about the dangers of physician suicide and drug abuse since the early 1900s, as evidenced in peer-reviewed literature. But there seems to be no improvement in the rate of annual suicides amongst physicians since at least the 1970s.
Some have proposed that poor physician mental health is due to physicians having been trained to be “superhuman,” which results in them feeling inadequate when they require assistance. Others have blamed the culture of medicine as a whole, with its indoctrination of physicians as wholly self-sacrificing individuals. They contend that the culture instills an exaggerated sense of duty and perfectionism magnifying poor mental, physical, and emotional health.
Physician well-being has been an area of prolonged investigation, but slow progress. The effect of mindfulness and meditation on the mental and emotional stability of health professionals has more recently become an active area of research. The basic definition of mindfulness is the simple practice of being conscious and present as much as possible. Meditation, as a branch of the mindfulness tree, can informally be defined as using periods of intense focus to hone the skill of being mindful, whether that focus is directed towards only your breath, or a mantra that is repeated for variable amounts of time. The goal of this process is to translate your thoughts more directly into actions in everyday life and be more proactive in dealing with situations in a stable or centered manner.
Biologically, several studies have documented neuroanatomical changes in people with a long history of meditation. Specifically, findings such as increased gray matter density and cortical thickness in regions of the somatosensory and insular areas have been repeatedly verified. More importantly, these anatomical changes have been shown to be related to psychological and emotional changes resulting in significant reduction of several psychological indices related to worry, state anxiety, and depression.
Growth in mindfulness literature, especially studies with a high level of evidence (peer-reviewed, prospective, randomized controlled trials), has grown quite literally exponentially over the last decade. In concurrence with the evolution of mindfulness research, there has been a move towards formal programs that place emphasis on mindfulness and open communication, with increasing research showing such practices to be a useful and easily applicable tool in the medical profession.
In a recent randomized controlled trial, it was determined that participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement. A meta-analysis similarly showed meditation to lead to decreased anxiety, depression, and pain. And these studies are a small part of the progressing research showing meditation and mindfulness to benefit patients with cancer, fibromyalgia, strokes, and chronic pain by allowing them to lead lives with reduced stress.
Similar results have been achieved in the health professional population with periods of meditation as short as eight weeks to be linked to positive emotional states such as at peace, optimism, and happiness. Even more significantly, physicians who were more mindful have been shown to be more likely to have good rapport with patients, leading to improved patient satisfaction and higher ratings. It is not surprising, therefore, that recently implemented mindfulness programs have been shown to be “positive and transformative,” allowing physicians to “listen deeply to patients’ concerns,” and “give themselves permission to attend to their own personal growth.”
The implementation of mindfulness does not have to wait for the long delay of a hospital system to implement program wide changes that may be resisted by administrative bureaucracy. Though system-wide changes in mental health are overdue and critical to the health of physicians, the plethora of Web-based and platform-based applications can tailor mindfulness to anyone and everyone’s needs. Therefore, it should not be difficult for the busiest individuals to forego at least ten minutes of meditation daily – whether during their morning commute or before bedtime.
Like most things, the practice of meditation becomes easier with time, though now with the use of technological advances and evidence-based information. As an innovative society, we are quick to jump to pharmaceutical measures which may improve the health of our patients as reported by peer-reviewed literature, but the same literature is now providing us with a cost-effective, time-efficient, and evidence-based method to improve both their physical and mental health along with our own. Mindfulness’s deliberate presence allows for improvement in care of peers and patients even when not directly caring for them in a medical manner. And it is this deliberate presence that can provide individuals with tools to be mentally and emotionally centered in a professional field that demands continuously increasing forms of self-sacrifice.
Ayoosh Pareek is a medical student.
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