health care

Watching the Clock

Watching the Clock

"As conscious human beings, we know we die, and we therefore know our clock ends on, some level. So time just seems foundational. And I think a lot of the gymnastics that we do as human beings has to do with our relationship to the clock, or lack of a relationship to the clock. We squander time until it’s too late, et cetera. I love looking at the building blocks, the raw material, the irreducibles."

~ B.J. Miller

Waiting Strategies for Giving and Receiving Care

Waiting Strategies for Giving and Receiving Care

Whether we are giving or receiving care, we come face-to-face with time’s elasticity – how it seems to speed up and slow down.

A Fundamental Ingredient of Excellent Care

Excerpt from "Teaching Doctors to Be Mindful," by Tara Parker-Hope, Well blog, New York Times, Oct. 27, 2011:

“Mindful communication is one way for practitioners to feel more ‘in the game’ and to find meaning in their practice,” said Dr. Michael S. Krasner, an associate professor of clinical medicine at Rochester and one of the study authors. He, along with his co-author Dr. Ronald Epstein, a professor of family medicine, psychiatry and oncology at Rochester, developed the course in mindfulness.

But it takes training, and that training can be particularly challenging for physicians who are used to denying their personal responses to difficult situations. In addition to learning to meditate, doctors participate in group discussions and writing and listening exercises on topics like medical errors, managing conflict, setting boundaries and self-care. Small group discussions are meant to increase awareness of how one’s emotions or physical sensations influence behaviors and decisions...

...But the real challenge for these participants — and the growing number of advocates of such training — is not acquiring mindfulness. It is finding the time and support necessary to sustain their skills and teach others.

Once back in their work environments, many say it is easy to fall back into old patterns. Dr. Krasner and Dr. Epstein have had to close down some of their programs directed at interns and residents because of financial issues. And a frequent topic of conversation among several of last week’s participants who hoped to teach at their own institutions were how to best introduce these ideas to colleagues who might be skeptical or administrators who might be hesitant to set aside valuable clinical time for training courses or pay for a program that does not generate revenue.

Nonetheless, Dr. Krasner and Dr. Epstein remain optimistic, in large part because they believe that mindful communication is not just another optional skill or fringe fad in health care. “Mindfulness,” Dr. Epstein said, “and the self-awareness it cultivates, is a fundamental ingredient of excellent care.”

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Outside the Network

by Daron Larson

It makes me feel alone
to answer to a name
I've never used.

What we say to each other
contracts space or expands it.

They keep saying the new system lets
all the departments communicate better,
but I live outside the network.

Explosives seem to be lurking in the forms,
so I step gently and imagine
relying on one leg or one eye
for the rest of my life, simply
because I am too timid to ask for clarification.

I am single in this world, alone on paper,
because our relationship is not one of the options.
After all this time, we're still just friends.
This is not personal, it's just a field,
in the same way that a name is a field.

I'm not sure what to remove
and struggle to take off my ring
wishing I'd left it at home where it means something.

I play along
and promise not to move,
not to breath too deeply,
to avoid painting a picture
that distorts the way things really are.

The machine bangs through my ear plugs,
but drowns out the comfort of human voices
warning me about what will happen next.

Another body reclined here just before mine,
and soon there will be another.

The machine will reveal esoteric details
about my bones and muscles,
but who will warn the caregivers
when their hidden hearts have atrophied
beyond their capacity to feel?

Mindfulness Training Improves Attitudes about Patients and Their Care

Excerpt from “Mindful Meditation, Shared Dialogues Reduce Physician Burnout,”  News Room - University of Rochester Medical Center (September 22, 2009):

Training in mindfulness meditation and communication can alleviate the psychological distress and burnout experienced by many physicians and can improve their well-being, University of Rochester Medical Center researchers report in this week’s issue of the Journal of the American Medical Association (JAMA).

The training also can expand a physician’s capacity to relate to patients and enhance patient-centered care, according to the researchers, who were led by Michael S. Krasner, M.D., associate professor of Clinical Medicine.

“From the patient’s perspective, we hear all too often of dissatisfaction in the quality of presence from their physician. From the practitioner’s perspective, the opportunity for deeper connection is all too often missed in the stressful, complex, and chaotic reality of medical practice,” Krasner said. “Enhancing the already inherent capacity of the physician to experience fully the clinical encounter—not only its pleasant but also its most unpleasant aspects—without judgment but with a sense of curiosity and adventure seems to have had a profound effect on the experience of stress and burnout. It also seems to enhance the physician’s ability to connect with the patient as a unique human being and to center care around that uniqueness.

“Cultivating these qualities of mindful communication with colleagues, anectodotally, had an unexpected benefit of combating the practitioners’ sense of isolation and brought forth the very experiences that are such a rich source of meaning in the life of the clinician,” he said.