“If while washing dishes, we think only of the cup of tea that awaits us, thus hurrying to get the dishes out of the way as if they were
a nuisance… [then] we are not alive during the time we are washing the dishes. In fact we are completely incapable of realizing the miracle of life while standing at the sink. If we can’t wash the dishes, the chances are we won’t be able to drink our tea either. While drinking the cup of tea, we will only be thinking of other things, barely aware of the cup in our hands. Thus we are sucked away into the future – and we are incapable of actually living one minute of life.”
can mindfulness and modern medicine coexist?
Often, especially when I practiced primary care, I felt the need to accomplish a task to get to the next one. My task-oriented nature repeatedly stole my present and gifted it to the future.
Prescription refills, prior authorizations, signing documents that have nothing to do with patient care – all exploited this weakness. I was always to trying to wash the dishes to have clean dishes.
I could not seem to live a minute of life while at work.
After I had decided to quit my job, I went on a solo grief retreat in the Mojave Desert. Among the joshua trees and cinder cones, I finally returned to the present. I read the Miracle of Mindfulness for the first time.
While reading, I had a revelation: the basic structure of modern medical practice sabotages mindfulness.
working on self-compassion
In current practice, organizations expect physicians to welcome any and all intrusion into their work in the name of patient care. However, increasingly non-patient centered tasks fall into this category. Seemingly, the system has learned how to manipulate our value system. Suddenly, anything anyone wants done is a reason to interrupt.
Sadly, even before I lost my daughter and things took a turn for the worst, I felt an intense pressure to try to fix what I found unpalatable in my worklife. I put the pressure for resolving my discontent with the system entirely on my shoulders.
Now, I am no accomplished mindfulness practitioner. In the Miracle of Mindfulness, Thich Nhat Hanh discusses the relative ease of being mindful alone on a walk in the woods rather than in company. I should not have realistically expected myself to find a way to mindfulness surrounded by the least mindful workplace I have experienced.
every system is designed to achieve the results it produces
It is unfair to expect a novice in mindfulness to advance as a practitioner in such an environment. Shift work has helped relieve me of this burden, an under-appreciated reason for its increase in popularity. I can focus on medicine while at work, and focus on washing the dishes when not.
I hope someday I will be mindful on the scale of minutes or seconds. On the other hand, isn’t that too much to ask of a novice? Yet, that is what our system demands of doctors. Burnout is the natural outcome, not an occasional, unfortunate byproduct.
Nonetheless, hospital executives seem to think that a half-day mindfulness seminar is good enough to prevent physician burnout. A lecture and some breathing exercises checked the box, no need for changes to systemic processes or organizational culture.
“Feelings, whether of compassion or irritation, should be welcomed, recognized, and treated on an absolutely equal basis; because both are ourselves. The tangerine I am eating is me. The mustard greens I am planting are me. I plant with all my heart and mind. I clean this teapot with the kind of attention I would have were I giving the baby Buddha or Jesus a bath. [emphasis added] Nothing should be treated more carefully than anything else. In mindfulness, compassion, irritation, mustard green plant, and teapot are all sacred.”
welcoming, recognizing, and treating ourselves equally
Part of learning to be in the world is coming to terms with our own frailties. At first, I viewed my current position of a traveling critical access doctor as a transition until I found a new permanent practice.
I had phone interviews for perhaps a half-dozen practices. A funny thing happened: by the end of every interview, I no longer wanted the job.
After having this epiphany, I eventually accepted I currently don’t have the level of accomplished mindfulness to face the mindlessness of modern medical practice. In the middle of a busy clinic or call day, I just don’t have the mental discipline to wash the teapot like a baby Buddha or Jesus.
I then asked myself a second question, “Should I want to?” I am still working on that answer. So far, in my grieving state, I am just not willing to work so hard just to be able to survive the barrage of dysfunctional practices that are currently de rigueur.
An opportunity to not only survive medicine, but actually thrive, may someday yet appear. We, as physicians and patients alike, can only hope.