Physicians are healing themselves through meditation
McGill’s mindfulness meditation teaches doctors coping skills
By JAY REID, Special to The Gazette April 19, 2012
MONTREAL – It’s not easy to work with critically ill children and stressed-out parents. Doctors who work in pediatric-palliative care do it every day. Conversations with parents are often tense; frustrations can boil over – on both sides.
Pediatrician Stephen Liben knew he needed to figure out how to cope better with the stress. The director of pediatric-palliative care at the Montreal Children’s Hospital was finding himself angry or defensive in heated moments with parents.
A calm doctor is a better doctor. He knew he could do better as a physician.
So he decided – reluctantly – to try mindfulness meditation.
McGill University offers such a program for healthcare professionals, and colleagues had spoken highly of it. Liben was skeptical, but willing.
“If you’re finding yourself reacting out of anger or frustration and it has brought neither you nor others around you any happiness or understanding, you start asking yourself: Is there any other way to be in the world other than this reactive way?” Liben said.
The Mindfulness-Based Medical Practice program is part of McGill University’s Whole Person Care program, which educates physicians on how to treat not only the physical, but also the psychosocial and spiritual aspects of a person, while also dealing with their own well-being. The mindfulness program is modelled after the University of Massachusetts Medical School’s Mindfulness-Based Stress Reduction Program (MBSR), which has been offered to health-care professionals for 25 years.
Mindfulness is about being fully present in the moment and able to take a step back from a stressful situation.
Meditation offers a structured way to achieve mindfulness. Liben says mindfulness can arise naturally, but meditation fosters it so it can happen more often, and it can be used at will.
Liben’s emotion-packed days were leaving him feeling drained and fatigued. If he were to begin a treatment to manage a sick child’s pain and it failed, he would get upset because he would see himself – rather than the treatment – failing the child.
Parents, feeling helpless at their child’s serious condition, are often angry, and sometimes take out their anger on Liben or other staff. Parents of very ill children often have an uneasy relationship with palliative-care doctors: They see them as somehow giving up hope for their child, Liben says. In cases where a child is likely to die, some parents even refuse to talk to him or his team, believing they are no longer looking for a cure.
Liben went through the program. Once a week for eight weeks, he attended class for two and a half hours, getting instruction in mindfulness meditation and mindful yoga along with methods to enhance awareness in everyday life. There was also a sixhour retreat.
The doctor gradually warmed up to the concepts, but was not completely sold by the end of the program. He would occasionally meditate for a few minutes in the mornings, but not regularly. He was still full of doubts about meditating: He thought it was silly and would rather be doing something else. But after attending other workshops where he learned to practise more regularly, he began to realize something was changing.
When faced with angry parents, Liben found that he could be more helpful. By not reacting negatively, he could acknowledge their suffering, and shift the conversation to how he could help them make things better for themselves and their ill child.
“It helps me realize that it’s not really about me at all, but rather about what the other person is going through and that my job is to do what I can for that person,” Liben said.
“At this point in my life, I look at morning meditation the way I look at brushing my teeth. I know I should brush my teeth and I know that even if I do not always feel like doing it, nonetheless it is a good thing for me to do.”
Patricia Dobkin, a clinical psychologist tenured in the Department of Medicine at McGill University, is responsible for all mindfulnessbased meditation programs in Whole Person Care, which offers a fourth-year elective in which mindfulness is taught to medical students.
Dobkin says that one-onone contact with patients is not always the main stressor, but that interactions between colleagues and changes in the health-care system also contribute to workplace stress.
Before entering the program, physicians and students are gauged for depression or burnout. After the course, they’re tested again. The results routinely show a significant reduction in both ailments and stress in general. Dobkin says feelings of self-compassion and well-being also rise.
Not all health-care professionals buy into mindful meditation. Some believe vacations and exercise can bring the same results.
“Some people think it’s just a way to relax, and it’s not at all that,” Dobkin said. “What we teach is a way to be present, a way to be self-reflective, so that when you’re encountering patients, you do so in a manner where your own self-knowledge makes a difference in how you interact with that person.”
Mindfulness meditation has been around for almost 3,000 years. It is practised by many religions, including Buddhism. Western psychology has begun employing mindfulness as way to alleviate such mental conditions as obsessive-compulsive disorder and anxiety.
Nearly half of all healthcare providers suffer from a high degree of stress at work, according to Statistics Canada. Since 2001, the Canadian Medical Association has urged physicians to manage their health so as to give the best care to patients.
Psychologist Joseph Flanders, director of the MindSpace clinic in Montreal, which specializes in mindfulness-based training and psychotherapy, has been meditating for 12 years.
“I like to think of it as exercise for the brain or the mind. People go to the gym to work on their physical fitness, and meditation is the mental equivalent.”
The practice is gaining popularity in the health-care profession. Not all hospitals have programs for employees, but there is a weekly mindfulness-meditation session at St-Anne-de-Bellevue Veterans’ hospital. An occupational therapist leads employees in the free lunchtime session, which has a core group of about 10 regulars.
Scientific studies have shown the benefits of mindfulness meditation.
A study published last year in the Jan. 30 issue of Psychiatry Research: Neuroimaging, conducted by a team led by Massachusetts General Hospital researchers, analyzed a study of 16 participants two weeks before and after they took part in the eight-week MBSR program at the University of Massachusetts. They analyzed magnetic resonance images of the brains of the participants, as well as a control group of non-participants over the same period of time. Along with changes to other brain structures, they noticed those who took part in the program showed reduced concentration of grey matter in the amygdala, an area of the brain that plays an important role in anxiety and stress, which correlated with participants reporting reductions in stress. None of these changes was noticed in the control group.
Flanders believes some of the skepticism in the healthcare community is because of meditation’s religious roots or that it might be seen as a fad.
Liben has helped develop a workshop on self-care for medical professionals that incorporates mindfulnessbased practices. He asks a lot of questions of himself and thinks that people should ask questions to better understand what mindfulness is and how it might be helpful. He says there is nothing to “believe in” – it’s not a belief system, but a way of understanding yourself and situations.
It helps Liben sleep better by reducing worrisome thinking and anxiety, and it helps him be less reactive in difficult situations. But he says it’s not a quick-fix situation: “It’s not magic. It’s very hard to get off that merry-goround in our minds that we’re constantly on, and there are tremendous challenges to even just sitting in stillness for a few moments a day.”
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