Mindfulness: A Surprisingly Practical Tool for Time Management

As a doctor you’ve studied, trained, and practiced for years, probably decades, to provide the best care for your patients. But as our world has become increasingly tech-driven and connected, the pressures from both within and outside of the healthcare workspace for your time and attention have multiplied.

Whether it’s pings from the EHR, text messages from the hospital, urgent calls from colleagues or families, or the never-ending torrent of emails, your attention has become more fragmented than ever before.

When you’re busy and feeling time-pressured, mindfulness may seem to be an uneasy, even unwelcome, construct.  Who has time for it? Yet it turns out that simple mindfulness practices can help you to reframe and de-escalate the struggles of the day.

Mindfulness won’t cure the ills that physicians face in the current healthcare environment, but it can mitigate their impact. In this article I will show you how using mindfulness can create the mental space you need to confidently and calmly manage patient care while protecting your precious time.

Start with Mindful Mornings

Mornings can often feel a little frantic, but finding room for a simple 5-minute mindfulness practice can help to set the tone for your day. Here are some ideas to get you started:

• Sit quietly with your morning coffee, allowing time for it to cool while you check in with your breath. Take a slow deep breath in through the nose, pause for a moment, and then breathe out through the mouth. You can use the box breathing technique, or simply find a rhythm that feels comfortable.

• Use a mindfulness app like Insight Timer or Headspace. You can enter the time you have available and you’ll find a wide range of guided meditations.

• Set a 5-minute timer and journal about anything that comes to mind.

Practice Mindful Transitions

Mindful task transitions can help you maintain your focus and prevent mental fatigue. Before moving on to a new task, appointment, or procedure, take a moment to pause, breathe deeply, and clear your mind.

You’ll be more present for your patient, which can build trust and connection. And this mindful pause can enhance your efficiency by helping to prevent the accumulation of mental clutter, or what is known as attention residue.

Embrace Single-Tasking

Multitasking used to be considered a prerequisite superpower for productivity. Doing two or more things at once--what could possibly go wrong? A lot, it turns out.

Emergency Department physicians may be the most pressed to multitask, with a recent Scandinavian study finding that almost 20 percent of their time is engaged this way. Not surprisingly, this study found that the more a physician multitasked, the more stressed they became. And other studies have found that multitasking can increase the risk for errors.

While you may not always have control over who or what interrupts you, it can help to remain mindful of the things that are pulling on your attention. When you are able to tune out distractions and put non-pressing matters on hold, you’re likely to be more productive and efficient with your time.

To tune up your ability to focus, regular meditation can help. That’s because mindfulness meditation is, at its foundation, a practice of returning your attention to the present moment.

Cultivate Presence

What exactly is presence? Actress Anna Deavere Smith, in her book Letters to a Young Artist, counsels that “Presence means you hold your own space, control the space around you, and sometimes welcome others into it.” Here she is describing the persona of an artist, but as a physician, you too are tasked with holding space, while simultaneously creating a place of safety for your patients to enter.

In being present, you are listening mindfully, without jumping to conclusions or judgments. You’re paying attention not only to the words but to the body language and, sometimes, to the unspoken fears beneath the words.

This might sound like it could add time to the encounter, but the truth is that when you lead with mindfulness, your patient is more likely to feel heard and safe. You are more apt to integrate information that might otherwise slip beneath your radar, so your differential may be more accurate.

And as you build trust, your treatment plan may be more readily accepted, and you’re likely to get fewer in-box messages or worried phone calls after the encounter.

End with Mindful Reflection

As you close out the day, take five to ten minutes to reflect on your “wins”, your “dones”, and your “to-dos”. Acknowledge both your successes and areas for improvement, without falling into self-criticism.

By creating a to-do list for the next day, you can set aside your lingering worries and unchecked boxes, knowing that you’ve made a plan to tackle them tomorrow.  

Your closing-down practice could even include stopping at a coffee shop on your way home to enjoy a cup of decaf and take a few minutes to journal and debrief before entering into your home life.

This time between work and home can also give you a safe space to decompress from your work day so that you’re able to be present for your loved ones, making the most of the time remaining in the day.

Conclusion

Mindfulness is not going to solve all that is troubling healthcare. It doesn’t mean pretending that the troublesome systemic problems facing physicians don’t exist. But by cultivating a mindful approach to the day, it’s likely that your time will be spent more meaningfully. And as a result, your focus and productivity will improve, and you’ll have more bandwidth to be present for your patients and your loved ones.

DISCLAIMER: As an Amazon Associate I may earn from qualifying purchases, which means that if you click on one of the product links, I’ll receive a small commission. This helps support the website, for which I am grateful! Please do your own research before making any important decisions.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

My Podcast Appearance on Dr. Bill Lombardi’s Journey to Better

It was a thrill to appear on legendary cardiologist Dr. Bill Lombardi’s podcast The Journey to Better. I was honored to be invited onto the show to discuss mindfulness, goal setting, and combating burnout.

Dr. Lombardi is one of the highest-volume operators for complex PCI and chronic total occlusions in the world. He has been open about his own struggles with well-being in this high stakes and intense field of cardiology. His episodes will resonate for cardiologists, but also for any physician who has experienced the struggles, highs, and lows of caring for patients in today’s world.

My Podcast Appearance with Kevin MD on Meditation and Mindfulness

I enjoyed my recent conversation with Kevin Pho, M.D. We discussed how mindfulness can have far-reaching effects not only for yourself, but for those you care for. We also discussed the best times for meditation, when you might want to avoid it, and how a brief meditation can impact your sense of well-being.

As a physician coach, I love sharing this story, because it encapsulates how such a simple and brief practice can have a meaningful impact.

Despite often heavy-handed corporate efforts to the contrary, mindfulness is not a bandaid to fix all that is wrong with healthcare. And it’s not a substitute for the meaningful change that is so desperately needed. Instead, it’s a reminder to be present and engage with what is happening right now, without judgement or reactivity.

Through mindfulness, you are can find a way to take a moment in the middle of the daily storm to re-center and reset. And for physicians, that can go a long way towards building stronger relationships with patients and staff based on trust and respect.

Physician Stress and Burnout: How Mindful Coaching Can Help

Physician burnout is not a new phenomenon, but over the past several years, it has become a true epidemic. In 2021, 930 academic papers were published on the topic, compared to 129 in 2011. In 1984, the year I started medical school, a total of 4 articles can be found in the PubMed archives.

Today burnout is out in the open. But the tools to manage and prevent burnout remain elusive.

The term “burnout” itself may sound a little nebulous, but there are methods to measure and define it. The Maslach Burnout Inventory defines burnout as “a psychological syndrome” that “occurs among individuals who work with other people”, with symptoms including:

• Emotional exhaustion, feeling unable to give more of yourself

• Depersonalization, resulting in negative or cynical attitudes towards patients

• Reduced sense of personal accomplishment, meaning a tendency towards negativity towards your own accomplishment.

It’s important to understand that burnout is not a psychiatric disorder, but rather it is “ a normal response to a chaotic and stressful environment”.

Many of us have experienced these feelings from time to time, and that’s completely normal. But when these feelings are persistent and overwhelming, then it’s likely that you’re dealing with burnout.

In a 2022 survey, Medscape found that 47% of physicians reported burnout, up from 42% in 2021. Not surprisingly, Emergency Medicine and Critical Care reported the greatest burnout (60% and 56% respectively), but Ob-Gyn (53%), Infectious Disease (51%) and Family Medicine (51%) were close behind.

Women reported more burnout (51%), perhaps due to competing responsibilities at home which were aggravated by the pandemic. But more than a third of men were also affected.

The contributors to burnout reported in the survey are not surprising to anyone in healthcare. Topping the list:

• Bureaucratic tasks

• Lack of respect

• Long hours

• Lack of autonomy

These features are nearly identical to the six factors associated with workplace stress that were identified by the British workplace health and safety regulatory agency:

• High work demands

• Low control over workload and process

• Inadequate support from management and colleagues

• Poor workplace relationships

• Lack of clarity regarding professional role and responsibilities

• Poor management of change within the organization

Beyond making you miserable, stress and burnout affect your quality of life, your self-confidence, your relationships at work and at home, and perhaps even your patient care.

Sometimes it feels as if everyone is talking about stress and burnout, but nothing is being done about it.

Although mindfulness has been shown to be effective in mitigating the symptoms of stress and burnout, it feels disingenuous to tell physicians to get a grip by practicing yoga and meditating.

Clearly, we are not going to yoga our way out of this mess. And hospitals and healthcare systems need to do more than offer lip service. But in the meantime, a little mindfulness may help. Here’s how:

First let’s start with a simple definition of mindfulness. As a certified Mindfulness Meditation Teacher, I’ve been fortunate to learn from Sean Fargo, a former Buddhist monk and gifted teacher. Sean defines mindfulness as “paying attention to the present moment with curiosity and non-judgment”. In other words, simply being present.

This sounds nice, but how can it possibly help you overcome the powerful forces that lead to stress and burnout?

As it turns out, there have been a number of studies in recent years that were designed to answer just this question. A meta-analysis of six high quality randomized controlled studies of mindfulness interventions for medical students, published in 2020, reported substantially lower stress indices in students who participated in the programs.

These programs incorporated interventions that included

• Body scanning

• Awareness of thoughts and emotions

• Breathing exercise

• Walking meditation

• Sitting meditation

• Coping with stress

Most programs were once weekly group sessions, while one used a mobile app.

Not only did stress scores improve in the short term, compared to controls, but studies that reported six-month follow-ups found that the benefits of mindfulness teaching persisted.

Coaching is another effective strategy for physicians at all stages of professional life. Although it is no substitute for system-wide change and mitigation of the issues that lead to burnout in the first place, coaching can help physicians gain traction and make decisions that help them to reclaim their connection to the profession.

That can range from important changes that create a better work-life balance in the current setting to a move to a new position or workplace. In some cases, a coach may work with a physician who decides to leave the profession altogether.

Research supports the role of coaching as a powerful tool for physicians at all stages. A small study from Duke University included primary and specialty care physicians ranging from first year residents to more senior physicians with leadership roles. The program focused on coaching for physician well-being, and reported improvements in coping strategies, resilience and stress.

Regardless of the specific modality or focus, physician coaching as an intervention has clearly been linked to improvement in well-being and resilience. A 2019 randomized controlled trial of primary care physicians in the Mayo Clinic system looked at the effects of 6 telephone coaching sessions on

• Burnout

• Quality of life

• Resilience

• Job satisfaction

• Engagement

• Meaning at work  

After 6 professional coaching sessions by credentialed coaches, the rate of burnout decreased by over 17% in the coached group but increased by nearly 5% in the control group. And absolute rates of emotional exhaustion dropped by nearly 20% in the coached physicians but increased about 10% in controls.

Coaching is a powerful tool. Mindful coaching may help physicians manage and overcome the effects of the sometimes-overwhelming forces that impact them and, indirectly, their patients on a daily basis.

But most importantly, addressing and repairing the underlying sources of burnout and stress is paramount. This is a commitment that needs to come from the highest levels of our healthcare systems.

---

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Berg, S. (2021). Q&A: Clearing up confusion on physician burnout and depression. American Medical Association

Christensen, A. J. et al. (2023). Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Military medicine, 189(Suppl 1), 64–70. https://doi.org/10.1093/milmed/usad277

Drybye, L.N. et al. (2019). Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. Journal of the American Medical Association Internal Medicine

Garcia, C. L. et al. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina

Hathaisaard, C. et al. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: a systematic review and meta-analysis. Asian Journal of Psychiatry

Health and Safety Executive. (2019). Tackling work-related stress using the management standards approach

Kane, L. (2022). Physician burnout and depression report 2022: stress, anxiety, and anger. Medscape

Maslach, C. et al. (1997). The Maslach Burnout Inventory Manual

Schneider, S. et al. (2014). Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore

The Power of the Pause: Creating Engagement and Presence

If you do surgery or procedures, you’re probably familiar with the idea of taking a timeout. This is a mandated hard stop in the operating room or procedure lab. It’s a moment for everyone involved to verify that they are on the same page and that all necessary preparations have been made.

What if you took the concept of taking a pause out of the OR and into the other demanding parts of your day? It makes sense that taking a brief pause between meetings, procedures, or complex patient care might be helpful. But my guess is that very few of us actually do this.

New research from Microsoft's Human Factors Lab supports the idea that taking a personal pause can not only help you to reset but may even improve your engagement with your next patient or procedure.

Since this was Microsoft, the study looked at the way people engaged in meetings. The 14 subjects were tasked with wearing an EEG while participating in video meetings. Each meeting lasted 30 minutes.

On one day, they took part in four back-to-back meetings, without a break. On the other, each meeting was followed by a 10-minute pause. Instead of simply checking their phones, the participants meditated with the Headspace app.

The results were pretty interesting. Analysis of brain waves showed that taking a pause for a brief meditation created greater engagement during the following meeting.

Conversely, with no pause, there was EEG evidence of greater stress during the next meeting.

Productivity is often measured by the amount of time spent working. But this study and others suggest that engagement is a more important (and healthier) metric.

Bringing these ideas into healthcare can be challenging when there is no end to the pressures of the inbox and adding one more procedure or working in one more patient (with fewer members of the support staff) is the norm.

How can you begin to practice taking a pause? It’s not always practical to take a 10-minute break for meditation in the middle of a busy day. But even a few mindful moments can help. Here are a few practical tips that can help you to create a little breathing space for yourself and to be more present for your patients:

• Breathe Mindfully:

Take a few deep, intentional breaths before going in to see a difficult or complex patient. Focus on the sensation of the breath entering and leaving your body. This simple act can help anchor your awareness to the present moment.

• Body Scan:

Conduct a quick body scan to release tension. Start from the top of your head and gradually move down to your toes, paying attention to any areas of tightness or discomfort. Allow these areas to relax, even if it’s just a little.

• Mindful Observation:

Take a moment to observe your surroundings without judgment or reactivity. Notice the colors, textures, and sounds in your environment. This brief shift in attention can provide a mental break and promote a sense of calm.

Taking mindful pauses between patients is not just a momentary break from a hectic schedule. It's an investment in your well-being and a way to engage more deeply with your patients. It can be a quick way to reboot your energy. By incorporating mindfulness into your routine, you can cultivate a sense of balance, focus, and empathy that positively impacts both you and those who depend on you.

It's time that healthcare leaders begin to learn the lessons that Microsoft and other leading companies already know. By supporting and empowering physicians and the healthcare team, healthcare systems will not only improve engagement and work satisfaction but will likely improve patient outcomes and physician and staff retention.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.