I am reading (or rather listening to) The Power of Now by Eckhart Tolle, which is hard for me to summarize because it is a book I will need to read and re-read in order to fully understand what the author is saying. Not surprisingly, it focuses on the practiced pursuit of mindfulness — being present in the very moment you are currently in.
Like many of us, I already knew I was supposed to be doing this, but it is so very difficult to do. My pesky past and uncertain future march around in my head, beating figurative drums to get my attention. The present moment seems to sit in a corner waiting for me to notice her.
One of the times I really try to be fully present is with my patients, which can be very challenging — more difficult than other situations even. First of all, my day is a series of appointments punctuated by seemingly endless interruptions: new results, patient calls, nurse triage questions, order clarifications from my medical assistant. Second, my brain starts constructing differential diagnoses and treatment plans as soon as a patient utters their chief complaint. In order to make room for the patient's story without interruption, I have to attempt to pause my natural instinct to start solving the problem and try to focus and listen.
As I go through the history-taking and exam, inevitably multiple other pieces of information and concerns are brought up. Sometimes I am uncertain about which is the best course of action, so I will start an argument (friendly, of course) with myself about which way to go. It can feel like a hurricane of thought spinning around in my head sometimes.
I have found some tools that help me stay present with my patients and focused on the moment that we are in.
The first is to fully finish with the previous patient before I enter the exam room — all orders signed, note complete, case mentally closed. Otherwise, I end up bringing all of the patients that have come before into the exam room with me, and their issues compete for my attention with the patient I am with at that moment.
The second is to enter orders as I go into the electronic health record or to keep notes on a pad of paper to remind myself that the patient needs their ears flushed before they leave, or that I need to touch base with their cardiologist about the dose of beta-blocker they are taking. If I don't do this, the to-do list keeps growing in my brain and inevitably something gets forgotten.
The final approach that I've found helpful has been to have a standard process for my checkout list. This process prompts me to identify all the things that need to be done the same day from a pick-list (such as immunizations, labs, x-rays, BP rechecks); the second which prompts me what future things — referrals, imaging, labs — need to be done; and the final one which prompts me to decide when I need to see them again and for what purpose.
I believe there is tremendous therapeutic value in being completely present and focused on the patient right in front of you. It allows us to notice what is unspoken and hear the full story before we start traveling down the wrong diagnostic road, and it fosters the kind of connection that promotes a great patient-physician relationship. We instinctively know when we have someone's full attention, and this includes our patients.
What about your pursuit of being in the present moment? What has allowed you to be more fully focused on your patients, colleagues, friends, or family?
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Cite this: Jennifer Frank. Being Mindful and Present With Patients: Challenges and Solutions - Medscape - May 04, 2022.
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