Taking a one-minute timeout to improve medical skill and help patients

Physician taking a timeoutIn our work with physicians, it’s impossible not to notice the extreme stress so many physicians endure every day. Some patients can be easy to work with; some patients can be challenging. It’s hard to know just how any day will go and how many challenges to expect. When a patient has a lot of questions, and there’s a full load of patients in the waiting room, the anxiety can mount.

So often there’s huge pressure to give a patient an answer right now and move on to the next patient to catch up.

What can physicians do to make this experience better for themselves and their patients?

It’s a given that many physicians are behind the eight ball when it comes to scheduling and meeting the demands of patients and administrators. To be an effective caregiver, physicians need to be able to go into a patient room, put the previous patients out of their minds, and establish trust. Instantly there’s a dynamic of two people who may be meeting each other for the very first time. A physician who can slow down and get the patient to do the same can accomplish a great deal.

A physician who examines a painful abdomen doesn’t start by placing a hand in the area with the most pain. With practice, physicians learn to come along rather slowly, in a reassuring way, to diagnose and treat patients. Just as we warm our hands and warm up the stethoscope, we need to approach patient communication in this warming way.

Doesn’t slowing down take too much time?

In the Harvard Business Review article “Are You Working Too Hard?” Dr. Herbert Benson argues that a great way to solve problems is through a meditation for 15 to 20 minutes each day.* And we agree that a meditation of this length can be enormously beneficial for people who want to decrease their stress and become more effective. Realistically, though, we understand that most physicians do not have this luxury of time. Many physicians might have a little bit of time when they first wake up, but during the day, they might have only a minute. Fortunately, extensive testing has shown that once you learn simple breathing principles and gain the ability to shut out external stimuli and become conscious of your breath, you can reboot your brain and gain lasting benefits in as little as one minute.

You rest your body at intervals. Shouldn’t you also rest your mind? When we’re overtired, our bodies don’t perform routine activities as well as they should. It should not be surprising that when we’re overtired and overstressed, we can’t achieve the same degree of clarity as we can when we’re rested. Quieting the mind for as little as a minute can make a big difference.

What’s the best way to achieve one minute of mental respite?

Get behind a closed door. Set the timer on your phone for one minute and put the phone down. Close your eyes and inhale slowly and deeply using your diaphragm. Exhale slowly. Focus on your breathing. Don’t push away your thoughts, but choose not to follow them. Keep focusing on your breathing. When the alarm goes off, slowly open your eyes. This deliberate relaxation has just enabled you to achieve better focus and improve your problem-solving abilities.

What benefits can physicians get from this moment of mental quietude?

Give yourself permission to spend a minute of care for your overworked mind; this will enable you to better care for your patients. The following will occur:

  • Blood pressure and heart rate will decrease.
  • Cortisol levels will decrease.
  • You will become a better listener.
  • You will become more present for and better connected to your patients.
  • Your cognitive abilities will be enhanced and you will come up with better solutions to the problems at hand.

Wouldn’t any physician want these benefits?

When is the best time to take your one-minute timeout?

Doing it on a reactive basis is not as helpful as practicing mindfulness proactively every day. Just before you begin your day is ideal. Next best: a minute or two before you see your first patient. Also, if you know you’re going to see a challenging patient, take a minute to close your eyes and focus on your breathing before entering the room.

Why the morning? If you quiet your mind briefly every morning on a regular basis, endorphins will kick in to help you make this a routine—and help sustain you throughout the day. But if you have trouble finding a minute in the morning, find a minute later in the day. Schedule it and see the difference.

Is it beneficial to take a mental respite on days off?

Although that minute without thinking is helpful, a four-minute break is better, and a longer one would be even more beneficial. No matter what the length, after a few weeks of daily practice, most people find that they look forward to their daily session of mental quietude. They can actually feel the lowering of their stress, and they know they are being more effective in their thinking and their work.

Is there a proper technique?

The thing to remember about quieting the mind is that there’s no judgment and no failing. No one is grading you. You don’t have to do it “properly.” It’s OK to simply close your eyes, breathe slowly, and focus on your breath. This is not a competition; nobody will be looking over your shoulder to see whether you are doing it right. It will be right, and you’ll be reaping rewards.

How do you measure the results, then? Don’t get into that. Congratulate yourself for having the discipline to take time out for whatever length you set for yourself. When you make yourself better, then everyone can improve. Improvement may not be dramatic—it’s usually incremental—but you will notice it over time. Odds are others may end up noticing improvements in your approach to patient care and communication as well.

“What if my brain won’t reboot?”

Physicians have so much to remember, and so much at stake, that sometimes they worry that if they stop paying attention to any of their thoughts, they’ll forget everything. Remember that even though you may be turning off your thoughts, you are remaining mindful and alert.

As you practice your minute or more of trying not to think, you may find that some of your thoughts are persistently pesky; they may resist being shut out for even a brief time, and this can be quite stressful. What you say to yourself during this minute, however, is “I’m not going to follow any thoughts—I’ll come back to them after I have finished.”

Your breathing during your quiet periods is as important as, or more important than, what you are doing with your mind. Simply doing diaphragmatic breathing can help. You can stand behind a door; you can sit in a chair. Allowing yourself to let go and breathe or stretch out will enable your mind to slow down.

Relax your abdomen as you inhale, and gently pull your navel center toward your spine as you exhale. Make your inhalation deep and your exhalation long and smooth. A few simple stretches as you come back from your quiet moments will enhance the effort.

Conclusion

Studies show that physicians who take a timeout to rest their minds can reap enormous benefits. Not only can they improve their health, but they can also improve the health of their patients. So set your timer, close your eyes, breathe deeply, and focus on your breath. You can be more effective, and your patients can be happier with the care they receive from you.

To read more about the benefits of one minute of mindfulness, see “Modern Etiquette: Time to Take Time Out” (Reuters).

To learn the basics of practicing four minutes of mindfulness, see “A 12-Step Method for Meditation” (The Mitchell Organization).

*Bronwyn Fryer, “Are You Working Too Hard? A Conversation with Herbert Benson,” Harvard Business Review, November 2005, accessed April 3, 2014, http://www.getinsidehealth.com/PageFiles/490/Are%20you%20working%20too%20hardR0511Bf2.pdf?epslanguage=en.

Read more blog posts about provider support:

Promoting patient safety and provider support through just culture

8 ways to respond to a provider who has experienced a medical error

Halting clinician burnout by increasing resiliency

Taking a one-minute timeout to improve medical skill and help patients

When a physician is devastated by the loss of a patient

Learn more about Physicians Insurance’s Leading WellTM Provider Support Services.

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