Finding Fascination in Medicine Again

A recent student of mine sent me an article he had written about his experience in one of my MBSR courses. It was published on Medscape. It's called Finding Fascination in Medicine Again. I'm including it below. What in your life calls you to be fascinated?

Finding Fascination in Medicine Again

Gregory B. Dodell, MD June 28, 2018

I have been reading lately that about half of physicians report experiencing burnout, and until recently, I included myself in that category.

After years of my wife urging me to do so, I finally signed up to take a Mindfulness- Based Stress Reduction (MBSR) course in Manhattan, New York. The course was taught by a certified MBSR teacher, and my group of about 20 individuals met once a week for 2.5 hours over the course of 8 weeks.

Research on mindfulness has demonstrated clinical improvement in a wide range of medical conditions, including chronic pain, diabetes, anxiety, and sleep disorders. Most people have heard of mindfulness at this point, and there's a reason why it has become trendy: It works! Trends often arise from necessity; the current pace of our lives is exceedingly faster than before, so it is crucial to find a means to slow down and enjoy the moment. This was my primary objective in signing up for this class.

Walking into this class for the first time, I felt excited. Perhaps it was stepping back into a classroom setting after so many years. I was also hopeful that learning mindfulness would help me in both my personal and professional life.

I looked around the circle of my classmates as we anticipated the teacher's first words. The participants ranged in age from late 20s to late 70s, an equal mix of men and women, and a range of ethnicities. Beyond my typical first impressions, I knew nothing about these individuals. I had no idea how well I would come to know them over the 8- week course.

The first night, we went around the circle and introduced ourselves. We were asked to share how we heard about the course and what brought us there.

In keeping with the practice of mindfulness, how about you (yes, you, reading this right now) take a pause and consider whether a practice designed to help people live in the moment could enhance your quality of life. See how it feels to close your eyes and notice a few breaths. This is basically mindfulness.

Lessons Learned

Have you ever savored a raisin? Now I can say that I have. This is one of the first exercises in MBSR. The teacher walked around and dumped raisins into all of our hands, and we were then asked to inspect them. I thought to myself, "Wow, look at them glisten in my palm. Look at the different sizes and shapes." We shared our observations with the group.

Next, we smelled the raisins. As expected, they smelled sweet, like putting your nose into a wine glass. Finally, we had a chance to taste one. It was the first time I had inspected something this much before I put it in my mouth to eat it (other than maybe as a kid trying something new).

This anticipatory process somehow made it taste better (but I imagine this could also make the taste disappointing, which would be okay too). The first raisin tasted so sweet and delicious as I chewed it. The saliva built up and so did the joy of this experience.

This exercise was not about the raisin but rather the quality that arose from using all of my senses. When was the last time that I did that? For me, this was an epiphany.

Translating Lessons to Practice

An epiphany implies a lasting change. This first exercise made me eager to learn how I could bring this quality to my daily life. Throughout the course we also learned basic yoga and meditation. This was conducted through both inclass guidance and homework assignments in which we were guided by audio recordings.

You may think that sitting in a circle meditating and sharing feelings with a bunch of strangers would be weird and uncomfortable. Shockingly, this experience felt kind of natural. We were all there to learn a skill, and that energy was palpable.

I started to wake up earlier to complete my "homework." From that first morning when I completed a 37minute "body scan," I felt things start to change: I noticed the sensation in my feet as they rested on the floor, the feeling in my chest as it rose to take in oxygen, and the pressure of my scalp from the floor. This was my time.

As I began to practice the techniques from the course, I realized that I had been missing out on much of life's quality, including the practice of medicine.

As physicians, we spend our days taking care of other people; perhaps we were built this way. Carving out this time for myself has reinvigorated me. Ironically, I think that caring for myself has made me a better doctor, husband, father, and friend.

Throughout the course, comments from my classmates elucidated some of my findings and helped me realize other important lessons from mindfulness. I realized that even if I am rushing to work, I could still enjoy hearing birds chirp and feeling the breeze across my scalp. We shared insights into our existence: parenting, worklife balance, commuting, relationships, and other intimate topics. Psychologists, lawyers, and business executives surrounded me. Despite spending our days differently, we shared a common thread.

There was another physician in the group, which enhanced my experience as we discussed how mindfulness quickly began to improve our existence. In addition, when the group was asked to identify the physiologic impacts of stress, I had a partner to chime in about the sympathetic nervous system with the background of a cardiologist.

As I began to practice the techniques from the course, I realized that I had been missing out on much of life's quality, including the practice of medicine. I had been more anxious than I thought and had fallen victim to the "gotta gotta" mindset ("I've gotta do this and that.").

It became clear that my mind was often elsewhere, or at least moving faster than required. As I clicked away in my EMR, it was hard not to focus on the tab full of messages and think about how much I needed to accomplish that evening or after my family went to sleep.

Mindfulness techniques allowed me the space to become amazed.

I think most physicians can relate to this. In our daily routine, it is often difficult not to think about who is in the waiting room, how many calls we have to return, and how many notes we have to write. The catch is that all of that worrying doesn't help us get those things done. It only robs us of the present moment and the reason we went into medicine in the first place: to take care of the human being in front of us.

Mindfulness techniques allowed me the space to become amazed. I began to become fascinated that I could feel and hear the beat of someone else's heart, that I could listen to their lungs as I notice my own breath, and that I had someone in front of me trusting me to take care of them. These are things that I have taken for granted, likely because I do them every day.

Prior to working on this article, I was not aware of the research literature stating that mindfulness is an effective tool for physicians to manage burnout. I am happy that this is not the first case report. Mindfulness is now being taught to medical students as well as at national medical conferences. I think that is awesome!

Unfortunately, we all know of colleagues who have committed suicide. Now is the time to have an open dialogue about how to approach this epidemic of physician burnout. It is not a failure to admit that we are anxious or depressed. We do not have to be "stronger" than our patients.

Taking this course has been revolutionary for me, and I have been "prescribing" it to my patients. I know that stress is a major detriment to our health, so I often discuss mindfulness with patients. I often say something along the lines of "I know this may sound cheesy or cliché, but have you thought about meditation or taking a class in mindfulness? It has been great for me."

In my opinion, there is no greater career than medicine. I hope that we can all find a way to tune out the background noise and act as if our only patient is the one right in front of us. This way, practicing medicine not only benefits the patient, but us, too.

Medscape Diabetes © 2018 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Finding Fascination in Medicine Again Medscape Jun 28, 2018.


To be (seen) or not to be (seen)

As I was creating this website, I found myself contemplating the Buddha’s teachings on the desire to be and be seen. He taught that there are three broad kinds of desire, each of which can lead to disappointment and dissatisfaction:

  • The desire for sense pleasure and to avoid pain
  • The desire to be, be seen, and to become - to have continued existence
  • The desire to not be seen, to not exist

Each of these is very ripe for investigation. However, in creating the website, I found myself reflecting upon and investigating this desire to be seen and become.

Of course, we are human beings, and especially as infants,  the need to be seen and acknowledged and cared for is absolutely vital for our well being and survival. As we grow, this connection, this being seen continues to be a source of joy and nourishment. So when can this be a cause of suffering?

In Pali (the language the Buddha's teachings were written in) desire is Tanha. It is an unquenchable thirst. Traditionally this is depicted in paintings as beings with pinhole mouths and large bellies. Never satisfied. Never possible to be satisfied.

Bhava Tanha, the desire to be and be seen can manifest in many ways: wanting more: power, love, recognition, accomplishments, control, security, fame … in all areas of one’s life (including, by the way, in one’s meditative attainments). It is easy to look around our political and economic worlds and see evidence of politicians wanting more power, recognition, control, security, fame ...  often (usually?) at the expense of others. We may also notice this from time to time in our personal lives, and experience how this naturally leads to a greater sense of there being "a me" separate from "a you" and "my" interests, views and opinions and needs taking precedence over "yours".

Bhava Tanha results in us continually leaning forward into the future towards what isn’t here. As a result, we can miss all the “enough” that is already present, right here, and right now. 

As I created this website, wanting it to be beautiful and pleasing, I also noticed a bit of greediness - really wanting to be seen and acknowledged, leaning into something just beyond this moment. A little bit perhaps of all of the above (Recognition of my accomplishments? Security? Fame?).

And I must say, I also noticed and reflected on the desire not to be, not to be seen as it manifested in the experience of my own vulnerability in taking the risk of being seen. Perhaps that’s why I waited so long to create a website?

Nothing wrong with seeing any of this of course. Of course! Of course! This is the shared human experience. This human mind! The practice is seeing all of this as it arises and not being carried away in ways that can be harmful to oneself or to others. 

Does this mean I shouldn't have created the website? No, of course not! It  was important to stay close to my intention to be of to benefit others - to let students and potential acupuncture clients know of my services and to always keep these primary in the dance of these different hungers.

I thought this might be a useful reflection for you as well. Do you notice the desire to be and be seen in your own experience? What is the impact of following these hungers?