Mindfulness in the Clinic

Although I have never participated in any structured learning or courses in relation to mindfulness, I have often kept the concept in back of mind. Without any training or guidance in the technique, my feeling has always been that mindfulness is a process where, particularly in the consulting room, we can step back from the immediate interactions and situation to try and more objectively understand without being driven or responsive by emotion.....we can deal with fact not feeling.

I often think that in the most simple terms this is just being professional and dealing with patients in a way that is respectful, courteous and understanding of their needs without necessarily being drawn into whatever emotional situation they are in.

Often is the case that we find ourselves in a consultation, which is at times an intimate meeting with someone on an emotional level. I believe it is our role as Doctors to deal with this situation in a way that not only protects us and allows us to do our job in the best way possible but also results in the best outcome for the patient.

I remember not that long ago a particular example with a patient who for sake of the story we will call John. John came into my office toward to the end of a long day of consulting and from the moment he sat down it was apparent that he didn’t want to be there. Without any doubt there was a sense of hostility and anger, the body language was threatening, the conversation was short, curt and aggressive. I had never met this person before, this was a first consultation in regard to an issue related to his heart. As you might imagine I immediately felt threatened, attacked and defensive by this individual’s demeanour, I realised that I didn’t want to be here or more to the point I didn’t want him here in my office. It was then that the concept of mindfulness, which was lurking in the back of my mind, came forward. I put down my pen, I took a gentle breath in and looked at this gentleman directly in the eye and said with a gentle tone, “John, I get a real sense that there is a lot of anger going on in this consultation. To be honest, that doesn’t make much sense to me because you don’t

even know me, we have never met before, so why would you be angry at me? I didn’t make you come here, you came of your own volition because there is something wrong with your heart and I might be able to help you. I can’t claim to know what is going on in your life as we really haven’t had a chance to get to know each other but right here right now the amount of anger that you are bringing to this consultation is going to make it really hard for me to do my job for you. What I would really like to say is that if you could put the anger aside then we can connect and work together in a far more positive environment and there is every chance I may well be able to help you and make you feel better. So, could you please put the anger and the attitude aside and let’s see what we can do to help you out”.

Well, it transpired that this was a gentleman who’d had a previous heart attack and he had come in with all sorts of symptoms. He was angry because he really just was scared and he hated doctors and he hated hospitals, not for what they were, but what they meant to him.

I ended up taking quite a bit of time with John and wrote back to his GP assuming I would never see him again. I listed about five or six different interventions or treatments, which I thought might be beneficial for him. There was a bit to sort out given he had not seen anyone for a number of years, due to his reluctance to be in touch with the medical profession.

By the end of the consultation we were on much better terms, I shook his hand and I wished him the very best thinking that “that was hard work” and I would probably never see this gentleman again.

Interestingly, about two to three months later I walked into my surgery only to see John sitting there in the waiting room. Remembering his disdain for the medical profession and my recollection that I would never see him again, I said “Hi John, I am pretty surprised to see you here? What is going on?” John turned around and said “Doc, you made me feel so much better the last time I saw you, I thought I’d come back and see you again”.

 It goes to show that mindfulness had a great impact on my interaction with a patient, which then led to a profound change within his state of being at the clinic and dealing with his health as well.

 BW - Dr. Warrick Bishop

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