No abstract

Person-centered medicine, while valued implicitly, is not always taught explicitly in medical schools or during residency programs. Threats to educating and practicing person-centered medicine include perceived lack of time, stress, burnout and a paucity of mentors with a systematic approach to modeling and teaching students how to relate to patients in a way that addresses them as whole persons. Herein we review how trainee stress and burnout negatively impact patient care and outline a program designed to teach mindful medical practice that may be an antidote to these problems. Moreover, we present quantitative data and a student’s narrative to highlight how to cultivate person-centered medicine in trainees.Fifty-eight 4th year medical students completed questionnaires pertaining to: depression, burnout, stress, wellbeing, self-compassion and mindfulness before and after taking a 4-week elective entitled, Mindful Medical Practice. Statistically significant improvements were found on emotional exhaustion, depression, self-compassion and mindfulness. One student’s experiences highlighted how what he learned in the elective guided him during his family medicine residency. We conclude with a discussion of how the culture of medicine and the training of future physicians in particular, need to take the whole persons of both the physician and patient into account in order for all to be satisfied with and benefit from medical care.

Background: A small percentage of patients screen positive for depression following a mindfulness-based program.

Objectives: Twenty-first century patients need to take a proactive stance with regard to their health in order to cope well with chronic illness.  Mindfulness-Based Stress Reduction (MBSR) is an 8-week structured group program that encourages patients to take responsibility for their health and teaches them to cope with stressors inherent in living with illness.Methods: Patients with chronic illnesses (e.g., breast cancer, chronic pain, multiple sclerosis) participated in the MBSR program from 2006-2012.  They completed questionnaires pertaining to depression, medical symptoms, stress, coping, sense of coherence, and mindfulness pre- and post-MBSR.  They filled out a follow-up questionnaire that asked them to rate the program and its components. A self-care index was created from 5 items.Results: Of the 126 patients, 85.7% were woman, breast cancer was the most common illness (46.8%), and the average age was 52.3 (SD = 13.3). There were significant improvements on the following outcomes: depression, stress, and medical symptoms. With regard to process measures, there were significant increases in: mindfulness, sense of coherence (comprehensibility, manageability, and meaningfulness of life), as well as significant decreases in emotional coping.  Patients rated the program with a mean of 8.94 (1 to 10 scale) for importance. They rank ordered the program components in terms of helpfulness with awareness of breath, the silent retreat day, and yoga practice as the highest of 10 items.  There was a significant positive correlation between self-care index at the end of the course and its perceived importance. Moreover, self-care was positively and significantly correlated with post-MBSR mindfulness and viewing life as meaningful.Conclusions:  Patients who took the MBSR program reported mental and physical health benefits. Furthermore, being mindful enabled them to cope better, take care of themselves, and view life as more coherent such that they became more stress resilient.

Objectives: The present study explored relationships between outcomes of the Mindfulness-Based Stress Reduction (MBSR) program and the importance attributed by patients to the mindfulness practices taught.Methods: Patients with chronic illnesses (46.8% breast cancer; N=126) completed questionnaires pertaining to medical symptoms, stress, and mindfulness, pre- and post-MBSR.  At program completion, each patient rated the importance of the mindfulness practices employed.  Stepwise linear regression analyses were run to investigate associations between changes in outcome variables and subjective ratings of practice importance.Results: Increases in mindfulness were associated with high ratings of importance for sitting meditation (p LT 0.02) and homework manual (p LT 0.02; Adjusted R2 = 0.10). Decreases in medical symptoms were associated with high ratings for the body scan (p LT 0.01) and small group exercises (p LT 0.01; Adjusted R2 = 0.13). High ratings for the body scan were moderately, albeit significantly, correlated with decreases in perceived stress (p LT 0.01, Adjusted R2 = 0.05). A cluster analysis performed on all 10 of the ratings of practice importance showed that greater importance was associated with better outcomes for all three dependent variables (p LT 0.01).  A qualitative examination of patients’ answers to open-ended questions revealed that incorporating mindfulness practices in daily life was a central component of the lifestyle changes experienced during the course of the program.Conclusions: Understanding the mechanisms underlying MBSR’s effectiveness is important as this program becomes recognized as an empirically-supported intervention. These results suggest that specific types of practice (concentration vs. the body scan) are related to distinct outcomes (dispositional mindfulness vs. medical symptoms, respectively). Overall, awareness of the importance of practicing is connected to actual program outcomes.