Mindful Decisions in Urogynecological Surgery: Paths from Awareness to Action

Abstract

I have a surgical referral practice in urogynecology and reconstructive pelvic surgery and treat pelvic floor disorders in women. I perform hysterectomies, reconstruct vaginas, and install urinary incontinence slings. Following a dozen years of experience, it has become apparent that repairing anatomy is relatively easier than managing the biopsychosocial impact of pelvic floor dysfunction within a holistic approach. Despite five years of residency, and two years of post-graduate fellowship, problems that stretched me beyond my boundaries of knowledge and expertise were those requiring patience, attentive listening, empathy, and compassion. Over time, I recognized that mindfulness, or awareness in the present moment [1-4], enhanced my therapeutic relationships with patients.Easier for me was to select surgical procedures and manage perioperative care compared to problems that caused significant suffering and cut deep into my patients' lives. Issues such as deficient self-care, unexplored aspects of sexuality, and blocks to emotional intimacy in relationships masqueraded as gynecological problems. Voluntarily expressed, inadvertently exposed, or furtively revealed clandestine issues emerged from behind a gynecological veneer and pushed me past my scope of training. Mindfulness invited temporal pauses as inherent parts of a health-care partnership, increased my awareness of the decision-making process, identified patients' ambivalence and resistance, allowed feelings to be ventilated, and increased respect for patient autonomy [5] by sharing control of the therapeutic plan. Mindfulness enlarged the capacity of intervention to include wellness and enabled me to interact with patients as medical expert, resource person, and learner.