Narrative Possibilities: using mindfulness in clinical practice

Abstract

Narrative is ever present in medicine and is an integral aspect of the doctor and patient relationship. Although theoretical discussions of narrative medicine and narrative ethics are important, they may serve to reify the patient's story, to make it a specific entity. In practice, the patient's story unfolds in the moment of communication depending on the individuals and the circumstances; the story is not an "object." Patients' narratives heard in clinical settings are often limited by physician behaviors, especially the tendency of physicians to control the interaction with the patient. To develop individual narratives effectively and competently, physicians must be able to help the patient tell the story that is most important, meaningful, and descriptive of the situation. If the patient's narrative is not heard fully, the possibility of diagnostic and therapeutic error increases, the likelihood of personal connections resulting from a shared experience diminishes, empathic opportunities are missed, and patients may not feel understood or cared for. The practice of mindfulness--moment-to-moment, nonjudgmental awareness--opens a doorway into the patient's story as it unfolds. Such mindful practice develops the physician's focus of attention and offers the possibility for a meaningful and important narrative to arise between patient and physician.

Impact of a contemplative end-of-life training program: Being with dying

“…One of the most widely used meditation techniques is Mindfulness-Based Stress Reduction (MBSR) (Kabat-Zinn, 2003). The qualities developed by mindfulness practice-self-reflection, deep listening, and moment-to-moment presence-are foundational to relationship-centered care, a core element of compassionate end-of-life care (Connelly, 1999(Connelly, , 2005Epstein, 1999). Our findings infer that cognitive approaches alone are insufficient to create the possibility of shifting one's awareness and way of being with others; experiencing and using contemplative practices can be instrumental in altering how clinicians care for dying people.…”

Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians

“…Methods from narrative medicine 28 and appreciative inquiry 25,29 wereusedtofosterinterpersonal self-awareness:awarenessofrelationships and communication. In each session participants were asked to write brief stories about personal experiences in medical practice focusing on that week's theme (TABLE 1).…”

“…Mindfulness-based interventions are increasingly frequent in health professions education 24,28,41,[56][57][58][59][61][62][63][64][65] and have demonstrated improvements in anxiety and mood disturbances in medical and premedical students, 65 as well as reductions in burnout among a selected group of family medicine residents. 66 One randomized controlled study of health professionals demonstrated that an 8-week mindfulness-based stress reduction program may be effective for According to convention, a score of more than 26 on the emotional exhaustion subscale, a score of more than 9 on the depersonalization subscale, or a score of less than 34 on the personal accomplishment subscale is considered an indicator of professional burnout for medical professionals.…”

A Multicenter Study of Physician Mindfulness and Health Care Quality

“…During the past decade, it has been recommended that physicians enhance their own capacities for mindfulness when practicing medicine and interacting with patients. 1,[4][5][6][7] Mindfulness is likely to have numerous personal benefits to practicing clinicians. Several studies have shown that MBSR reduces psychological distress or improves the well-being of nurses and physicians in training, [8][9][10][11][12] and a recent study found that a program teaching mindful communication reduces burnout, as well as improves self-reported well-…”