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Brenda Ernst, MD
The Buddhist teaching that “Your true work is to discover your world and then with all your heart give yourself to it”2 can certainly be applied to oncology.
Medical practice is complex, and we may easily become perplexed and forget our own driving philosophies. The delivery of 21st century medicine is still, at its core, a science and an art. In successful practice, perhaps the application of mindfulness, resilience, and selfcare provide the artist both the canvas and the art.
Mindfulness is an English translation of the Pali word “sati,”3 meaning a simultaneous broad awareness of the present and a narrow focus of attention on the experience.4 Mindfulness provides a way of dealing skillfully with what you’re experiencing. Its practice is not about controlling experience but rather allowing space for the occurrences in your life. Some may mistake this concept as the act of focusing away from sadness toward happiness.
However, more accurately, it is accepting the sadness, placing it in an appropriate compartment, and then choosing to open up the next door.
Resilience explores how we adapt to change and respond to difficult experiences.4 In practice, this allows us to recover in a way that sustains our ability to be present in the future without fear of our past. Some methods of resilience incorporate positive engagement in the midst of the stress, while mindful understanding of the experience allows one to learn and grow from these experiences.
Stress is inevitable in medicine, and the practice of oncology brings with it a host of emotions. Mindfulness-based resilience acknowledges that it is normal to feel these emotions.
Ideally, we receive training in the science and art of practicing medicine, but rarely do we learn to incorporate the skills that allow for adaptation to the stressors inherent in the doctor-patient relationship. It is then that resilience is born.
As individuals, team leaders, and patient advocates, a multitude of stressors arise from internal and external sources to challenge us. Over the course of a busy clinic day, many competing goals may lead us to feel overwhelmed and detached from the task at hand. Unexpected patient changes or emotions may arise in the context of a clinic visit and sap our energy. Family or interpersonal concerns may play a role in the day-to-day experience. As we move from appointment to appointment, we can better serve our patients by allowing time to recognize the unique constructs in each relationship, patient visit, and role we play as physicians. There will be times when our patients merely need us to listen to the burdens of coupling a chronic illness with the business of daily life. As physicians, our challenge is to maintain compassion while standing steadfast in the gap between work and home, thereby garnering the strength and resolve to meet the next patient with the same novelty. To meet these challenges, techniques in self-care serve us well through the consideration of mindbody interventions, self-awareness, and preservation, as well as understanding the difficulties in coping with loss, burnout, and depersonalization. It is important to maintain work-life balance. Applying daily rituals allows pause for reflection and transition and functions to sustain our lifelong practice as caregivers.
Mindfulness and meditation have been, and continue to be, studied in cancer, primarily to measure outcomes related to pain control, anxiety reduction, and an enhanced quality of life.5-7 Perhaps the application of this broader science has, at its core, a place for the provider as well.
Canadian physician William Osler once implored physicians to “throw away all ambition beyond that of doing the day’s work well. The travelers on the road to success live in the present, heedless of taking thought for the morrow.
Live neither in the past nor in the future, but let each day’s work absorb your entire energies, and satisfy your wildest ambition.”1 To truly focus on the task at hand is difficult, as it relies on tuning out the distractions that frequent the clinical day. The application of mindfulness, resilience, and self-care allow a means to learn our own tendencies so that we can better communicate with patients and ourselves.
Self-awareness and preservation
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