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INTRODUCTION

Excellent patient care requires not only the knowledge and skills to diagnose and treat disease but also the ability to form therapeutic relationships with patients and their families, recognize and respond to emotionally demanding situations, make decisions under uncertainty, and deal with technical failures and errors. These capabilities require that clinicians have self-awareness to distinguish their values and feelings from those of their patients, recognize faulty reasoning early in the diagnostic thinking process, be attentive to when a technical procedure is not going as it should, recognize the need to gather more data, and be able to incorporate disconfirming data into an evolving assessment of the patient. Often, there is no tool or instrument that can help physicians with these situations on a moment-to-moment basis other than their own cognitive and emotional resources.

Mindful practice refers to clinicians’ capacity for reflection, self-monitoring, and self-awareness during actual clinical practice in order to practice with clarity, insight, expertise, and compassion. Clinicians generally value the principles of mindful practice—attentive observation, critical curiosity, presence, and the capacity to see a familiar situation with new eyes (“beginner’s mind”). Yet, during training and practice, clinicians spend little time “sharpening the saw”—developing, refining, and calibrating their own capacity for self-understanding as they think and feel their way through the complex demands of clinical practice. For psychotherapists, athletes, and musicians, self-calibration and self-awareness are considered fundamental to excellence and are often explicit aspects of training. Yet, for clinicians, there is often the assumption that knowledge and technical expertise are sufficient, when on reflection most clinicians value “adaptive expertise” and cultivating habits of mind that allow the clinician to self-calibrate and reflect continuously during everyday work. This chapter will suggest why mindful practice is important and indicate ways in which it can be cultivated.

Mindful practice is fundamental to excellent patient care. Mindful practice means being attentive, on purpose, to one’s own thoughts and feelings during everyday clinical practice and educational activities. Mindfulness implies a stance in which the practitioner can observe not only the patient situation but also his or her own reactions to it. A mindful practitioner can see a situation from several angles at the same time. Mindful practice implies curiosity rather than premature judgment, and presence rather than detachment. Mindfulness is especially helpful when dealing with difficult relationships with patients and families, challenging clinical situations, and in recognizing the need for self-care. Furthermore, recent research among students, residents, and practicing clinicians suggests that mindfulness is associated with better communication, better quality of technical (e.g., fewer errors) and interpersonal (e.g., empathy) care, less implicit racial and gender bias, and greater clinician well-being (e.g., lower burnout).

In contrast, mindless practice involves self-deception, often with the illusion of competence. Blind certainty, ignoring of disconfirming data and arrogance without self-examination or reflection, dooms us to “seeing things not as they are, but as we are.” An example of mindlessness is the common ...

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