The Mindful Health Professional: Techniques for Effectively Communicating with Patients

hello everyone welcome to this presentation from osmosis from Elsevier the mindful health professional we will give you a few minutes to settle in before we actually start the presentation I'm glad you all could make it and I am hopeful that this will be worthwhile and interesting for everyone we'll wait a few minutes and there will be a comprehensive presentation with questions and answers at the end which you could put in the chat and you could also let us know where you're from I see that there are two questions three questions are already four that looks exciting apparently people are interested in the topic and I hope you find it interesting from my point of view Wait Another Minute or so and then I'll start the presentation on the mindful health professional techniques for effectively communicating with patients questions are coming in we've got a lovely group of people we've got Muna who's a Med medical student we have Charles from Jacksonville Florida we have Halal from Turkey so and welcome everybody super happy to have you Frank whenever you want to get started feel free to okay I think we should start now mindful health professional techniques for effectively communicating with patients this is a presentation on mindfulness from the point of view of communication and communicating with patients from the health professional's point of view and the health professional means doctor nurse physician?s assistant APRN a nurse practitioner or anyone that works with patients or clients and I'm going to use those two terms synonymously I'm Frank John Nagi medical doctor from Yale University School of Medicine Yale child study center which is the department of child psychiatry at Yale I am a board certified psychiatrist in the department of child adolescent Psychiatry brief biological biographical sketch I'm with Yale University I was trained at John's Hopkins in Baltimore in adult psychiatry I trained also in medicine at Oxford University Hospital in London and did my child psychiatry training at Yale child study center in New Haven where I continue to reside I've written five books on Psychiatry and Integrative Medicine particularly ayurveda which is traditional Indian medicine I've written a book on Child Development I've written a book on Envy Theory emotional intelligence and the topic of today mindfulness which I call learned mindfulness these are the covers of the book and by the way I actually painted this and designed the cover of this book I did take painting many years ago mindfulness definition the moment is the zone of action mindfulness invites us to pause be curious and open and continuously awaken to Quality engage engagement in our present moment experience precisely as we find it mindful Communication in patient centered Health Care is a dialogue of Allied partnership and collaboration it involves sharing and explaining with clients and patients to enhance Focus minimize anxiety exchange meaningful information reinforce treatment adherence and improve outcomes the provider models mindfulness for the distressed patient mindfulness is in essence pause mindfulness is openness mindfulness is attentive listening mindfulness is quality engagement exactly where we and I'll use the collective we to mean the provider and the patient together that is the communication and the provider him herself is a model for the patient why is learning mindfulness relevant mindfulness as attention in the present moment makes one's personal life easier to understand and negotiate and more satisfying to enjoy with fewer obstacles in working with others in other words job satisfaction increases the risk of anxiety and depression is lessened under inevitable conditions of stress potential trauma and time constraints the mindful health profession benefits from using these mindfulness techniques which we will discuss when communicating respectfully with patients this is a very important Slide the absence of mindful living breeds burnout Syndrome has three main components exhaustion depersonalization sense of professional inadequacy exhaustion is physical fatigue emotional depletion and lack of enthusiasm depersonalization is overwhelming stress leading to feeling your thoughts and sense of self are unreal resulting in physical and emotional withdrawal and Detachment and that is very critical the word Detachment when a person experiences burnout and the burnout syndrome he she becomes withdrawn from the clinical work which means from engagement with the patient withdrawn and detached and that leads to a sense of professional inadequacy feeling depleted and unable to recover which numbs reason and clear thinking and doubting one's skill competence and Effectiveness as a provider what we call that nowadays is impostor syndrome MD providers who self-identify with burnout 50 6% are women 44% are men and 83% have identified the cause of burnout as job stress psychological mindfulness and spiritual meditation are very much related but there are nuances this slide talks about spiritual meditation practices meditation involves engaging in Awareness practices to attain a clear focused thoughtless State of Mind practices like Sati patana establishing the framework originated by Buddha 550 BC and vipasana bavana cultivating insight and these phrases are mixtures of Sanskrit and piali the language of the Buddha establish Mindful and Insight Meditation they lead to a state of psychological awareness called mindfulness or Sati Insight Meditation Society in Barry Massachusetts Insight Meditation which is called vasana bana was formalized by mahasi Saad who is the founder his dates were 1904 to 1982 and in 1967 to the present time the Insight Meditation Society trains people in the formal Buddhist practice that aims to experience and see things as they are in themselves meditation proper which is called the vasana bana attaining mindful mindedness or mindfulness from the Western point of view formal therapeutic mindfulness techniques there are three major schools there are multiple forms and styles but three major techniques are number one acceptance and commitment therapy called act formulated in the 1990s by Stephen Hayes concentrated on four major issues fusion with your thoughts evaluating your experience avoidance of distress and suffering and instead attempting to accept the issues and problems you were dealing with accept rather than overreact accept doesn't mean deny it just means accept and see for what they are do not overreact and lastly reconceptualize the problems which means flexibly trying to understand them and broadening your perspective from one which is more egocentric self-centered toward one which is much broader and inclusive the next formal technique was constructed by John cabat Zen called mindfulness-based stress reduction therapy mbsr in the 1980s and the last one was mindfulness-based cognitive therapy mbct which was developed to treat resistant depressions there are three current styles of Mind training practices or mindfulness practices task focused open monitoring and ethical enhancement task focused attention practices use an anchor and the anchor is usually the breath or a bodily felt sensation or a sound or some material object one effortlessly engages with it and then disengages from it and then returns back to the Anchor this method helps steady the mind the next method is called open monitoring om it helps one become less reactive to the flow of spontaneous everchanging mental experiences not one concrete specific anchor and the idea is permit all the spontaneous mental events that come into the mind to be noticed one doesn't react or overreact to them one doesn't label them specifically but just notices them then moves on and the goal here or the outcome is helping to calm and balance the mind and the last mind training practice is called ethical enhancement practice it has two forms loving kindness which Sanskrit word is meta which means wish for happiness and the other form is compassion meditation karuna which means compassion freedom from suffering these are phrases that support and reinforce care and tenderheartedness to self and others now this slide is probably one of the most if not the most important slide for mindfulness and mindfulness practices there are seven essential keys that go into mindfulness non-judging patience beginner's mind trust non-striving acceptance and letting go number one non-judging is the impartial observation of experiences without automatic evaluation or judging judgments are evaluation of good and bad right and wrong and then the impulse to act on them non-judging is open-mindedness without bias and reduces discrepancy conflict and suffering it creates a safe space number two patience cultivating a calm and accepting attitude toward experiences allowing for reflection natural unfold in and responding skillfully number three beginners mind this means approaching experiences with a fresh open perspective like a beginner number four is trust developing trust in oneself and one's abilities to navigate mindfulness practices and personal growth trust is the belief in the reliability and truth of one's experience number five non-striving diffusing the need for specific outcomes or goals and focusing on the present moment without attaching and without expectation number six acceptance acknowledging experiences and oneself as is where you are no matter how difficult without adding judgments or qualifiers number seven Letting Go releasing attachments and unhealthy habits allowing thoughts and emotions to flow freely decoupling mind wandering letting go of the past and the hope for future I'll pick out a few which are extremely fundamental non-judging evaluating what comes into the mind or what we think of or feel as good bad right wrong this is fundamental mindfulness the more mindful one is the less one evaluates the contents of the Mind as good bad right wrong to extremes the next prerequisite is letting and go people hold on to thoughts and feelings they hold on to the past and they hold on to the Future the wished for anticipation of what they want or the past what they had as being the best rather than concentrating on the present the be present of what is and accepting that as the given to be worked with to its fullest in mindfulness no goals just a perspective in mindfulness goals per are less useful than an orientation to an ongoing process practice and perspective performance and achievement are deemphasized pause and being comfortable with uncertainty are Central that's a very important sentence pause and being comfortable with uncertainty are Central with patience identify and when appropriate reflect back par paraphrase the patient's feelings a regular mindfulness practice stabilizes the mind and minimizes mind wandering yielding more than mindfulness itself it is a lifestyle change reducing stress and chronic tension decentering this is an important slide in terms of the word and the concept and the reality of decentering a Psychotherapy mindfulness-based cognitive therapy mbct was used for depression relapse mbct emphasized changing the awareness of and relationship to thoughts changing the awareness of and relationship to thoughts rather than the thought thoughts themselves a significant part of this process included the development of decentering entails dis distinguishing rigid identification with one's thoughts as personal facts identical with oneself that is crucial to understand and to become one with in a lived way not just a cognitively understood way to distinguish rigid identification with one's thoughts as if they actually were you rather than merely ideas passing and floating flexibly through the Mind attaining learned mindfulness learn mindfulness as present awareness learned mindfulness emphasizes the importance of being present in the now moving away from past regrets or future anxieties bare attention is living fully in the moment and embracing complexity as part of a whole Integrated Life emotional intelligence and integrity mindfulness emotional intelligence and integrity are Central to learned mindfulness they integrate emotions and thoughts seamlessly improve mental function in and stabilized mood regulation Integrity mindfulness emotional intelligence plus authentic Integrity emotional intelligence is defined as the ability to perceive label work with understand manage and Implement emotions adaptively in real life authentic Integrity is selfless freedom from self-deceit and transparency selfless is less divided sense of self freedom from self-deceit is the ability to identify self-criticism and self-distrust and transparency is communicative Clarity honesty and directness mindfulness practice techniques two levels one is formal practice one is informal practice formal practice the core is Paul pause and silence regular mindfulness exercises typically 15 minutes long one to three times a week initially to cultivate a mindful mindset in daily life it encourages maintaining residual mindful awareness between formal practices aiding in reducing anxiety and enhancing overall mindfulness informal practice is practicing pause and Silent time and reflection this should be a routine part of everyone's life informal practice practicing pause you utilizing brief pauses throughout the day to realign attention and reduce anxiety fostering an inclination for enduring mindfulness silent time and reflection these practices create space for introspection and insight allowing new lifestyle perspectives and solutions to emerge practicing pause is key practicing pause this technique involves both formal sessions of dedicated mindfulness practice and informal moments of mindful through throughout the day formal practice self-observation mindful attention and decentering informal practices of pause and silence on the other hand encourage regular short pauses to observe Sensations emotions and breathing three pillars of learned mindfulness technique to jump start in a reflection pause first and then self- observe noticing and exploring Sensations descriptively labeling understanding the underlying emotions mindful attention by choosing to pay quality attention we break free from unhealthy habits and Foster adaptive behaviors disengaging self-processing learning to disengage from Total identification with thoughts and feelings promotes a more flexible and fluid sense of self this disengaging includes a decentering or rigid identification with one's thoughts as immutable personal facts identical to oneself the role of breathing in mindfulness breathing techniques this technique emphasizes slower deeper breathing patterns like abdominal breathing which stimulate the vagus nerve and activate parasympathetic nervous system inducing calmness and relaxation breath awareness focusing on breath Sensations AIDS mindfulness by anchoring attention to the present moment thus cultivating mental Clarity and emotional regulation benefits of self-regulation feeling more in control and the ability to manage distress breath awareness models self-direction and motivation bomal benefits of mindfulness Narrative reframing of how we interpret and experience our life stories changes how we react and respond paused silence active listening and greater empathy and this counters feelings of burnout cynicism and compassion fatigue with health promoting mindful engagement quality of life is upgraded priority blindness downgraded well-being which means happiness the perception of satisfaction and fulfillment increases and wellness is enhanced that is Health lifestyle and physical wellness mindful communication and clinical work developing a solid base and quality mindfulness supports strategies for communicating good and bad news humanly and appropriately in specific contexts daytime clinic on the phone etc. is effective in bridging cross-cultural and diversity differences builds trust and acute care and long-term interventions empowers both provider and client health and wellbeing being emotional cognitive stability to regulate skillfully and not overreact enhance a social engagement and improves physical and lifestyle Wellness in conclusion effectively communicating with patients does practice active listening not interrupting use open-ended questions more than yes or no show empathy maintain eye contact showing attentive respect clarify and summarize paraphrase reflect back slowly and clearly provide clear explanations encourage questions use positive body language a welcoming receptive expression and body gestures respect patient privacy in an appropriate setting that also means don't go too fast instinctively and intellectually measure the patient's Tempo modulate your Tempo with the patient Tempo become in sync and do follow-up to show ongoing support less helpful communicative interactions are interrupting your patient using medical jargon using acronyms I think that is something that has crept into not only medicine Psychiatry social work but all fields acronyms I strongly advise against using acronyms unless you do that in writing and when you use an acronym first spell out the phrase dismissing patient concerns appearing rushed making assumptions and overreacting impulsively showing negative body language providing too much information thinking we need to get everything in and we don't because usually the first few minutes is all that the patient hears if you're with a patient for let let's just say 15 minutes the first five minutes are gone the patient is anxious doesn't hear anything and the next five minutes the patient hears something so go slowly and look at the patient's responses and even if you have to repeat don't think you're kind of being topical or too repetitive and wasting time because patients all people are always anxious in discussions and try to get too much information in in a brief period of time number eight don't ignore nonverbal cues of discomfort number nine remember about being judgmental number 10 becoming too generic or impersonal rather than trying to be as authentic and genuine in an appropriate fashion and this is the last slide key points mindfulness is be attention mindfulness is nonjudgment Letting Go acceptance and patience and remember these are not just cognitive inanimate Concepts these are lived experiences interpersonally lived experiences non-judgment letting go of past assumptions and hoped for outcomes within reason we hope for health and well-being that's reasonable but when you're with a patient in the here and now just as you are with your yourself what's important is concentrating on the here and now in essence in Vivo to get as much out of it as possible and then in retrospect to make sense out of it number three deterrence to mindfulness are excessive talking which is very common mind wandering which is distractibility multitasking and daydreaming number four what enhances mindfulness is pause active listening eye contact and I can't say enough about empathy cognitive empathy and emotional empathy and real empathy means both understanding and communicating to the patient client that you understand their ideas and for you whether or not you EX accept them as true and valid you understand them and you understand that the patient believes them and emotional empathy means that you feel what the patient is feeling and you communicate that to the patient thank you now we'll have time for questions and answers got a handful of wonderful questions here for you Dr Nagi the first one is when a patient is getting sidetracked about what we're asking what we're focusing on how can we effectively empathetically communicate that we need to get back to the main topic so that we can address their issues in that question is the answer and main topic address the issues is the key to getting back by repeating to the patient who is being distracted or sidetracked with what we think are less relevant issues at the moment we can say what we need to do now is focus on main issues and very relevant topics which are and I will enumerate two of them and they are number one is this number two is that I know all the other things you've brought up are very important to you but for us now at this time mostly we need to talk about main topics which are number one is this number two is that can we talk about those two topics right now fantastic thank you so much the next question we have is do you have any advice for medical students when it comes to staying mindful in such a competitive environment especially when it comes to preparations for residency and how do I apply this in my daily life should I start with meditation starting and ending with meditation is always a wise thing to do being in meditation in the mindful way that I've spoken about the routine way of being in the world and in with yourself in the world is less anxiety provoking and sets the tonus of your mind which means you?re thinking and your emotions it sets the tonus at a level where you are receptive and accepting of what is happening in the moment to the fullest that helps you to not become distracted with issues which not which may not be as beneficial or enhancing or problem solving to you at the moment or for your future as is the case if you're not in mindfulness now to be in mindfulness when you're in your private time it's important to do formal mindfulness practice and then in between informal mindfulness practice which is pause and self-reflect because obviously each of us when we're awake is not speaking and talking continuously we have time to not talk and during a not talking period should be active listening and observing if we're with others it is active listening to the other that is interpersonal Humane engagement if we're by ourselves it is introspective engagement the word in Psychiatry and psychoanalysis used to be intra psychic means introspect I?ve internal monitoring what's happening in ourselves observation and that helps that pause and silence helps to reduce anxiety and mind wandering and distractive and helps us to operate in a field of being with others which seems to generate competitiveness especially when one is younger and trying to you use the word compete or that there is competition there is competition more so when one is younger and striving to learn and to achieve and that many times focusing on the competition is a distraction that causes anxiety and less learning so reducing the distraction reducing the anxiety increases and enhances learning and helps improving advancement that was a really helpful answer thank you so much we have one more question can you please share practical tips about not overthinking what colleagues and management think of me as an RN I'm feeling judged all the time which is causing me stress do you have any recommendations for types of meditations or mindfulness exercises that we should try as beginners Well the word projection comes to my mind when any of us think that others are thinking about us in a certain way it usually is a projection of how we are thinking of ourselves and that was one of the ideas I talked about when I talked about self-criticism and that actually is one of the features of depersonalization it's a Nuance self-criticism when one distrusts one's own competence one's own Effectiveness one's own abilities one's own intelligence one's own skills it's easier to project that out and see it in others and that others are thinking it or judging you in that way now objectively the only way you can know the validity and truth and verify that is if they tell you that in words but if they don't tell you that in words then it's better to think that it's in your ballpark your mind so that gives you the upper hand that puts you that empowers you or gives you self-control to work on yourself and examine why it is you self-doubt you self- criticize you question your abilities and skills and there are so many ways you can do that you can do it by yourself you can do it by discussing those fears and doubts with a very close friend confident or if you're in therapy with a therapist but it's important to realize it is in your quote unquote control self-control you're not at the mercy of others you have the power to work with that this is an empowering thing and mindfulness helps to feel for a person to feel more empowered that they can re in all these emotions that have their roots and this is for everyone all our emotions feelings thoughts and behaviors have their roots in our earliest childhood our middle childhood or adolescence up to the present day and their roots are there but if we become aware that this is true and we see these distressing events we can work to modify maybe not change 100% but we can modify what we feel is distressing and recontextualize it toward Improvement great that is a wonderful answer super helpful I have one more question for you and this could be a fairly involved one which is can how do we encourage our staff or colleagues to practice mindful communication on a daily basis is especially as a tool to improve communication and reduce stress when under pressure and intense time constraints they're asking specifically in reference to avoiding burnout I wrote a paper for psychology today about five years ago and it was called you are your child's first verb now to some people that was a very perplexing or confusing or enigmatic puzzling title what I meant by it was you are the prime model and example for your child from day one actually every day that your child adolescent adult looks at you as a leader you are the prime model and example for those under you who want to see you and use you as an example of how they should behave in such a way how they should think how they should formulate and handle their values appropriate to their context in whatever position they have under your leadership or guidance leadership is a good word but a softer concept is guide a leader is a guide and so if you as a guide model and show and demonstrate the appropriate values and behaviors that you want those you work with and that work with you and that work with each other to demonstrate in a concrete way on a day-to-day basis then you will also behave that way certainly and the Latin phrase is mutus mutandis with the necessary changes everybody behaves according to the context and role therein so if you model the principles that you want your people your team to demonstrate daily then you demonstrate them maybe a little bit more in an exaggerated fashion and specifically in a group process when you have group or team meetings and then even in a more concentrated way on a one-to-one interpersonal basis and that's when I talked about authenticity authentic mindfulness authentic Integrity authenticity is really something that each of us needs to look at in ourselves and in our relationships with others authenticity is a bell that Rings loudly when we ring it and it has a lot of meaning and a lot of repercussions a lot of it can sound beautiful and melodious or it cannot depending on how we use our authenticity and how we share it with others sharing is very important and modeling is very important and that's what mindfulness does do when we understand it incorporate it and kind of hold it as part of as I used the expression before lived self it's not a one and one thing it's something which has to be like breath inhale hold exhale renewed continuously for life to occur the life of the Mind the life of the emotions the life of interpersonal authenticity fantastic we have one more question today and that is how do we manage feeling emotional ourselves while empathizing with a patient I can't imagine not feeling emotional when empathizing with a patient but I add I remember years ago in Psychiatry and psychoanalysis when we used to talk about ego boundaries there are boundaries ego boundaries interpersonal boundaries that are between people and we have to be aware that there are appropriate boundaries and if we cross the boundaries of appropriateness it's inappropriate and harmful to ourselves and others therefore when we are comfortable enough with ourselves and our emotions we can be with a patient and feel our emotions and be accepting of what the patient is describing be receptive accepting and receptive and open and so feel to a certain extent the Resonance of the tears the anguish and the hate and hatred and negativity that the patient is experiencing but we don't have to become one or fused with it to the point where we lose the boundaries that make us and them that make us the provider who is the helper and them the patient who is in need of help and sharing and guidance that we can provide because if we lose that then nobody benefits it's not that we're better and they're worse it's that we are sharing our skill with someone who needs to improve their skills and so we participate in their distress but we don't become at one or fused with their distress but we're kind of sampling it without becoming it it's like a parent dealing with the temp temper tantrum of a 5-year-old we can feel it but we've been told by child developmentalists don't reduce yourself to the level of a child remain the adult in the room and then you can help the child and usually it was said help the child by saying settle down and use your words and in a therapy session or with others who are undergoing a lot of emotional turmoil we participate with them and resonate with their distress and then in an appropriate moment or two or three or four when they've settled we try to put into words and put into words with them what that experience was like and why it has occurred and then possibly how it can be managed in a more skillful way that is fantastic that is all we have time for today but thank you so much Dr Nagi for sharing your wisdom and knowledge with all of us and thank you everyone for joining us today we genuinely appreciate you taking part and learning about this fantastic technique for mind mindfulness and we hope it was helpful for you thank you all very much it was a great honor and pleasure and a learning experience for me as well to participate with you in these questions and in this experience thank you helping current and future clinicians Focus learn retain and Thrive learn more ?Music?