By Megan McGrane, PA 
What do you know about mindfulness? Jon Kabat-Zinn, the father of the modern mindfulness practice, is a professor at the University of Massachusetts Medical School. He describes mindfulness as the practice of being fully present in each moment, clear from distraction (1). Best put, mindfulness is paying attention “on purpose.” So why am I telling you this? And what does it have to do with your day-to-day in the emergency department?
Mindfulness is certainly not a concept broached by most medical training programs. However, mindfulness is a practice that has been in my life for almost a decade and is integral in my interactions with patients in the emergency department.
I understand you may be thinking, “So, what does this mindfulness thing have to do with helping sick patients?” Let me tell you how this practice has everything to do with emergency medicine and how I believe it can revolutionize the way you interact with patients and families.
We have all been there. It is Monday at 5 p.m., a patient has been waiting for a few hours and now you are telling them they need a study that could take an additional two to three hours to complete. Maybe you have a patient in a hallway bed that is constantly being shuffled past and bumped into as stretchers round the bend in the busy part of the department.
Perhaps a patient’s blood draw was lost or misplaced and never made it to the lab. Frustration can ensue in any of these scenarios, and they are far from ideal for all parties involved. Let me give you a few techniques that use mindfulness to help you “pay attention on purpose” and ease your interaction with patients.
Breathe
It is easy to take shallow, rapid breaths when we get angry, anxious or stressed. Often we are so unaware of this habit that it never even occurs to us. In a frustrated moment, taking a deep breath in through your nose, holding for four counts, and then breathing out again is a great technique to slow everything down. I often do this when a patient is raising his voice with me or is becoming increasingly frustrated. It helps me to slow down and respond rather than react.
Listen. And then Pause
The empty spaces in conversations can be uncomfortable. That is, until you get used to them! Practice allowing a few seconds to pass before speaking or responding when a patient is voicing concerns; this practice can make a huge difference in how the conversation goes. It allows you time to process what has been said, take a breath, and then respond. It also gives patients a chance to know they are being heard. Sometimes they also may take this space to continue their thoughts if needed. Allowing a pause in conversation tells patients you are taking time to think about what they said, not just give an instant reply.
Allow Room For the Patient to Ask Questions
Asking at the end of each interaction if the patient has any questions for you and then PAUSING (as in #2) gives the patient time to think of anything he or she might not understand about what you have said or what is happening during the visit. “What is a CT?” “How long do I have to take this medicine?” “What happens when you do this procedure?” This is a simple tip taught in the early stages of medical education that’s easy to skip over in the fast-paced emergency department.
Remember, It is Not About You
The ER is a familiar place to us as healthcare providers. We spend many days (and nights) in these halls. The dinging of monitors and overhead pages are like white noise in our day. However, for our patients it may be their first time in a hospital, not to mention a busy emergency department. The patient or a family member may be experiencing a health crisis. Often anger, frustration and irritation are multifaceted, and in the ER setting, they are inextricably linked to fear and pain. Using mindfulness and breathing strategies during a tough interaction can help remind you of this: it is not about you.
Source:
(1) Mindful Medical Practice: Just another fad? Can Fam Physician. Aug 2009; 55(8): 778–779.
Megan McGrane, PA, is a full-time emergency department physician assistant at Saint Barnabas Medical Center in Livingston, N.J. She received a bachelor’s degree and a master’s degree in exercise physiology from the University of Pittsburgh and holds a second master’s degree from University of Medicine and Dentistry of New Jersey (UMDNJ/Rutgers), Piscataway, N.J. She is a member of the American Academy of Physician Assistants.
