Mindfulness in medicine: Why just a moment can make a difference

Mindfulness in clinical practice need not be time-consuming. Ronald M. Epstein, M.D., FAAHPM, describes brief, practical pauses, such as taking a breath at the doorway between patients or during handwashing, to intentionally reset attention and improve presence across encounters. He illustrates how these seconds-long practices, including shared mindful moments in high-stakes settings like surgery or palliative care during COVID, can enhance focus, compassion, and team cohesion without adding burden to clinicians’ schedules.

Melissa Lucarelli, M.D., FAAFP: There's a lot of time pressure on practicing physicians as we do our work in the clinic or in the hospital, and yet, you describe circumstances in which just a few seconds of preparation or awareness might lead to better patient care now and save time later. How do you respond when someone suggests that increased mindfulness requires hours of meditation every day, or that it sounds like yet another thing on their to do list?

Ronald M. Epstein, M.D., FAAHPM: I think it's possible to develop some pretty simple practices that take virtually no time in your practice. Learning anything new, first of all, feels awkward, and second of all, there's a learning curve. So one thing that I suggest people just try out is pausing for a moment when you touch the doorknob or door handle, when you're going from one patient encounter to another, whether in the hospital or in an outpatient setting. And when you do that, in that pause, just take a breath and then imagine what it is that you want to carry into that room and what you want to leave outside. So as a family doctor, I could, in a typical day, see an 80-year-old with advanced lung cancer as one patient, and the next patient could be a healthy 6-month old coming in for a well child check. Now I don't want to, I don't want to bring in that 80-yearold, I don't want to carry that person and that mood and that event with me. So I kind of imagine there's a little job outside every room, and I just kind of put that the 80-year-old and his problems on that little shelf. I can come back and retrieve it and I do, because when I write my notes. But just that little mental exercise of saying, what do I need to bring with me to this next encounter?

During the dark days of COVID I was on the palliative care service at a time when people could not visit their dying relatives in the hospital and relied on Zoom calls that — it was awful. The halls were empty. It was incredibly bleak. So just as a way to, I guess, maybe maintain my sanity and able to be attentive in this kind of circumstance, I just decided that every day there would be one moment of exquisite beauty, and I never knew when that moment would happen. And I'm not pollyannish, I don't think everything's beautiful and all that. But there always is one moment. It could be someone's face, a smile. It could be a flower, it could be the snowstorm outside, it could be anything and but just knowing that that moment would happen somehow shifted the way that I paid attention to the world.

So when I when I do longer workshops to help clinicians be more mindful, we just talk about these little things. When you wash your hands, you know, surgeons wash their hands, I ask them, what do they think about? What's going through their mind? And some say that it's actually incredibly relaxing, they just are there in the present moment. Some kind of mentally go through the operation that's going to happen. There are some surgeons that, there's a video of a neurosurgical group in New York, that have intentional mindful moments in the beginning of an operation. They first make sure that it's the right patient and the right side and the right limb and all of that stuff, they've got the right equipment. And then they just have a mindful moment and just ask to imagine that this person lying, maybe now unconscious on the gurney in the operating room, just to take a moment to take in that this is a human being. That's it. And that mindful moment lasts for maybe 30 seconds. It seems like a very long 30 seconds, but it's a way of bringing the team together around common purpose and really setting the stage for paying attention to one another.