Think Twice Before You Mandate Mindfulness

Well, I’m back in the saddle again after experiencing a difficult move to a new house in the last 3 days. I guess that shouldn’t be in past tense yet. The trauma of moving endures for a while longer than just a few days.

However, I did manage to practice mindfulness for the worst parts of it, as well as the easy parts.

The article referred to in the tweet above describes a cross-sectional, qualitative study to determine attitudes and habits which doctors think contribute to sustaining the ability to provide and teach humanistic patient care. It turns out that one of the habits is practicing mindfulness, which doesn’t surprise me.

Attitudes like humility, curiosity, the desire to live up to a standard of behavior and others, along with habits like self-reflection and mindfulness can be developed and maintained by trainees and experienced physicians.

The authors also mention the practice environment necessary to help sustain mindfulness. Collegial support, chaplain services, and learners were cited as being important. What got left out is the regulatory, administrative, and governmental matrix which leads to the sense of lack of control and which contributes substantially to physician burnout.

Doctors can do a lot to prevent burnout by tapping into inner resources. On the other hand, it still makes sense to apply a both/and approach by also changing the health care system to ensure that patients receive the highest quality medical care possible.

In other words, we ought to also pay attention to the working environment in order to reduce the toxic effect of mindless bureaucracy in the system.

Regarding the recommendation of the authors about habits such as mindfulness and reflection, I was a little disappointed that the authors of the study wrote “…in searching for methods to retain physicians and promote physician well-being, health systems and physician employers may do well to consider mandating faculty development programs on the basis of these habits…”

The issue here is that “mandating” participation in programs that some claim will improve patient outcomes and the patient-physician relationship can backfire. Many of you know what I’m thinking and you’re right–remember Maintenance of Certification (MOC) and the threat of Maintenance of Licensure (MOL).

While some will try to maintain MOC is voluntary, it is anything but for those of us whose hospital privileges and assignment to insurance panels are tied to participation in MOC. That makes it a mandated physician development program. Ironically, the MOL system requires some sort of self-reflection exercise as well.

But MOC and MOL are criticized and resisted all over America, at least in part because they’ve been mandated without sufficient input from physicians. Not enough effort was made to elicit the opinions of doctors about the application of the MOC model for how self-improvement gets done. In fact, most physicians feel railroaded by the specialty and state medical board actions promulgating MOC. As just one example, you can see that in the petition to simply not comply with MOC.

Mindfulness is not about passive acceptance of changes in the health care system that academic leaders and regulators want to impose on doctors. And there is such a thing as readiness for change.

I was aware of mindfulness for years before I was ready to act on my own decision to change. When I did, I valued the experience much more than if it had been mandated. Leaders need to remember that, as Stephen Covey pointed out, the most important change happens from the inside out. I think it’s great for me at this time in my life. But just because I think I should have done it sooner doesn’t mean it’s right for everyone.

“A leader is best when people barely know he exists; when his work is done, his aim fulfilled, they will say: we did it ourselves.”–Lao Tzu


Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.