I've had a series of encounters with doctors recently. Some caused by ridiculous accidents (aren't they all?). Some possibly the result of minor nerve complications of diabetes. But all have left me dispirited and fatigued. Because I find something crucial lacking in so many health care professionals -- mindfulness.
Mindfulness is the act of paying full conscious attention to whatever you're doing in the present moment; it's the act of being right where you are fully present in this moment of now. Imagine how different the quality of an interaction would be between a mindful doctor and patient.
It's ironic that many health care providers have forgotten, or don't realize, the enormous healing power of merely being fully engaged and present with their patients. When my provider is mindful I feel calm enough to hold onto a world where my nerves are running riot. I feel safe when I'm not sure I am. I feel confident that even if my world has just tipped on its axis I can still live in it as me, and that together we will handle whatever has happened.
Yet, increasingly I find my providers multi-tasking when they're with me.
Benefits of Mindfulness
For a patient, a doctor's full attention immediately creates an environment of safety and support. In such a space worries lessen and a patient can better hear what her doctor says. For a physician, a mindful patient offers more and higher quality information to help you more quickly and effectively diagnose and treat, leading to better outcomes.
While most insurance companies require doctors see multiple patients in an hour, no matter how little time there is for a visit, a mindful interaction is already healing.
My visits feel so perfunctory that "care" has gone missing from the term "health care provider" and the healing power of human connection is on my, and I imagine many patients' Most Wanted List.
Below are a few recent medical encounters I've had both with mindless and mindful providers. Plus 10 suggestions for more mindful encounters with patients.
Examples of Mindless Encounters
Hand surgeon: Due to severe pain in my wrist I go to a hand surgeon. After the nurse shows me to a treatment room, she stands with her back to me reading my intake form. Still with her back to me, she asks me a question. I have to say to her, "Can you please face me when you talk to me?"
The hand surgeon examines my hand and gives me a clinical diagnosis I don't understand. I have to ask several questions to understand what is wrong with me. He answers each question before I finish asking it. He talks so quickly my brain cannot process the information. By time he gives me my options I'm in a brain fog.
Podiatrist: My foot falls asleep while I am working at my computer. Unaware, when I get up from my chair and put my foot on the floor, it buckles underneath me and I hear "crack, snapple, pop."
My podiatrist begins our session by typing notes into his computer. He tells me he'll be with me in a minute. Several minutes pass before he looks up and asks me what happened.
After developing my X-rays, he rushes back into the treatment room and tells me while whizzing past me, "h.lama.m. rrfemmema..a,, wlejjejs OJK." His next sentence is even more garbled -- delivered while stacking the X-ray plates back in the closet. I ask him what he said. "Looks like a hairline fracture. You're going to be OK." I really would have liked hearing that the first time, since as a type 1 diabetic with a foot problem I've been hyperventilating since the incident.
Neurologist: After the hairline fracture in my foot heals I'm still in pain so my podiatrist sends me to a neurologist.
I learn I have a nerve entrapment. I also learn that my neurologist grew up in France, lived in the jungle of Vietnam for years to study meditation with a Buddha. He left Vietnam just before the war and came to America with $100 in his pocket. He supported himself as a chef until he got cancer. He was so appalled how doctors treated him as a cancer patient that he decided to become a doctor. He knows neurology is perfect for him because it combines his interest in the body's energy meridians, chi and caring for patients.
Funny thing is he never learns a thing about me. In three visits he never asks me anything other than, "Does this hurt?"
Without intending, his powerful personality and lack of interest in me intimidate me from asking many questions -- even though I can't understand his French accent. I actually leave his office not sure of my prognosis. If he would have asked me this one question, "Do you understand what I've just told you?," he would ensure that I had.
Physical therapists: I now go to physical therapy three times a week to unlock the nerve entrapment. I work with two different assistant therapists, one mindless and one mindful.
They both perform the same exercise with me separately. They hold a strong, thick band around my ankle as I move against the tension. The mindless assistant, looks around the room and gives instructions to other patients while working with me. Each time her attention is diverted the band she's holding goes slack and she loses count of our repetitions. I feel I am wasting my time.
Examples of Mindful Encounters
The mindful assistant looks only at me, talks with me, counts the reps, never eases up on the tension. I feel myself growing stronger.
I had to dig deep to think of another interaction I've had recently with a mindful provider. It was my diabetes educator.
She came out to the reception area, smiled, shook my hand and walked me back to her office. She pointed to a chair for me to sit in. She asked me questions both related to my diabetes, and some just about me in general.
When she learned I write books about diabetes, she talked to me like an industry peer. She listened more than she talked and I never felt judged.
When she wanted to share information on her computer, she turned the screen around so we could look at it together. At one point she pulled my chair over so we were sitting together.
She gave me her email address when I left just in case I had any questions.
My 10 recommendations to turn a patient visit into a mindful healing encounter
1. Greet me by looking at me, call me by name and smile. Knowing you see me makes me more encouraged I'll get good results working with you.
2. Point out where I should sit if it's not obvious. Having you take charge of the small things helps reduce my anxiety about the big things.
3. Ask me a few personal questions. It energizes me and stimulates my thinking. This may help you better diagnose the problem.
4. Look at me when you talk to me. The eye-to-eye connection makes me feel that whatever is wrong you will help me get through it.
5. Use language I understand and speak slowly enough for me to follow. If I understand the issue I can better weigh my options and/or know what to do and why it's important. This affects whether or not I follow your instructions.
6. Ask me if I have any questions and listen to the whole question before you answer. Listening attentively you may also hear what I'm afraid to ask.
7. Be thoughtful in what you say and do. I am there because something is wrong and I am worried. Your understanding will help me to do better, your criticism will add to the problem.
8. Reserve judgment. It will help me hear you.
9. Ask me to repeat back to you any instructions you give me. That way we will both know I have understood what to do.
10. Ask me if I have any questions at the end of the visit. If I do, answering them will help me take any necessary actions. If I don't, you'll have given me a dose of kindness and respect.
It's ironic, but while providers may feel they'll lose time by not multi-tasking, they'll actually gain time by helping patients more immediately through more meaningful interactions.
Tell me, would it make a difference to you if your health care provider were more mindful? As a physician, can you imagine the quality of your interaction with a patient who is more mindful?
In a future post I'm going to share with you how Kaiser Permanente, one of the nation's largest not-for-profit health providers, is training physicians in a mindful approach that's increasing positive health outcomes.
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