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Physician Health and Well-Being: Mindful Walking

Physician Health and Well-Being: Mindful Walking
By John A. Patterson MD, MSPH, FAAFP, ABIHM
Founding co-chair LMS Physician Wellness Program

“Walking on the Earth is a miracle”

Zen Master Thich Nhat Hanh

       Walking and mindfulness both have significant physical, mental and emotional health benefits. You can combine them by practicing mindful walking. Empirical evidence over centuries from many cultures and traditions supports the use of mindful, meditative walking as part of a conscious, contemplative lifestyle.

Cultivating Mindfulness– Walking meditation helps cultivate mindfulness in everyday life. Training the mind to pay attention when you are physically moving with open eyes can help bring mindfulness to everything in your home life, work life, traffic and simply being with yourself. Mindful awareness can inform everything you think, feel and do. Mindful walking can connect you to your inner sense of peace and calm, manage stress, increase spontaneity, and enhance mental focus, creativity and problem solving. It can also help you feel more resilient in the face of anxiety, worry, fear, anger, confusion, agitation, obsessive thoughts, rumination, grief, depression and pain.

Simple Mindful Walking Instructions– As you walk, mindfully and intentionally direct your attention to the physical sensations in your body- feeling your feet touching the Earth, feeling your heel landing, feeling the weight transferring to the ball of the foot, feeling the foot lifting and moving through the air and landing again on the heel. Bring special attention to the breath coming into the body and leaving the body- feeling the air at the nostrils, the movement of the chest and the movement of the belly. Feel your clothing moving across your skin, the air touching your skin, the movement of your arms, legs, muscles and joints. Notice sounds as simply sounds, without reacting to them.

Benefits of Mindful Walking– The formal practice of mindful walking cultivates an alert, aware engagement with your life as it is unfolding moment to moment- right here- wherever you are. Walking meditation trains your mind to skillfully cultivate wakefulness and awareness, increasing your sense of being present to everyday activities. Routine daily activities can begin to feel richer, more 3-dimensional. A deeper sense of gratitude can begin to grow. Interestingly, you may not be the first one to notice these changes. Those you live with and work with may notice them before you do, as your speech and behavior reflect your increasingly conscious, intentional, mindful living.  

Walking Mindfully During Ordinary Activity– You can carve out dedicated time for formal mindful walking or informally bring mindfulness to any walking that you do. As mindful walking connects you to your inner calmness, peacefulness and confidence, you may bring these qualities to relationships at home and work. You may find mindful walking more relaxing than other forms of meditation, especially if your mind is particularly churned up. At those times, walking meditation can be relaxing in a way that sitting meditation may not. Conversely, when your mind feels dull, lethargic or sleepy, walking practice may increase alertness and energy. A traditional instruction is to practice mindful walking before prayer or sitting meditation. Having trained the mind to pay attention to the body while walking- your prayer or sitting practice may be less distracted.

Walking Outdoors– Many people prefer walking outdoors. Compared to those who exercise indoors, those who exercise outdoors seem to enjoy it more, report less tension, depression and fatigue- while reporting more vitality, enthusiasm, pleasure and self-esteem. You can also attend to the sky, the wind, smells, sounds, birds and other animals (including your dog!). You can recite the Native American saying- ‘with beauty around me, with beauty beside me, with beauty in front of me, with beauty behind me, with beauty above me, with beauty below me, with beauty inside me- I walk in beauty.

Training the Mind– As with any other meditative practice, your attention may wander to the past or the future or to other places and circumstances. When your attention drifts away from the sensations of walking and awareness of your surroundings, take notice of those distracting thoughts or emotions without judgment and gently guide your attention back to walking. That moment of noticing the wandering mind is very important. All human minds wander. We all have what’s called a ‘monkey mind.’ It is completely normal for the mind to be all over the place- like a restless monkey jumping all around. Our job is to calm down the mind and train it to be our ally rather than our master- and anyone can do it (with dedicated practice).

Be Kind to Yourself– Harshly judging yourself for ‘failing’ at the task of mindful walking is counter-productive. Rather, use wanderings as part of the practice, gently labeling them as “thinking”, “planning”, “remembering”, “sounds” or “emotions.” Use wanderings as ‘reminders’ to gently guide your awareness back to the present moment, back to the walking and to your surroundings.

       You can practice mindful walking for whatever amount of time you have available, either dedicating time specifically to that formal meditative activity or informally bringing mindful attention to all of your walking- anytime, anywhere.

       May you walk in beauty.

Resources-

Mindful Practice in Medicine (Helping Clinicians Thrive)

A Daily Mindful Walking Practice (script and recording) https://www.mindful.org/daily-mindful-walking-practice/

About the Author

Dr Patterson is past president of the Kentucky Academy of Family Physicians and practiced in Irvine for 30 years. He is board certified in family medicine and integrative holistic medicine. He teaches mind-body approaches to stress management for the University of Kentucky Wellness Program, Saybrook College of Integrative Medicine and Health Sciences (Pasadena) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers individual consultations and group classes in stress management, mindfulness and relaxation training. He can be reached through his website at www.mindbodystudio.org

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Annual Wellness Visits: Successful Billing Using myCGS

Early detection can save lives. Annual Wellness Visits (AWVs) are an important opportunity for healthcare providers to assess preventive health history, disease screening and early detection, and advance care planning.

Billing these services require some coordination and research to avoid billing the wrong visit at the wrong time, which can result in denied claims.

Check myCGS:

AWVs have frequency limitations.

  • The initial AWV is conducted once per lifetime, after a patient’s

first year of Medicare enrollment.

  • Subsequent AWVs should be conducted annually, beginning 12

months after the patient’s initial AWV.

Always use myCGS to check your patient’s eligibility for an AWV. Under the Preventive sub-tab, you can find when the patient is next eligible to receive the service. This will help you avoid medical necessity denials if the service is provided too soon.

Choose the correct codes:

Each Medicare wellness visit has a separate set of billing codes, and it’s important to understand the differences among them. To reduce the number of denied claims, check out this printable chart that outlines which billing codes to use and when.

For details on each of the AWV components and documentation to maintain in the patient’s medical

record, refer to the Medicare Wellness Visits Tool.