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Physician Health and Well-Being: S.T.O.P. – A Simple Mindfulness Practice for Physicians and Patients

S.T.O.P. – A Simple Mindfulness Practice for Physicians and Patients
By John A. Patterson MD, MSPH, FAAFP, ABIHM
Founding co-chair LMS Physician Wellness Program

       Modern life and the COVID pandemic are taking its toll on our nation’s mental and physical health. Physicians and their patients both suffer from stress-related conditions and burnout. Multiple national surveys have documented an alarming increase in perceived stress, anxiety, depression and suicide among health professionals and their patients. Our health and our very lives depend on our ability to manage stress in healthy ways at home, at work, in traffic, in relationships- and simply inside our own skin. We need simple tools that we can use personally and also prescribe to bring some calm to the chaos- some peace to the frenzy- some kindness to the aggression and competition. S.T.O.P. is one such tool- taken from the Mindfulness-Based Stress Reduction curriculum (1). This practice can take as little time as a few seconds or as much time as you like.

“S” is for “Stop” and take Stock

       Aren’t there times when you just need a break- even for a minute- even for a breath? Make yourself a promise to recognize several times each day when you need some self-care and rejuvenation and simply stop. Step out of the unskillful, habitual reactivity of automatic pilot mode and step into the present moment. Step out of the doing mode and into the being mode. Reconnect with yourself and your natural inner resources of resilience, relaxation, peacefulness, compassion and wisdom. Really tune in- paying attention to what is happening right now, right here, without expectation, without an agenda other than a curious, open inquiry into what is actually happening inside you and around you.

       Even if you don’t remember this entire sequence, just remember the word stop. Have the intention to truly inquire into the three primary domains of your experience- 1) Body- sense perceptions and physical sensations , 2) Mind- thoughts, images, plans, memories and 3) Emotions and feelings. Bring some well-deserved self-compassion and kindness to yourself, especially if your experience is unpleasant, stressful or painful.

       Ask yourself, ‘What is my experience right now?” Simply notice what’s going on around you and inside of you, take stock of the situation, take your foot off the accelerator and slow down, grounding yourself with some conscious, natural breaths. In the process, your pleasant experiences may be more fully nurtured and your unpleasant experiences may be less onerous.

       Alternatively, you might ask, ‘What is absent from my experience right now- what have I forgotten about myself, my work, my colleagues, my family.’ Allow experiences of kindness, compassion, generosity, awe and beauty and smell the roses along the way.

“T” is for “Take” a Breath

       Take a normal, natural breath, directing your full attention to breathing. Even one breath experienced with your full, unhurried attention can counteract the stress response. Feel the physical sensations of each inbreath and each outbreath- sensations in the nostrils as the air moves in and out- sensations as the air moves back and forth across the upper lip- sensations as the air moves in and out of the back of the throat- sensations as the chest expands and contracts- and sensations as the belly expands and contracts.

       You may find it helpful to say to yourself “in” on the inbreath and “out” on the outbreath. Use your breath as an anchor to bring you into the present moment and help you tune intentionally into your natural state of calm awareness and restful alertness.

“O” is for “Open” and “Observe”

       Expand the field of your awareness beyond your breathing, including a sense of the body as a whole, your posture, your facial expression and the sensations on your skin. Notice all your sense perceptions- touch, sight, sounds, smells and tastes. Expanding your awareness beyond your body, connect to the trees and all the green growing things you depend on for oxygen. Notice your thoughts and their fleeting, impermanent nature. Notice that thoughts are not always facts and not necessarily true. Notice that you can intentionally choose to think your thoughts or let them go. Allow your emotions to surface, recognizing and naming them without judgment- ‘this is anger’- ‘this is joy’- ‘this is grief’- ‘this is happiness’- ‘this is anxiety’- ‘this is depression’- ‘I know you. I am experiencing you but you do not define me.’           

       Naming your emotions without self-judgment helps to cultivate emotional intelligence, magnifying the benefits of uplifting emotions and reducing the power of distressing emotions. Opening your heart to your own stress, difficult emotions and suffering can nurture your natural capacity for human affiliation and social support and your capacity to help relieve the stress and suffering of other people and all living things. Your own self-healing is the core foundation of your patient care.

“P” is for “Proceed”/new “Possibilities”

       After this intentional slowing down, stepping off the treadmill and out of the rat race, take the benefits of this practice into the next moment, the next task, the next meeting, the next conversation, the next relationship- informing ordinary daily activity with the physiological benefits of mindful self-care.

       Notice the world around you, experiencing how things really are, tapping into your intuitive inner wisdom for what you need right now- a chat with a colleague, a call or text to a friend, a quiet moment alone, a bite of chocolate, a cup of tea. Then proceed with more clarity, from a place of choice and skillful responding rather than reactive, habitual auto-pilot.

       Proceed without any expectation of how others will act or speak or behave. Be realistic about your inability to control the pace at which other people are moving. Know with increasing confidence that you can consciously choose the pace of your own mind and body, where you place your attention and whether you perceive your cup as half empty or half full. Feel your inner parasympathetic relaxation response naturally balancing your stress response. With an open, curious mind, experiment with the S.T.O.P. practice several times a day, anywhere, anytime- as you enter the exam room, while listening to your patients, before each meal, before starting the car, turning on the computer, bathing, brushing your teeth, taking out the trash, during conversation, going to bed, waking up in the morning- anytime, anywhere.

       As you take control of where you place your attention, you will understand why ‘mindfulness’ is also translated as ‘heartfulness.’ Refining your ability to slow down and S.T.O.P. can help you promote resilience, manage stress, prevent burnout and cultivate compassion. Keeping a log of your practice can be extremely helpful. The following questions are taken from the S.T.O.P. practice log (3) below.

What was the situation?
What was going on with you when you thought to S.T.O.P.? (body, mind, emotion)
What did you notice WHILE you were practicing? (body, mind, emotion)
What did you notice AFTER your practice? (body, mind, emotion, action)
What did you learn?

Resources

1) U Mass Medical Center for Mindfulness in Medicine, Health Care and Society

2) Downloadable basic S.T.O.P. instruction summary

3) Downloadable detailed 1 week S.T.O.P. practice log

About the Author-

Dr Patterson is past president of the Kentucky Academy of Family Physicians and is certified in family medicine, mind body medicine, integrative holistic medicine, mindfulness-based stress reduction, physician coaching and yoga therapy. He is founding co-chair of the LMS Physician Wellness Program. He teaches stress management for the UK Health and 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 classes, consultations and coaching to manage stress-related conditions and prevent burnout. He can be reached through his website at www.mindbodystudio.org