Therapeutic Presence: Mindfulness in the Exam Room

By Becky Tilahun, PhD

As healthcare providers, we are keen to obtain information from the nonverbal cues of patients during the diagnostic process. We observe and document their mental status, energy level, attire and mood.

What we may fail to be cognizant of is our own nonverbal presence in the exam room, which may certainly be noticed or felt by patients. Using mindfulness, we can increase our self-awareness and be more attuned to patients during treatment visits.

Why mindfulness is critical

Stressful days are part of our professional lives. As medical providers, there are times when the day goes wrong and we feel overwhelmed or stretched beyond our limits. For example, after running late in a busy clinic day with back-to-back appointments with complex patients and then an emergency phone call from home, we may appear preoccupied or rushed when we go into the next appointment.

Even as we try to appear composed and focus on the patient’s needs, the patient may perceive in the tone of our voice, facial expression or change in our usual warmth with them that we didn’t hear them, interrupted them or showed frustration. Even if it may look like a usual visit to us, the patient may go home with disappointment.

How to implement in your practice

Mindfulness meditation is a common stress management tool used in behavioral medicine and can be integrated as a self-awareness technique to improve emotional and bodily awareness in stressful moments. Just like the word implies, mindfulness is about being mindful of the here-and-now by learning to avoid mental preoccupation. It can be a long 10- to 45-minute regular practice or a way of being aware and attentive to the present moment. Mindfulness can be practiced by tuning our attention to internal experiences and the environment.

There are many ways mindfulness can be done. It can be taking a moment before seeing the patient to tune attention to sensory experiences, including sensation of the coolness of air on the skin, brightness of light in the room, smell and background sounds. It can be paying attention to the sensations such as touch of the computer keyboard and the sound of typing, brightness of the computer screen or comfort level of the chair we are using. Mindfulness helps to anchor the mind to the moment and as a result produce a feeling of inner stillness.

One can be mindful of emotions by taking a moment to do an internal check-in, by asking “What do I feel now? Am I stressed, frustrated, or overwhelmed?” Then notice where the emotion is experienced in the body. Feelings may include tightness in the shoulders and neck, heaviness in the chest area, a burning sensation in the forehead or tension in the back of the head. By noticing where emotions are experienced in the body, the caregiver can diffuse internal tension and experience mental calmness.

But does it really work?

Among the numerous studies supporting the benefits of mindfulness meditation, one study using fMRI showed that individuals who practiced mindfulness meditation formally for eight weeks showed less engagement of brain areas involved in multitasking (medial prefrontal cortex) and more time in the viscersomatic areas, the insula and somatosensory cortex, compared with those who did not practice. Results showed that mindfulness meditation helped increase present focus by reducing mind-wandering to the past or future.

Just like we review the patient’s chart and ensure our professional appearance before greeting the patient, mindfulness can be the mirror that we use to check inward and be mentally ready to be wholly present with patients. This way, we may offer patients more than medicine alone can, which is our human touch and connection ― that may sometimes be more comforting to patients than the treatment itself.

Dr. Becky Tilahun is a Clinical Psychologist who teaches mindfulness meditation to patients and is passionate about promoting mindfulness meditation to professionals as a stress management tool. She trained in Mindfulness Meditation at the Duke Integrative Medicine professional mindfulness training program.