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Index
A note about the index: The pages referenced in this index refer to the page numbers in the print edition. Clicking on a page number will take you to the ebook location that corresponds to the beginning of that page in the print edition. For a comprehensive list of locations of any word or phrase, use your reading system’s search function.
AIDS, 10, 21, 79–80, 91, 101, 161, 189
Appreciative Inquiry, 186, 197
Aristotle, 92, 134, 170
Arnold P. Gold Foundation, 199–200
attending. See attention
attending physician (“the attending”), responsibility of, x
attention, 15–34
addressing patients’ needs and, 3
bottom-up, 25–27, 28, 30, 193
brain pathways in, 25
clinical care example of, 15–17
distractions and, 21–22
emotional concerns and, 19–21
executive, 28–29, 181
expectations affecting decisions and, 32–33
focused, 13, 19, 22, 33–34, 167, 183, 200
imperative to simplify and, 23–24
inattentional blindness and, 17
inattentional deafness and, 17–18
mindful, 33–34
mindfulness during surgery and, 2, 3, 6, 7
mindful practice and, 201
multitasking and, 23
organizational, 194
practicing, 209–10
red exercise and, 30–31
scripts and, 31–32
surgery and, 6
top-down, 24–25
attention in automaticity, 218n33
attention practice
in Vipassana training, 209–10
in Zen training, 209
attention training, 182. See also focused attention practice
amount needed, 183
benefits of, 149, 181–82, 183
research on impact and benefits of, 64, 98, 235n28
as skill building, 182
stages of, 244n13
attentive listening, 235n28
autism, 77
availability bias, 229n14
awareness training, 182. See also open awareness practice
Bach, Johann Sebastian, 53–54
Back, Tony, 119
Balint, Michael, 212n12
Balint groups, 9, 212n12
Baron, Richard, 21–22
Batson, Carl, 128, 132
Beach, Mary Catherine, 10–11, 213n21
Beckman, Howard, 11
beginner’s mind, 51–65
clinical environment as barrier to, 55–56
cognitive rigidity and, 55
creativity and, 53–54
diagnosis and, 6, 51–52, 54–55, 58–59
emptying the mind and, 59–61
expertise and, 52–53
mindfulness and, 64–65
“not knowing” and, 57–58
perspectives and, 56–57
Rumi on, 62
two kinds of intelligence used in, 61–63
water jar test and, 63–64
Zen practice and, 51
being present. See presence
Bereiter, Carl, 27
bias
availability, 229n14
decision making and, 98
diagnosis and treatment and, 227n28, 229n14
health care and, 226n23
meditation to address, 217n27
sources of, 218n29
strategies for eliminating, 230n26
tribalism and, 79–80
biopsychosocial approach, 8–10, 125
Bodenheimer, Tom, 192
body scan, 45, 64, 183, 184, 210, 220n12
Bohr, Niels, 57
Borrell-Carrió, Francesc, 184, 245n22
bottom-up attention, 25–27, 28, 30, 193
Bradowski, Angela (patient), 137–40
brain structure and function
attention pathways in, 25
attention training and, 182
bottom-up attention and, 27
clinician abilities and, 179
cognitive overload and, 86
compassion and, 132–33, 135
curiosity and, 48, 221n21
decision making and, 25, 86, 100
emotional responses and, 80–81, 83, 100, 178, 222n6
empathy and, 222n6
experience of presence and, 76, 77, 81, 227n29
expertise and performance and, 179–80
filtering of stimuli and, 17, 23–24, 31, 211n4
hyperscanning research and, 93
meditation practices and, 183
mindfulness training and, 81
mirror neurons in, 80–81
neuroplasticity and, 177–79
olfactory neural pathways and, 93–94
prefrontal cortex on, 100
red exercise to demonstrate, 31
reshaping, 173, 177, 178–79
resilience and exercise of, 164, 165
taxi drivers and, 177–78
tribalism and, 80
working memory and, 18, 19
breath and breathing
in attention training, 64
in body scan, 45
in focused attention, 183, 209
in open awareness training, 210
tension and, 43, 45, 78
in Vipassana training, 209–10
in Zen training, 209
Breedlove, Charlene, 10
Brigham and Women’s Hospital, Boston, 155
Brown, Alexis (patient), 41–44
Buddhist philosophy, 108, 212n9
emptiness in, 7, 60, 217n27
immaculate perception concept in, 217n27
inner chatter (“monkey mind”) in, 69
burnout
awareness of warning signs of, 171–72
career timing
of, 238n4
electronic records system design and, 161–62
empathy and, 133, 163
examples of, 157, 159, 160
factors in, 160–61
gender differences in, 238n4
health care organizational structure and, 161–62
inner environment of physicians and, 163
lack of support for physicians and, 145
meaning and, 171
medical training and, 133
mindful practice and, 11
number of physicians reporting, 159–60
personality traits and, 163–64, 165
personal qualities and, 165
physicians’ reactions to, 162
resilience and, 165–66, 168, 238n4
rigidity and, 163
self-rating of, 171–72
trauma awareness program to address, 155
Candib, Lucy, 123
care
connexional dimension of, 68
quality of. See quality in health care
Cassell, Eric, 113–14
Catholic Health Association, 198
Charney, Dennis, 164–65
Chinese medicine, 63, 232n8
clinical supervision, 9, 179, 180
cognitive capacity
emptying the mind and, 59–60
expertise and, 180–81
mindful practice and, 182
cognitive dissonance, 58
cognitive load
decision making and, 86
distraction and, 20–21, 57
efficiency and, 23–24, 195
mindful practice and, 182
cognitive rigidity, 55, 65
collective mind. See also organizational mindfulness
high-reliability organizations and, 193–94
mindfulness and, 194
principles of, 194–96
quality in health care and, 196–97
community
in contemplative practices, 135, 201, 215n28
in health care settings, 168, 175, 201
mindfulness as, 12, 168
compassion, 125–35
brain function and, 132–33, 135
clinical practice and, 9, 10, 123, 133, 179
compassionate solidarity, 119
conditions for cultivating, 129
deep listening and, 126
emotional lives of physicians and, 133–34
empathy and, 131–32, 187, 189
fatigue and, 134
grief and, 149
health care institutional conditions to promote, 197, 198–99, 200
health care system’s lack of, 127, 128, 133, 144, 154
Insight Dialogue and, 186
medical errors and, 146
medical training and, 8
meditation traditions and, 134–35, 182, 183
metta meditation and, 134
obedience to authority and, 127–28
Schwartz Rounds and, 199
self-compassion and, 153–54
training in, 134–35, 235n28
compassion fatigue, 134
compassion meditation, 182, 183
research on impact and benefits of, 64, 98, 132–33
training in, 134–35, 235n28
complexity
decision making and, 60, 89, 90–91, 92–93, 95, 97
intuition and, 99
mental efficiency and, 60, 91
patient care and, 60
Comprehensive Assessment program for medical students, 213n19
computers. See also electronic health records
video games on, 76–77
confessions project (Karan), 147–48, 153, 236n14
Connelly, Julie, 64
connexional dimension of care, 68
Corea, Chick, 70,
Coulehan, Jack, 119, 187, 188
Croskerry, Patrick, 98, 218n29, 230n26
curiosity, 35–49
brain and, 48, 221n21
in clinicians, 5, 34
confessions project and, 148
deep listening and, 83
environments encouraging, 48–49, 221n26
importance of adopting, 39–40, 49
lack of, 38–39, 41–43
medical training and, 37
quest for certainty and, 37
uncertainty and, 46–47
use of, 35–36, 43–44
visceral feelings (“fuzzy traces”) and, 40–41, 45
ways to promote, 37–38, 45-46
Damasio, Antonio, 100, 225n15, 245n21
Darley, J. M., 128
death and dying
chemotherapy and, 86
curiosity and, 47–48
oncologists’ reactions to, 150–53
physicians’ avoidance of discussions about, 86–87
physicians’ emotional reactions to, 88, 122, 144, 149–50, 151, 152, 166
refocusing and reclaiming and, 122–23
technological advances and, 112, 152
decentering, 82
Deci, Edward, 165
decision making
biases in, 98
brain function in, 25, 94, 100
cancer treatment choices and, 85–87
cognitive overload in, 86
complex problems and, 89, 90–91, 92–93, 95
complicated problems and, 89, 90
efficiency in diagnosis and, 32, 60, 91–92
evidence and, 97–98
intuition in, 27, 33, 92, 97, 99–101
loss of control and, 158–59
military mind-fitness programs and, 174
mindful health care systems and, 191, 192
nonrational factors influencing, 97–98
organizational approaches to, 193, 195–96
practical wisdom and, 92
shared approach to, 87–89, 104–5
simple problems and, 89, 90
slowing down and, 76
decision science, 97–98
deep listening. See also listening
communication and, 126, 186
compassion and, 126
Insight Dialogue and, 186
medical training in, 8
practice in, 84
presence and, 186
reflection and, 186
shared presence and, 83
workshops for learning, 83–84, 126–27
Descartes’ Error (Damasio), 100
Dewey, John, 60, 223n10
Diane (primary care physician), 157–59, 175
Dirk (patient), 72–73
distractions
attention and, 21–22, 145, 148, 182
cognitive load and, 21
design of clinical work spaces to eliminate, 197
focused attention training to reduce, 235n28
multitasking and, 23
Dittersdorf, Karl Ditters von, 54, 222n8
dopaminergic systems, 221n21
compassion and, 130
curiosity and, 48, 49
emotion regulation and, 83
resilience and, 165
Dreyfus, Hubert and Stuart, 52, 180, 222n3
dyadic attention training, 235n28
dying. See death and dying
efficiency
cognitive overload and, 23
decision making and, 32, 60, 91–92
safety and, 195
“Eight leaps” 186–90
Einstellung effect, 63
Eisenberg, Nancy, 132
electronic health records
burnout from design and functionalities of, 161–62
computer distractions while using, 28–29
patient errors from system design failures in, 141, 158
small changes by physicians to make more useful, 175
stresses from using, 162
embodied simulation, 78
emotional intelligence, 81, 100, 135, 173, 174
emotional labor, 88
emotions and emotional responses
to bad outcomes in patients, 142, 143, 144, 145
Balint groups for exploring, 9, 212n12
being mindful of, 47, 173
biopsychosocial approach and, 9
brain processing of, 80–81, 83, 100, 178, 222n6
burnout in physicians and attention to, 133, 161, 164, 172
compassion and, 129, 130–31, 132, 133
contemplative practices and, 82
decentering and, 82
decision making and, 100–101, 104
detachment and, 132, 162, 187
empathy and, 131, 133
health care institutions and physicians’, 133–34, 155, 192
impact on physicians of, 9, 161–62, 174
inferences about, 93
intuition and, 99
medical training and lack of attention to, 179–80
military mind-fitness programs and, 174
mindfulness and, 131, 174
mindful practice and, 11
olfactory neural pathways and, 93–94
of oncologists, 151, 152–53
open awareness training and, 210
to patients in pain, 53
to patients with terminal illnesses, 86–87, 88, 149
physicians’ lack of awareness of patients’, 19, 20–21, 23, 53
presence and, 67, 72, 83
red exercise for becoming aware of, 30, 32
residents’ self-awareness of, 28
Schwartz Rounds and, 199
self-compassion and, 153
sensory experiences and, 184
in shared mental processes, 78, 188
as signals to slow down, 45
smiling and, 184–85
social relationships shaping, 93
task performance and flow of, 23
trauma awareness training and, 155
empathy
brain reactions in, 222n6
clinician behaviors showing, 120, 130, 157
compassion training and, 132–34
deep listening and, 83
definition of, 131
emotional lives of physicians and, 133–34, 163–64
leap to compassion from, 187, 189
medical training and, 53, 131, 133
mindfulness training and, 11
patients’ desire for, 131, 163
physicians’ inattention and lack of, 20, 24
walking with patients to show, 120
emptiness
Buddhist philosophy and, 7, 217n27
Dewey on, 60
Zen story on, 59–60
Engel, George, 8–9, 72, 125–26, 180
engineers, Search Inside Yourself program for, 84
eudaimonia (Aristotelian concept), 170
executive attention, 29, 181
expertise
acquiring, 179–80
automatic tasks and, 180–81
beginner’s mind and, 51, 52, 53
cognitive processing and, 181
diagnosis and, 61
experience and, 179
“not knowing” and, 57–58