reflective questions and, 65
understanding patients and, 52–53, 54, 56
exquisite empathy, 132
failure
beginner’s mind and, 54
medical errors and, 141–42, 236n4
organizational mindfulness and, 194
patients’ sense of, 111–12
physicians’ reaction to death as, 149, 151, 152
self-compassion and, 153
family-of-origin groups, 9, 207, 212n13
Farber, Stu, 101–2
Fisher, C. Miller, 35–36
Fitzgerald, F. Scott, 55
Fitzgerald, Faith, 37–38, 39, 96
Fleming, Alexander, 36
focused attention, 13, 19, 22, 33–34, 167, 183, 200
focused attention practice, 183, 209–10, 235n28, 241n29
Fox, Deborah, 170
Frank, Arthur, 112
“From Jerusalem to Jericho” (Darley and Batson), 128
Gage, Phineas, 100
Gandhi, Mahatma, 70
Gary (patient), 54–55, 57, 195
gender differences
burnout and, 238n4
physicians’ awareness of patients’ pain and, 227n28
genetic factors
biopsychosocial approach to care and, 8
curiosity propensity and, 48
resilience and, 165–66
social environment and expression of, 49, 221n22
stress hormone expression and, 82
Glenberg, Arthur, 185
Glouberman, Sholom, 89–90, 96
goal-directed attention, 24–25
Gold Foundation, 199–200
Granek, Leeat, 150–51, 152
Grayson, Richard (patient), 85–87, 89–93, 104, 105
Greece, ancient, 63
“Guest House, The” (Rumi), 75
guided meditation, 134, 210, 220n12, 248n2
Gunderson, Mark, 1–3, 24
Hagopian, Lena (patient), 3–4
Halifax, Joan, 129
Haqim (patient), 71
Harlow, Harry, 77
Harper, Ralph, 68
health care
compassion versus checklists and industrial models of, 129
physicians’ inattention to patients and decisions to seek, 20
quality in. See quality in health care
social (shared) presence needed in, 77
health care institutions
conditions for caring and compassion in, 197–98
lack of emotional support in, 133
medical errors in, 139, 141, 143
mission statements of, 114, 198
need for sense of community for physicians in, 168
number of burned-out physicians in, 159–60
Schwartz Rounds in, 199
secondary trauma of physicians and, 154, 155
health care system
clinician well-being related to health of, 155
commodification of medicine and, 13
communication in, 19
compassionate care rating for, 127
crisis in, 12–13
curiosity of physicians and support in, 69
fragmentation of, 12
as mindful system, 191–201
patients distrustful of, 10
patient suffering worsened by contact with, 113
quality of care, quality of caring, and physician resilience synergism in, 200–201
stresses on physicians in, 162, 174
health records, electronic, 28–29, 141, 158, 161–62, 175
Hebb, Donald, 178
high-reliability organizations, mindfulness in, 193–94
HIV infection, 10, 11, 21, 80, 112, 189
Hogan, Laura, 69–70
humors, 63, 232n8
immaculate perception, 30, 217n27
inattentional blindness, 17
inattentional deafness, 17–18, 22
incidentalomas, 103, 104–5
Insight Dialogue, 186
Institute of Medicine, 141, 194
International Classification of Diseases (ICD-10), 61, 114
interpersonal mindfulness, 93, 185–86, 214n25
interruption recovery failure, 23
intuition
beginner’s mind and, 54
diagnosis using, 27, 33, 92, 97, 99–101
James, Henry, 119
James, William, 60–61, 92, 181
“Jerusalem to Jericho” study (Darley and Batson), 128
Johnson, Douglas, 166
Just Like Me exercise, 84
Kabat-Zinn, Jon, 7, 45, 244n16
Kahneman, Daniel, 19, 97–98
Karan, Suzie, 146–47, 148, 153, 236n14
Kashdan, Todd, 47–48
Kassirer, Jerome, 37
Kaszniak, Al, 182, 185
Kearney, Michael, 132
Keats, John, 223n10
Kerner, Laura (patient), 74–76
King, Martin Luther, 70
Klimecki, Olga, 132–33
Krasner, Mick, 11, 205, 207, 214n22
Kübler-Ross, Elisabeth, 122
Langer, Ellen, 39, 46
Larson, Eric, 88
Laszlo, Emil (patient), 15–17, 23, 28, 194–95
Lesser, Marc, 154, 169
Lindblom, Charles, 91
listening. See also deep listening
dyadic attention training using, 235n28
examples of doctors using, 71, 89, 104, 149
inattentional deafness and, 17–18, 22
learning how to listen, 123–24
malpractice suits due to lack of, 142
mindful health care system with, 191–92
mindfulness during, 244n15
mindfulness survey on, 214n21
patient’s validation from being listened to, 127
presence as quality of, 68, 84
resilience and ability to change personality traits related to mindfulness in, 167, 175
silences during, 72, 89
talking by patients and difficulty in, 21–22
visual tasks interfering with, 18
London taxi driver training, and neuroplasticity, 177–78, 179
Lown, Beth, 127, 199
Maguire, Eleanor, 178
Marvel, Kim, 68
Mary Ann (patient), 90
Maslach, Christina, 160–61, 171
Maue, Ken, 29–30, 217n26
McCallum, Douglas (patient), 5–6
medical training
communication skills training in, 131
connecting Zen perspectives on the inner life with, 8
culture of, 8
deep listening training in, 8
empathy in, 131
illness experiences and decision to enter, 107–10
self-awareness training in, 7
medications. See also pain medications
mindfulness in prescribing, 197
patients’ feelings about, 111
physician burnout and use of, 171
physicians’ errors with, 140–41, 145
physicians’ focus on prescribing, 20, 28, 52, 73
pro-social behavior in prescribing, 132
utilities and prescribing, 97
meditation, 116. See also specific practices
alternate names for, 182–83
amount of training needed in, 183
attention training using, 181–82
benefits of using, 82, 183, 214n21, 235n28
Buddhist philosophy on, 217n27
combining practices in, 183
compassion practice as part of, 134–35
compassion training using, 132
distressed clinicians and, 175
expectations and associations with, 182
genetic predispositions to disease and, 111
how to begin, 182–83, 209, 248n2
immediate emotional reactions to stress and, 82–83
insight dialogue and, 186
medical training related to, 9, 11, 13
military min
d-fitness programs using, 174
mindfulness and, 244n15
mindful practice with, 13–14
posture and, 184
practicing, 209–10
purpose of, 183
reflection and mindfulness program for oncologists using, 152–53
research on beginner’s mind in, 63–65
shared etymologies of medicine and, 205
as skill building, 182, 235n28
smiling and, 185
Suzuki on core principles of, 51
Mehta, Ashwin, 3–5, 7
Mencken, H. L., 91
mentalization, 82
metta, 134
metta meditation, 134, 210
Milgram, Stanley, 127–28, 233n6
military mind-fitness programs, 174
Miller, Ruth (patient), 148–49, 151
mind-fitness programs, for soldiers, 174
mindfulness
Appreciative Inquiry and, 186
assessment of physicians’, 213n21
body scan exercise and, 45
brain function and structure and changes in, 81, 179
as a community activity, 168
curiosity research and, 48
de-biasing strategies and, 230n26
decision making and, 98
description of, 13
“eight leaps” approach to patients and, 186–90
emotional reactions to patients’ distress and, 131
health care organizations’ promotion of, 193
health care quality and, 196–97, 200–201
Insight Dialogue and, 186
interpersonal, in relationships, 93, 185–86, 214n25
kidney surgery example of lack of, 1–3
knowing others’ in, 93
neuroimaging research on, 93
organizations and, 193–96
patient-doctor interactions and, 10–11
personal experience of, 13–14
physicians’ belief in benefits of, 12
poetry and beginner’s mind in, 64–65
problem-solving time and, 64
psychiatrist’s interview example of, 5–6
reflective questions for, 65
vascular surgery example of, 3–5
Mindfulness-Based Stress Reduction programs (Kabat-Zinn), 45
mindfulness meditation (Vipassana training), 209–10, 215n28
mindfulness training
benefits of, 183
brain function response to, 81
for experienced primary care physicians, 11–12
medical training with, 200
for military recruits, 166
for oncologists, 152–53
patient ratings related to, 183
results of, 11–12
Search Inside Yourself program for, 84
mindful practice
attending in, 201
community involved in, 201
description of, in medicine, 13
health care system and, 201
medical training in, 11, 167, 207
“Mindful Practice” (Epstein), 10
mind reading, 93
mirror neurons, 80–81
mission statements, 114, 198
moral distress, 238n3
Moulton, Carol-Anne, 4, 218n33
multitasking, 23, 182
Murthy, Vivek, 159
music and music performances
being creative by setting aside preconceived ideas in, 53–54
being present during, 68, 72, 76
capacity for awareness and, 29–30, 217n26
capacity for joy in, 170
critiques during training for, 180
expertise and deliberate practice in, 179
focused attention in, 33–34
moment-to-moment attention in, 215n28
practice and preparing for concerts in, 77
presentness of time in, 70–71
self-awareness in, 7
silences in, 72
National Cancer Institute, 112, 114
Naval Health Research Center, San Diego, 166
neuroimaging research, 53, 93, 178, 222n6, 242n36
neurotransmitters
curiosity and, 48
decision making and, 94
emotion regulation and, 83
resilience and, 165–66
“not knowing” stance, 57–58
oncologists
patients’ chemotherapy decisions and, 86, 92–93
reactions to death among, 150–53
secondary trauma and, 154
On Presence (Harper), 68
open awareness, 64, 183, 210
open awareness practice, 183, 209, 210
organizational attention, 194
organizational mindfulness
health care quality and, 196–97
principles of, 194–96
quality in health care and, 196
organizations
attention in, 193
decision making in, 193, 195–96
mindfulness promotion in, 193
Trauma Informed Systems (TIS) framework and, 237n24
Osler, William, 19
pain
accuracy of physicians’ estimates of, 52–53
brain reaction to, 132
clinicians’ failure to notice, 15, 16, 20, 23, 24, 51–52, 54, 196
communication between patients and physicians about, 53
dilemmas in treating, 229n14
doctor’s illness experiences with, 108, 109, 110
inability to diagnose long-term, 58, 59
Just Like Me exercise on, 84
medical training to recognize symptoms of, 26–27, 31–32, 37, 117, 133, 171, 194–95
patient’s experience of chronic, 115, 116
physicians’ biases in treating, 227n28
physicians’ emotional reaction to, 53, 67, 107, 130, 152, 222n6
physicians’ sense of shared experience with patients of, 126, 130, 133, 227n29
suffering related to, 107, 113, 114
walking with patients to communicate understanding of, 120
pain medications
chronic pain and, 116
communication between patients and physicians about, 53
differences in prescribing, 227n28
dilemmas in prescribing, 229n14, 238n3
physicians’ focus on prescribing, 20, 28, 52, 73
palliative care, 45–46, 69, 74–75, 91, 113, 122, 148–49
paranoid schizophrenia, 72–73
Pedersen, Mary, 170
peer coaching, 155
peer counselors, 154
personal awareness groups, 9, 213n14
phronesis (Aristotelian concept), 92, 96
Porter, Mitch (patient), 149–50
posture, in Vipassana training, 209
practical wisdom, 92–93
pratices. See also specific practices
choosing, 210
presence (being present), 67–84, 110
addressing patients’ needs and, 3
approaches used in, 67, 68–69, 69–70
attending and, 201
attention training and, 182
bonded resonance in, 68
boundary situations and, 68
brain function and, 76–77, 178
breathing to help, 64
burnout prevention and, 168
compassion and, 127
contemplative practices and, 82
death and, 151
deep listening and, 186
embodied simulation and, 78
equanimity and, 134
examples of, 4, 6, 7, 67, 74–76
feeling helpless and, 117
grief and, 149, 150, 161
hospitality and, 75–76
inner environment of physicians and, 163
intuitive approach to, 7
Just Like Me exercise and, 84
knowing a patient as a person and, 72–73
medical errors and, 141, 142
medical training on, 3
meditation and, 8, 209
mindfulness and, 4, 6, 7, 131
“not like me” patients and, 79, 81
organizations and, 193, 195
patients’ reactions to, 68, 70, 71
pro-social behavior and, 132
relational mind and, 225n15
self-care and, 153
shared, 69, 72, 76, 77, 83–84, 186
shared mind and, 78
smiling and, 184
social, 77
stillness practice and, 81–83
theory of mind and, 78
time and, 70–72
tribalism and, 79–80
“where are my feet?” practice and, 83–84
Principles of Psychology (James), 181
psychiatrist, mindfulness in interview by, 5–6
quality in health care
certainty in care decisions and, 37
curiosity of physicians and, 49
health care systems and, 162
mindful practice and, 11–12, 13
patients’ concerns about questioning physicians and, 88
resilience and quality of caring synergistic with, 200
safety and, 196–97
quality metrics, 96, 114, 158, 237n2
quality of caring
mindful practice and, 11–12
resilience and quality of care synergistic with, 200
quality of life, and care decisions, 85, 89, 90, 91, 97, 107, 114, 151
Quill, Tim, 11, 120, 152
red exercise, 30–31
reflection
deep listening and, 186
medical training on, 8, 9
program for oncologists promoting, 152
stillness and, 82
reflection-in-action, 65, 213n16
reflective practice, 213n16
Reich, Peter, 5–6, 7, 8
resilience
biochemical and genetic makeup and, 165–66
burnout prevention and, 168, 238n4
exercise and stress to develop, 164
health care system support of, 192
leap from well-being to, 187, 189
mental stability and development of, 166–67
mindful practice program for, 11, 12
organizational mindfulness and commitment to, 195–96
physician burnout and lack of, 162, 163
quality of care and quality of caring synergistic with, 200
ten factors in, 165
training for, 173–74
trauma survival and, 164
Zen practice and, 8
Reyna, Valerie, 40
Riva, Giuseppe, 76, 225n13
Rochester, University of, 8, 9, 11, 125, 152, 214n22, 241n25, 247n16
Rodenbach, Rachel, 151–52
Rogers, Carl, 213n14
Rostro, Jane (patient), 26–27, 29
Rumi, Jellaludin, 61–63, 64, 75
Ryan, Richard, 165
Sacks, Oliver, 36
safety
confessions project and initiatives in, 148
efficiency in decisions and, 195
health care quality and, 196–97