siyli’s abri holden sat down with dr. reena kotecha, founder of mindful medics, to discuss her efforts to bring mindfulness to health care. as an md herself, dr reena understands first-hand the mental and emotional toll of working in this field. she developed, designed and delivers the ‘mindful medics; healthcare starts with self care’ course across the globe. her focus is to train health care workers in the essential skills of mindfulness and emotional intelligence to support their well-being at work especially as they take to the front-lines of the covid-19 pandemic.
i studied medicine at imperial college london, uk. within my medical degree i also undertook a bsc in neuroscience and 伟德亚洲备用网址. i was always fascinated by the intricacies of the brain and the wonders of the mind. my medical education was credible and yet i believe it to have been incomplete. i was trained in anatomy, physiology, pharmacology and so on, all with a view to diagnose and manage my patients. of course, while patient care is imperative, what had been overlooked was the importance of provider wellbeing.
upon graduating i started working on the front-line in the national health service, uk. after serving some years in mostly acute specialties such as the acute medical unit and accident and emergency (er), the long odd hours and unrelenting pressure started to take a toll. i began to struggle with stress related symptoms such as anxiety, depression and irritable bowel syndrome. i look back now and realise that i was in sympathetic overdrive for prolonged periods without adequate rest and recovery, but there was a huge irony in that i had a personal blindspot to my own symptoms and when i did get a hunch that something was not right, i looked around and convinced myself that my peers and colleagues were fine just getting on with it and so i should be too.
some years in, i took two weeks off work which actually ended up being two years. the first few months were difficult, and my anxiety heightened. i was caught up in a tyranny of thoughts such as, i’m not good enough. what if my colleagues and patients find out? will they think less of me because i have a diagnosis of depression and anxiety and am off sick from burn out? my biggest struggle was my attachment to the identity of doctor. i was so caught up in the identity of being a doctor, that i now questioned who i am if i’m not spending my days practising. it’s interesting how we can get so attached to labels. one day, i was walking in cambridge, uk, and came across an advertisement for free lunchtime meditation. i didn’t have much else to do, and i wasn’t earning money, so free was good! i walked into the shop and was greeted by a beautiful lady in her 70’s with a soft voice and grandmother-like feel. she led me through a body scan and breath-work exercise and in those moments i wasn’t concerned about my identity, my career or what others may or may not think of me. i felt a little lighter. overtime i started meditating daily, morning and evening. i also discovered the mindfulness based stress reduction course and how it can help with depression and anxiety. i took the course, twice. i was beginning to ‘feel alive’ again, and this feeling sparked further curiosity into the theory of the practice.
in my two years out of clinical practice i had established a mindfulness and self-compassion practice, and given my background in medicine and research and interest in neuroscience and 伟德亚洲备用网址 i was drawn to study the neuroscientific research underpinning mindfulness and emotional intelligence. at this stage i had also begun to ‘let go’ of the need to have my life planned out and had cultivated a deep trusting that my foot would meet the path intended for me.
i started reconnecting with some of my medical friends and colleagues who were now sitting their post-graduate exams. they were stressed and tired. one was struggling with her sleep, another with anxiety and another with balancing work and home responsibilities. this felt like my opportunity to serve and so i offered to teach them what i had learnt. i would write out my mindfulness scripts and incorporate some science into the teaching. they would give feedback on the pace of my guidance, or whether a particular practice sounded too ‘woo woo’ etc. i discovered, the more i taught, the more i learnt, and the more clarity of purpose emerged. if mindfulness could help improve my own wellbeing, and help a handful of friends with their stressors then perhaps it could be of benefit to a larger healthcare audience not just in terms of their wellbeing but also more widely such as engagement at work and patient care. we know mindfulness promotes focus and attention, surely that’s an invaluable asset in an environment where there is a deluge of distractions all the time; alarms, pagers, monitors etc. and a patient’s health is in your hands. it may reduce prescription errors? or what if the practice could somehow translate into a better interpersonal doctor patient relationship through deep listening, empathy, and compassion? and considering there are multiple triggers in hospital and primary care settings, wouldn’t emotional self-management be a welcome tool in the doctor’s bag? these ‘what if’s’ fuelled my curiosity and passion in creating the ‘mindful medics; healthcare starts with self care’ programme which was first piloted in 2017 at milton keynes university hospital nhs trust and has since been delivered in various healthcare settings in the uk and middle east.
as an example, the mindful medics programme was delivered at central northwest london nhs trust to 50 staff members (clinical and non-clinical). the post-programme survey revealed positive results in the subjective state of physical health, 伟德亚洲备用网址, resilience, as well as performance and productivity in the workplace, along with a subjective improvement in interpersonal relationships at work and at home. further research is necessary to discern whether these changes translate to improved patient outcomes, improved population health and reduced sickness absence and costs.
healthcare is a relationship between doctor (or other healthcare worker) and patient. within the healthcare environment there are also other relationships e.g. between healthcare professionals, between clinical and administrative staff and so on. many such relationships make up the healthcare system. we all know that relationships fare well in terms of trust, satisfaction and outcomes when ideas, concerns and expectations are well managed and when there is shared space for connection, empathy and non-judgement. this sounds nice on paper, but clinical environments are fast paced, psychologically demanding and the pressure is unrelenting. multiple patients with multiple problems need to be carefully managed, and understaffed, under-resourced settings make it all the more difficult to stay fully focused and provide skilful and compassionate care at all times. mindfulness as a practice allows us to cultivate mental agility. we can quickly and effectively pulse between focused attention and open awareness. this cultivates self awareness which in turn provides an opening for self regulation.
in practical terms self awareness may look like the following:
‘i have been on shift for 8 hours and haven’t stopped to eat, i should stop to refuel’
or,
‘i’m out of my comfort zone in doing this procedure, i need to ask for help from a senior and i’m aware that i’m worried about coming across incompetent but i choose to not let that thought hold me back’
or,
‘i’m really affected by that last patient consultation. he’s going through the same diagnosis as my father. i need to take a moment to reset before i see my next patient’
having this moment-to-moment self awareness allows us to recalibrate and/or make more effective decisions in terms of self care and patient wellbeing. and we know that provider wellbeing translates to improved patient satisfaction, health outcomes and reduced costs (1/2).
as per the mindfulness initiative uk, mindfulness is a capacity that enables people to focus on what they experience in the moment, inside of themselves as well as in their environment, with an attitude of openness, curiosity and kindness. the cultivation of the attitudes of mindfulness; a beginners mind, non-judgement, kindness and so on, strengthen the interpersonal domains of emotional intelligence and these are pivotal in establishing psychological safety in the doctor patient relationship. trust can result in, for example, better patient compliance in taking medication or implementing a doctor’s advice. trust is also the cornerstone of effective teams. often trust within teams will show up as discretionary effort applied by individual team members. for example, a non-supervising senior may stay late to teach a procedure to a junior. one peer may share the remaining ward jobs of his counterpart so that they can both go home on time.
overall, i believe mindfulness based emotional intelligence opens a space for high quality healthcare and healthcare practices.
in 2016 i attended a mindful leadership conference in washington dc. i was drawn to the dynamism and presence of one particular speaker: rich fernandez. i followed rich’s professional journey and heard about siy when he took on the position as ceo of siyli. i was struck by how much resonance there was between the siy curriculum and the mindful medics training; both focused on mindfulness based emotional intelligence. i work by myself mostly and at times that can get lonely. it can also be difficult to get an alternative and well-informed perspective when required. connection and community fuel me and my work and so i decided to take up the teacher training in order to be part of a global community of like-minded individuals who are dedicated to the practice and to bringing the work to their respective fields.
at this moment, two specific examples come to mind:
i’ve had the mindful medics programme rejected more times than accepted and of course the reasons for this aren’t personal (although they can certainly feel like it at times). it is difficult to release staff to undertake such a training programme in already overstretched, under-staffed and under-resourced clinical environments. the micro-practices in siy such as the self-compassion practice, “breathing in i do my best, breathing out i let go the rest’’, have been instrumental to my own wellbeing during difficult times.
healthcare systems across the globe are well established. the primary organising principle is patient centred care. i believe this paradigm to be incomplete. my holistic vision is that healthcare systems should be organised around staff and patient centred care. while some are aligned with this, others are happy with the status quo. i use the siy envisioning journaling practice when considering the positive impact i want to have within healthcare through the mindful medics training.
when the pandemic hit the population was largely split into two groups. the essential key worker group who were required to actively work on the frontline and another group that was asked to stay indoors and work from home. healthcare professionals largely fell into the former category. the pandemic has been a challenging time for all but it has been uniquely intense for healthcare staff. to support this group, i shifted the mindful medics programme into open evening sessions for reflection, sharing and mindfulness practice. healthcare professionals from across the globe accessed these sessions and began opening up about their anxieties and difficulties. many were facing war-zone like situations. hospitals were overflowing with patients. nurses who might usually be responsible for 3 or 4 patients during a shift were having to look after 8 or 10. shortages of ppe led to fear for one’s own safety and the safety of colleagues. some decided to move out of home into a hotel in order to continue serving the population whilst also safeguarding their families. doctors were being redeployed into specialties they hadn’t worked in for years. staff were having to tell the loved ones of dying patients that they must say their goodbyes over facetime. along with this many were grieving the loss of their patients and/or colleagues. i felt that this group needed to be acknowledged and supported in and among all that they were navigating and i was keen to have the experts such as jon kabat zinn, kristen neff and richie davidson talk directly to them and offer them practices, tools and wisdom, keeping their wellbeing in heart and mind. a secondary goal was to provide the lay public with an informed understanding of the pandemic through the lens of the medical community.
the mindful healthcare speaker series was accessed by over 16,000 healthcare staff and i thank each of them and the healthcare community more widely for their service to humanity during this time.
dr reena kotecha is physician by background currently working across organisations to improve employee wellbeing and in turn organisational effectiveness. reena qualified with a dual degree in medicine and neuroscience & mental from imperial college london. she spent the early part of her career in the national health service, uk, as a hospital doctor. some years into her clinical career, the work environment took a toll on reena’s 伟德亚洲备用网址 and wellbeing and she took an extended period out of practice. she began studying ayurvedic medicine and practicing pranayama (yogic breath-work) and mindfulness meditation. with the mission of ‘healthcare starts with self care,’ reena set up ‘mindful medics’, a mindfulness and compassion based emotional intelligence training programme which enables healthcare professionals to come together in a safe setting and discuss their unique challenges whilst also encompassing tools and techniques to improve self care and wellbeing. reena also delivers talks, workshops and courses across many sectors outside of healthcare. if you’re an individual interested in taking an online public programme or an organisation looking to bring mindful medics training into your institution you can get in touch with reena through her website.