Dr. Smitha Murthy is an Assistant Professor of Psychiatry at the University of Austin Dell Medical School, clinical faculty on the Consultation-Liaison Psychiatry Service as part of Ascension Seton. She is board-certified in Psychiatry and Consultation-Liaison Psychiatry, and serves as the site director for the Psychiatry C&L service for medical students, residents, and fellows at Seton Medical Center Austin. She graduated from JSS Medical School in India, attended residency at the Brody School of Medicine, East Carolina University, and completed her fellowship training at Emory University in Atlanta, GA.

Her primary focus is clinical work on inpatient medical-surgical settings and teaching medical students, residents, and fellows. She also conducts telepsychiatry consultations. She has a special area of interest in the field of mindfulness, having completed the Duke Integrative Medicine Mindfulness Training for Professionals on two separate occasions and incorporating mindfulness techniques in both personal and professional arenas.

What is mindfulness?

Mindfulness is the basic human capacity to pay attention to the present, on purpose, without judgment. Contrary to what many believe, mindfulness doesn’t necessarily mean meditation. Certainly, a person can practice mindful meditation, but the essence of mindfulness is to simply to pay attention.

We have probably had moments of mindfulness but didn’t really label it that way. It happens when we notice the flavors of the pasta at lunch, tasting the oregano and basil in it, and enjoying the flavors without thinking about the load of laundry waiting at home. It happens when we hear a song we enjoy, and appreciate the tune, lyrics and bass and are not worrying about a conversation that occurred earlier. If we're paying attention in the moment, we're practicing mindfulness. It’s a simple concept, but sometimes challenging to put into regular practice when we’re being inundated with distractions of cell phones, notifications from social media sources, and our own brains which worry about the other hundred tasks we need to complete before the end of shift.

Why would I want to pay attention to one single thing, why wouldn’t I want to multi-task?

The term, “multi-task,” is not an accurate label, because an individual’s brain can only focus on a single task at a time. There can be a switch of attention to any one task and this frequent switching to different attention tasks can be considered “multi-tasking,” however studies have shown this can be quite ineffective. “Multi-tasking” is a myth that has been shown by research to be counter-productive. In fact, studies show that with frequent changing up of tasks, productivity is decreased, more errors are likely to be made, and it takes longer for the brain to gain back to the original momentum that it may have had with the previous task. Even with seemingly routine tasks, such as walking and driving, that are coupled with other tasks (e.g., talking on a cell phone), are shown to be impaired.

Why is mindfulness helpful?

A growing body of research demonstrates the positive impact mindfulness can have on the brain. Goleman and Davidson wrote about the science behind mindfulness in their new book, Altered Traits. Even three, ten minute sessions of breath counting in subjects improved scores on a battery of cognitive tests.

It can help enhance cognitive flexibility; it's like pilates for your brain. Like with any exercise it takes repetition and persistence to develop those mindfulness muscles. The ability to have cognitive flexibility in approaching medication issues and patient encounters is an important attribute in a pharmacist’s practice.

Being mindful can reduce medication errors. If it’s a busy day with a hectic schedule, it’s easy to carry the lingering thoughts of previous tasks, medications that still need dispensing, any administrative duties, communicating with other providers, and it is challenging to fully be present during these instances. However, by making a concerted effort to be aware and present and pay attention in an active way, it is possible to attend to the tasks at hand without precious moments being used to re-do tasks that may have been compromised because of distractions.

Furthermore, research shows that mindfulness helps to increase attentiveness. It strengthens our ability to focus and tune out distractions, and improves working memory. Mindfulness practices have also been shown to improve adaptation to novel and non-habitual task requirements. So as early career pharmacists learn the nuances of their work, they are better able to learn from these new experiences.

How does mindfulness help with burnout?

Mindfulness research demonstrates it can help reduce stress and anxiety pertaining to work situations. It can help sleep. It can lead to better balance between work and home because by practicing awareness of the present, thoughts of work are not accompanying people home. All of these factors can reduce burnout.

Additionally, mindfulness has various “attitudes” and one of those is the concept of “beginner’s mind." It's seeing a problem as if it’s the first time it's ever been seen, even if it’s been seen twenty times that day. By avoiding working on autopilot and avoiding assumptions, it not only helps to reduce possible medication errors but can create enjoyment in work that may be repetitive.

How does one practice being mindful?

Simply pay attention to what you’re doing. Pay attention to how you’re doing it. Pay attention to the sights, the sounds, maybe even the temperature of the air while you’re doing it.

Ways to Incorporate Mindfulness in the Day:

  • Mindfulness can even happen on the move. For example, pay attention to how you walk from the car to the office or pharmacy (without thinking about the day's schedule). Pay attention to each step, the feel of every step and the sound it generates.
  • If you’re on the phone with a patient, notice not only what they’re saying, but how they’re speaking, the tone of voice, the inflections of speech.
  • Another example is from Dr. Ronald Epstein, author of Attending: Medicine, Mindfulness, and Humanity, who often talks about the "door knob method" of reminding ourselves to be more mindful. Before entering a patient's room, as the hand touches the door knob, gently bring the attention to the present moment, quietly count three breaths, and then enter the room. This can be modified to suit routine tasks in the pharmacy setting.
  • Find your breath. This is another example of centering yourself in the moment. Notice how you’re breathing, without trying to control the rate or depth of your breathing, and counting to 10 with each inhalation and each exhalation counting as a separate count.
  • When you notice a swirling headspace of thoughts or worries, pay attention to your feet. Notice your feet making contact with the floor. Feel the support of the floor holding you up. Notice the positioning of the feet. This is a simple grounding exercise.

Finally, there are countless resources and smartphone applications that can help one cultivate the practice of mindfulness.

References

  1. Goleman, D., & Davidson, R. J. (2017). Altered traits: Science reveals how meditation changes your mind, brain, and body.
  2. Epstein, R. (2017). Attending: Medicine, mindfulness, and humanity
  3. MacLean KA, Ferrer E, Aichele SR, Bridwell DA, Zanesco AP, Jacobs TL, et al. Intensive meditation training improves perceptual discrimination and sustained attention. Psychol Sci. 2nd ed. 2010;21(6):829-39. DOI: 10.1177/0956797610371339. PubMed PMID: 20483826; PubMed Central PMCID: PMC3132583.