Zen in the art of physician maintenance

An increasing number of doctors are
turning to eastern spirituality for their
patients' sake -- and their own

By Madeleine Partous

Olve oil isn't bad -- but it isn't exactly good On Terry Gross's NPR program "Fresh Air," Thursday August 12, 1993, Dr Ornish roused listeners by dismissing claims that olive oil is good for you. The views he expressed then, he believes, are just as valid today. ORNISH: Well, I do think that the fruits and vegetables and grains and beans in the Mediterranean diet are protective. But you know what's really protective about the oils in the Mediterranean diet is not the olive oil. I mean, the olive oil people would like you to think that olive oil is good for you. It really isn't. It's not as bad for you as, say, coconut oil or Crisco. But olive oil has virtually none of the omega-3 fatty acids that are protective, and it's higher in the omega-6 that are harmful. It's the small amounts of the omega-3 that are so protective. You only need about three to four grams a day of flax seed or fish oil. And you can take those in little one-gram capsules. You don't need the excessive amounts that cause problems. Even canola oil has at least as some of the omega-3, olive oil has none. So it's despite the olive oil, not because of it. Now, if you're eating olive oil instead of lard or butter you're going to have a lower risk of heart disease, and that's good. But if you actually look at the Mediterranean countries, they have lower risks of heart disease, breast cancer, prostate cancer, colon cancer than countries like the US, but not nearly as low as Asian countries like Japan and China.

Carolyn Thiedke is a doctor with a difference. She's part of a growing movement of physicians who have come to realize that age-old techniques like meditation and visualization can help patients and doctors reduce stress and even work toward acceptance of difficult life conditions, including chronic or terminal illnesses.

Dr Thiedke is an associate professor in the Department of Family Medicine, Medical University of South Carolina, Charleston. She's created a unique "inner strength" model to help her in her practice.

She believes that the propensity for everyone, including physicians, to blame external events for the lack of equilibrium in our lives, is at the heart of our general trend towards discontentment. "We have a tendency to either dwell on the past or look toward the future," she writes in the American Academy of Family Physicians' publication Family Practice Management, October 2003. "We also function on autopilot much of the time. We go about our routine tasks without much thought. These habits leave us out of touch with ourselves and the world around us, causing us to feel chronically, vaguely unsatisfied."

A well-known proponent of these kinds of "self-help" spiritual systems is Dr Dean Ornish who, for 24 years, has conducted clinical research showing comprehensive lifestyle changes may help to reverse even severe coronary heart disease. Dr Ornish was recognized as "one of the most interesting people of 1996" by People magazine, and by LIFE magazine as "one of the 50 most influential members of his generation." He's found a way to combine traditional medicine with "alternative" techniques like guided meditation and yoga, along with diet.

"Our work is a model of a scientifically-based approach that may be helpful to others in building bridges between the alternative and conventional medical communities," Dr Ornish told a senate hearing into alternative therapies in March 2000. "The idea that heart disease might be reversible was a radical concept when we began our first study; now it has become mainstream and is generally accepted as true by most cardiologists and scientists."

MDs AND MEDITATION
According to Dr Joe Kabat-Zinn, a PhD who heads the Stress Reduction Clinic at the University of Massachusetts Medical Center and authored Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life, we tend to suffer because we continue to believe in our ability to "control" our circumstances -- a control which eastern traditions have always maintained is an illusion. Hindu scholars of the Upanishadic era were the first to define the world as illusion (maya) and the constant changes and impermanence of the material world as samsara. By learning to let go of this need for what amounts to impossible control, we can taste a real freedom and an appreciation for life in the moment.

Physicians face daunting challenges; it's the nature of the job. "Most of us went into medicine because of a belief that we could help people. In our real practices when we see that people don't always get well or aren't always grateful, we may become cynical at times," Dr Thiedke points out. By trying to live and appreciate the moment, she believes the everyday life of practising physicians can be greatly enhanced.

One way to cultivate this appreciation is to allow yourself to acknowledge the social prestige and benefits that come with the job, rather than dwelling on the frustrations and difficulties. The Buddhist and even Christian meditation technique of "mindfulness," or inhabiting the present moment, is one she takes seriously in her own daily life. "In the Buddhist tradition, a bell is used as a call to the present. In my practice, the ritual of taking a patient's chart out of the rack just before I meet the patient serves as a 'bell.' When I reach for the chart, I clear my mind of competing thoughts (other patients, tasks, my family) and focus completely on the present. I look at the patient's name, the vital signs, the reason for this visit and the most recent visit."

Dr Lucinda Sykes, a Toronto MD with 20 years of experience in GP psychotherapy, has been practising hatha yoga and meditation for more than 15 years. Since 1997 she has led patients and students in Meditation for Health groups modelled on the "Mindfulness-based stress reduction (MBSR)" program developed by Dr Kabat-Zinn.

Dr Sykes' website (www.meditationforhealth.com) describes Meditation for Health as "a complement and support to regular medical treatment. It helps people to mobilize their own inner resources for coping and healing -- especially for symptoms no longer responding to more standard medical treatments, or for symptoms exacerbating the course of chronic disease."

While this is a typical way in which physicians use meditative techniques with patients, the fact remains that these practices can benefit doctors in their own lives too.

PRESSURES OF EVERYDAY LIFE
Daily life, with its myriad problems and challenges, intrudes constantly, particularly where busy physicians are concerned. Meaningfulness in everyday life can be attained -- if not on an ongoing basis, then one moment at a time. The key is repetition of effort, returning again and again to "being here now."

Dr Thiedke stresses that in these changing times, doctors need all the tools they can get to help cope with increased pressure and demands on both their time and their expertise. "We must stay alert to how changes in the healthcare system affect family practice and be ready to adapt to new and different demands. What may be called for is a new way of seeing our work in the 21st century." She feels that by developing their inner world and working towards a freedom from "external forces," doctors can come closer to achieving this goal.