Eyeworld

12 Ophthalmology Business • March 2017 by John Banja, PhD Mindfulness in clinical practice inadequate evidence—in short, all the stuff that can skew our thinking, cause us to leap to hasty and unwar- ranted conclusions, and miss things. Because space is short in this article, I'll list some of the more common strategies of the MP that apply to any practice setting. Techniques of the mindful practitioner Practices humility. The MP is exqui- sitely impressed with Herbert Simon's notion of "bounded rationality"— that is, that our environments, our knowledge, and our cognition are imperfect, flawed, and limited. That acceptance is based on humility, and allows much of the rest to occur. Frequently steps outside of and objectively observes his or her performance. The MP is extremely self-critical but not in a self-dises- teeming way. Rather he or she realiz- es that endless and relatively mind- less immersion in task performance will not improve its delivery. Conse- quently, the MP practices stepping outside his or her performance and imagining how it is perceived and evaluated by an independent observ- er. Often, this occurs after a task is performed and the actor reflects on how it went and how he or she could have done better. Implements cognitive forcing strategies. Here the MP is particular- ly concerned about not succumbing to the ways automatic and relatively mindless task execution can dispose to errors and lapses. Forcing strate- gies are ways that the agent—while performing the task—can check the tendency to rush through it uncrit- ically. Thus the clinician will ask him or herself things like, "What do I not want to miss here? What am I seen, not enough staff, inadequate documentation, unreliable or com- plex technology, unworkable policies, unfamiliarity with a procedure or a particular patient's symptoms—one's performance will become much more vulnerable to errors, mistakes, lapses, standards deviations, and shortcuts that go unnoticed until they morph into nasty adverse events. Since the Institute of Medicine's "To Err Is Human" report appeared in 2000, patient safety has moved to the forefront of our professional con- sciousness, making the safety-pro- ductivity tradeoff even more glaring. Not surprisingly, numerous strategies have been offered to ease the ten- sions connected with high consumer demand, its economic sustainability, and quality care. This article will fo- cus on a particularly challenging but interesting one: mindfulness. Mindfulness is often character- ized in the psychological, medita- tive, and religious literatures as an in-the-moment awareness combined with a nonjudgmental acceptance of one's emotions and thoughts. These practices are complementary in that people allow themselves to be im- mersed in not only their patients' de- scriptions of their symptoms but also how they are dressed, talk, express anxieties and concerns, what they do for a living, and what they value (and hate; you can tell a lot about a person by finding out what he or she hates). Furthermore, the mind- ful practitioner (MP) couples this awareness with an open mind and a reluctance to evaluate or judge what's happening. The MP lets go of his or her biases that might cause misinter- pretation, assumptions that might be unwarranted, and the temptation to feel unreasonably confident despite F or at least the last 5 years, patient safety ex- perts have been voicing a deep concern that the production pressures that shape the delivery of today's health care have become so onerous that they are frankly jeopardizing patient safety. Whether care occurs in a family practice clinic, an ICU, or an ophthalmologist's office, the fear is that the pressure to produce (and conserve) revenue makes for exces- sive stress, distractions, and cognitive lapses that cause clinicians to breach the "edge of the hazard envelope." Once that happens, clinicians will be flying by the seat of their pants because they are no longer in reason- able control of the variables that can precipitate disaster. Usually, disasters are averted by clinicians paying close enough attention to their environ- ments so that they can detect and extinguish safety threats before they materialize. But when there is excessive cognitive noise, disruption, or overload—too many patients to be

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