Response

Dr Dobkin and I are grateful for the interest shown by Drs Smith1 and Raza in our article on mindful medical practice.2 Dr Smith appears to believe that mindful practice means physicians distancing themselves from patients. He therefore hopes that it dies a swift death. If this were the meaning of mindful practice, we would completely agree with him; however, this is not the case. In fact, the aim of mindful practice is to allow physicians to fully engage with their patients. Mindful training helps practitioners practise being alive in the present moment, in a way that both relieves their stress and enhances their well-being so that this might be possible. We had hoped to make that clear in our article. With this added clarification, we hope that Dr Smith (whose core values we probably share) might join us in advocating the continued use and development of mindfulness in medicine.

Dr Raza makes a very important point about the influence of colleagues on medical practice, and wonders whether mindfulness can do anything about this. We believe that the answer is yes. He is correct—we have also found when talking with physicians that the greatest source of stress in medicine is not patients but other physicians and health care workers. This is why in the mindfulness courses and workshops that we conduct for health care practitioners we spend a substantial amount of time on mindful interactions with colleagues. We do role-play exercises in which physicians practise combining mindfulness with congruent communication (based on the work of pioneering family therapist Virginia Satir). We also teach the same approach to medical students at McGill University in Montreal, Que, using actors playing the role of other physicians in the simulation centre. In this way we hope to help individual physicians and students handle themselves more effectively in stressful interactions with colleagues and, in the long run, to change the environment in which medicine is practised. Dr Raza has raised an important issue—stressful interaction with professional colleagues—which we believe mindful medical practice can help alleviate or resolve. We thank him for his insight and interest.

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