Lancaster Physician Spring 2021 - 18

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Healthy Communities
The Cleveland Clinic defines stress as " a process in which environmental demands strain an
organism's adaptive capacity. " When I trained as
a family physician, we were " taught " to adapt to
environmental stressors. The phrase " eat when
someone tells you to eat, sleep when someone
tells you to sleep and leave when someone tells
you to leave, " lives deep in the recesses of my
brain. Our adaptations were to learn as much
as we possibly could and always remember what
came last AND anticipate all the things that could
happen next. This made us the best and most
able to care for our patients.
Or did it?
How many times was it encouraged to reflect
on an experience, good or bad? There was always
more to know, more to learn, more to face. Yes,
there were joyful moments, but there was also
heartache. It varies from the disappointment
of not providing the right help to being completely helpless. One trauma-informed CME
(Continuing Medical Education) taught me
about vicarious and secondary trauma. What I
learned helped me navigate my own reactions to
the upheaval we've experienced in the last year.
I took that trauma-informed CME in 2019. I
signed up because I wanted to be a better doctor
to patients who were victims of trauma. At the
end, it made me better for all of my patients.
The focus of the course was vicarious trauma
health care providers experience during routine
practice. Mindfulness breaks were built into the
syllabus in four-minute sessions, where we used
techniques like " box breathing " and " five senses "
to practice grounding. The instructor encouraged
us to continue this practice in our day-to-day
schedule. I left that class and started thinking
about my own experiences, feelings, reactions (I
call them reactions, but we often refer to them as
symptoms.). Something that stuck with me was
the physical reaction I used to get when my pager
buzzed and the evolution of that reaction over the
years. As an intern, I experienced every fight or
flight reaction/symptom-racing mind and heart
rate, clammy palms and nausea. Looking back to
2019, when I had an after-hours call, I thought
" And I just sat down to dinner, " but answered the
call without much more than that slight feeling
of being disrupted. Then came March 2020,
which threw me right back to internship days.
The phone rang constantly and after a few hours
I started having that physical reaction again. So,

I had to lean on my seasoned experience with a
global pandemic...wait, no.

Mindfulness
is a practice
of both mind
and body
awareness.
It is really a
philosophy
that you
weave into
your life, but
I recommend
starting
small and
allowing
the practice
to grow
naturally as
you learn.

LANCASTER

18

PHYSICIAN

Everyone was in survival mode. We gave
answers only to find out three days later the information had changed. Everyone was panicking. I
had no real answers, no real action plan to give
my patients. The comfort I had gained with my
experience was pulled from me overnight.
Here we are a year later, and, I think, in a much
better place. However, my patients continue to
experience symptoms of poor concentration,
sleep disruption, brain fog, fatigue, excessive
worry, and physical symptoms of headaches,
body aches, and change in appetite. Not all of
these patients are suffering from " Long COVID
Syndrome. " I have experienced these symptoms
and so have my friends and colleagues. These
are symptoms of major depression, anxiety,
post-viral syndromes, etc. That's what we call it
when you present for help and we have to label
it for medical-billing reasons. Some people may
benefit from pharmacological therapy, but all
could benefit from mindfulness being a key part
of the treatment plan. It's an under-appreciated
lifestyle practice. If mindfulness was a more regular
part of our practice (both health care professionals
and patients), I think it would lead to less visits,
less concern about " pre-existing " conditions,
less vicarious trauma, less burnout, and better
outcomes overall for both parties.
Mindfulness is a practice of both mind and
body awareness. It is really a philosophy that you
weave into your life, but I recommend starting
small and allowing the practice to grow naturally as you learn. It is a flexible tool to have but
requires intention and practice. Many people I
talk to (both in practice and in my personal life)
get discouraged because they aren't good at it or
can't turn off their minds. Don't get discouraged,
it's a practice, a muscle you are toning. It gets
easier as you work on building those skills, but
it is challenging. For more information about
the effect stress has on our mind and body, I
recommend Why Zebras Don't Get Ulcers, by
Robert Sapolsky. After understanding how we
experience anxiety and worry and what it can do
to us, check out apps like Calm, Headspace and
Insight Timer (both free and paid subscriptions
available) to begin your journey to being more
mindful and ultimately adapting to the stressors
in your environment in a healthy way.



Lancaster Physician Spring 2021

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