Tuesday, April 15, 2014

Just Breathe

This is Scott Selinger and welcome to another scintillating episode (webisode? pod? I’m not totally sure what to call these serial casts) any way, it’s another ABC’s for ECP’s, the podcast on behalf of the Northern California’s chapter of the American College of Physicians Council of Early Career Physicians. 

As I’ve got a wedding to head to in beautiful scenic St. Louis this weekend flanked by a trip to the national ACP meeting in Orlando next week, I’ll make this a  brief one.  We’ve all heard about mindfulness and mindful meditation, and it sounds great in theory, but how do we bring it into our daily practice?  Is there actually a way in our hectic shift schedules to find time for a calming experience?  I think so, and I’ve been starting to do it.

Deep breathing exercises are a great relaxation technique.  The NIH’s National Center for Complementary and Alternative Medicine has noted research supporting the power of relaxation techniques on improving control of numerous medical and psychiatric conditions, or to put it a way we more commonly hear it, “Side effects of relaxation techniques may include improved control of anxiety, depression, asthma, fibromyalgia, headaches, chronic pain, angina, hypertension, insomnia, IBS, nausea, TMJ syndrome, tinnitus, and overactive bladder.”  Sounds pretty good right?  If only we had a time when we could incorporate it into our daily practice …

But fear not!  There is a way!  The next time you’re getting ready to perform an auscultation as part of your respiratory exam, give this a try: put your hand on your patient’s shoulder, your stethoscope on their chest, ask them to take some deep slow breaths through their mouths, and then breathe along with them.  This can help you out in a few ways:

1)  Firstly, if you’re breathing along with them, you’ll be able to make sure they aren’t hyperventilating to the point they might pass out by the end of the exam (as I’ve seen a few overeager patients do)

2)  Second, as mentioned above, for the patient with any of the conditions mentioned above, the act of deep breathing may help put them more at ease in their interaction with you.  They may feel less anxious, their pain may be a little diminished, their blood pressure may go down a little bit and if they do get any of these benefits, you will have just illustrated a safe, effective, free, non-pharmacologic treatment that they can take home with them

3) Finally, looking at your own wellness and all the stress and external stimuli we’re bombarded with in our daily practice, it can help give YOU a moment of calmness and clarity, probably making you spend a few extra seconds on auscultation, and let you both come out on the other side of the exam feeling a little more at ease and connected as you get ready to discuss the assessment and plan.

Personally I can say that I’ve been trying this for the last few months and in the midst of seeing 11 or 12 patients every 4 hours, it has been a little oasis of respite so I definitely encourage you to give it a shot with your next patient.

            Additionally, I want to give another little plug for mini meditation sessions to make your day easier.  Search for “how to meditate in a minute” and you’ll find a nice, short, animated cartoon that will talk about the benefits of meditation and show you how quickly you can see them if you can find just a minute in your busy day.  It’s a cartoon and it’s about 5 minutes long and I think it’s something that can be beneficial for us and our patients in a ton of different situations.

            As always, we’d love to hear your feedback on this, so if you have any burning questions or comments, you can post them on our facebook page or email them to canocecp@gmail.com.  And if you have time, be sure to head on over to our facebook page for the Northern California Chapter of the ACP Council of Early Career Physicians so you can find out more about the events going on in the chapter.

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