Physician Thriving: More on Mindfulness – Recognizing Your Stress Response

By Hilary McClafferty, MD, FAAP

Mindfulness, described by Kabat-Zinn, PhD, as “paying attention, on purpose, with moment-to-moment awareness, in a particular way, without judgment”, is a highly adaptable practice that is gaining support in the medical community for both physicians and patients.

The benefits of mindfulness in physicians have been widely reported and include: stress reduction, increase in self-awareness, improved listening, increased attention and compassion, more thoughtful decision making, increased adaptive reserve, and reduction in ruminative thoughts. (West)

Cultivating an internal locus of control may be one of the most important components of mindfulness in physicians, where perceived loss of control over professional life is a common theme with the advent of electronic medical records, productivity pressures, and insurance company regulations.

The feeling of losing control both generates and exacerbates stress, which in turn activates unwanted physiologic changes such as up-regulation of the inflammatory response and triggering of the classic ‘freeze, fight, flight’ response.

An important first step in cultivating an enhanced internal locus of control is recognition of your own typical stress response. This can be challenging in some physicians who have been living with elevated stress levels for so long it has become their ‘new normal’. Common themes mentioned by physicians include elevated heart rate, palpitations, perspiration, muscle tension, irritability, anger, overeating, heartburn, headaches, and social withdrawal.

If you develop the skill of early stress recognition you can interrupt the well-worn physiologic feedback loops associated with the stress response and instead learn to trigger your relaxation response – resulting in slowing of the heart rate, reduction of blood pressure, decrease in cortisol release and respiratory rate, and recapture of emotional equilibrium.

Mindfulness can be a powerful tool in this process by training you to focus attention in the present moment and separate the stress stimulus from your response to the stimulus. Allowing yourself that instant of recognition provides you with an opportunity to use a simple physiologic trigger, for example a conscious breath, which you can use to cue a cascade of physiologic relaxation such as muscle loosening, heart rate slowing, reduction in blood pressure and so on which result in a protective buffering from the wear and tear of chronic and acute stress.

Over time, one can learn to create a default state of relaxed awareness using mindfulness, which in turn has the potential to promote more effective problem solving, clearer communication, reduced emotional reactivity, and lowering of baseline stress levels with benefit to your overall health.

Mindfulness is a powerful, flexible and effective tool and as with most things takes time to refine. Perhaps over the next two weeks you can begin to practice simply noticing how you are feeling as you move through your day. Keep a simple journal to record your findings in a quiet moment, perhaps at the end of the day. This will help provide insight into your physical, emotional, and behavioral baseline and provide a starting point for change. Here are the steps to practice:

  1. Pay attention with kindness
  2. Notice your stress response
  3. Pause
  4. Recognize your opportunity
  5. Take a breath
  6. Exhale
  7. Consciously cue your relaxation response
  8. Choose your next action or word with mindfulness

Practice, reflect, repeat and continue to care for yourself day by day. If you are interested in learning more about mindfulness while earning 6.0 AMA PRA Category 1 CME Credits™, explore this upcoming webinar course: Mindfulness & Medicine: Foundation and Clinical Application



West, et al., Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial JAMA Intern Med. 2014 Apr;174(4):527-33. PMID: 24515493

Hilary McClafferty, MD, FAAP, is board certified in pediatrics, pediatric emergency medicine, and integrative medicine. She writes and speaks nationally on physician wellbeing, resiliency, and whole physician wellness. She is a certified physician coach and author of two books: Mind-Body Medicine in Clinical Practice and Integrative Pediatrics: Art, Science, and Clinical Application, and editor of two Special Editions on the use of integrative medicine in practice. She is Founding Director of the Pediatric Integrative Medicine in Residency program, University of Arizona, and Medical Director, Pediatric Emergency Medicine at Tucson Medical Center, Tucson, AZ. Email:  Website:  Twitter: @drmcclafferty

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House of Delegates & Annual Scientific Meeting
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Patient Care Is Our Priority

Medical organizations throughout North America understand that our rigorous certification standards prove that ABPS Diplomates are capable of delivering the best patient care possible.

On October 18, 2007, President George W. Bush released Homeland Security Presidential Directive 21 (HSPD-21), calling on our nation, among other initiatives, to “collectively support and facilitate the establishment of a discipline of disaster health”. It is a great testament to the wisdom and foresight of the American Board of Physician Specialties that it immediately set to work and created, within the short span of only one year, an educational blueprint and set of certification examinations, both written and oral, for a new subspecialty of disaster medicine—and it is why I chose to be part this vital initiative and this wonderful organization. This is but one of the many innovative programs initiated by the American Board of Physician Specialties over the years, and why I am proud to support its work on behalf of our nation’s public health.

Art Cooper, MD
Disaster Medicine
When the American Board of Physician Specialties offered to host the American Board of Integrative Medicine, ABPS became a landmark organization working to move medicine into the twenty first century. Certifying physicians who have completed rigorous academic training in Integrative Medicine ensures that the field of Integrative Medicine will continue to develop academically, clinically, and professionally. The leadership of ABPS continues to impress me - they are diligent in constantly innovating to provide certifications for physicians who want to advance their careers and their areas of expertise. I am honored to be a part of this organization.

Ann Marie Chiasson, MD
Integrative Medicine
There are many ways board certification advances a physician career. ABPS Board examination verifies your accuracy, precision, and reflects your mastery of your residency training verifying your expertise. ABPS Board certification demonstrates your level of expertise beyond your practice experience, primary education degrees, and training which are necessary for insurance reimbursement and practice privilege requirements. Attaining your ABPS Board Certification will clarify your purpose, secure your practice growth, and expand into leadership positions. Board certification can serve as an indication of a physician’s commitment to medicine, beyond the minimal standards and competency of training, their measurement to quality of care, and attaining an award for excellence.

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Internal Medicine
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Emergency Medicine
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Richard Paula, MD
Administrative Medicine
The American Board of Physician Specialties has provided me with the opportunity to demonstrate mastery of internal medicine through board certification. As a hospitalist, board certification is an expected credential, and hospitals recognize the American Board of Physician Specialties (ABPS) as one of the three standard credentialling bodies for Internal Medicine. Additionally, the ABPS has helped me develop leadership skills as a Board member and Committee Chairperson. ABPS has also helped me sharpen critical thinking skills as a test question developer and reviewer. The Allopathic (MD) and Osteopathic (DO) physicians in the ABPS are lifelong learners and frequently pursue multiple board certifications. I enjoy the camaraderie of my peers in ABPS.

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Internal Medicine