Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Mindful Doctoring in the EHR Era


Mindfulness is essential in clinical excellence. Consider these five tips while working with the EHR.

I was intrigued by this idea after listening to a webinar by David Levy, author of the book “Mindful Tech: How to Bring Balance into our Digital Lives,” hosted by the Center for Contemplative Mind in Society. I wondered how I could apply his suggestions to my relationship with the EHR, one that is admittedly quite challenging. We document our notes, place orders, answer staff and patient messages and pages using computers or mobile phones. It has become a ubiquitous but necessary distraction to the work of “doctoring,” in a world already inundated with many distractors. Literature demonstrates the negative impact of working with the EHR on physician well-being. So I asked the Internal Medicine Associate Residency Program Director if I could present this topic as part of a monthly morning report/resilience series. To my delight, she was likewise intrigued and agreed.


Cell phone meditation

We started our session with Levy’s cell phone meditation exercise. Following instructions to notice our breath, posture, emotional reaction and quality of attention, we moved from thinking about the cell phone, then holding, and opening, reading, and responding to an email message on it. We identified our habitual thought patterns and relationship to the mobile device, without judgment. Finally, we probed new internal or external actions to change these habits, and shared it with the group.


One of the residents mentioned that she incessantly checks her phone because she fears missing important messages. Whenever she hears a sound notifying her about a message, she holds her breath, anticipating something “big” that needs her immediate attention, and automatically checks the phone. With this exercise, she noticed that most of the messages were not really important. She will consider turning off the sound notifications, or taking a deep breath before she opens and reads messages. We were surprised to uncover many habitual mindless actions and shared several ideas for change.


Doing a cell phone meditation yourself may be a good way to start identifying your own habitual thoughts and actions as you work with digital and electronic devices.


We can also consider taking some of these new actions when working with the EHR:


1.) Before opening the EHR, do a mindful check in. Notice breath, posture, emotional reaction, and quality of attention. Take an action based on what you notice before working. It may be as simple as taking a deep breath, acknowledging your feelings, or loosening your neck, back, or shoulders.


2.) Consider choosing a password that helps reset or refocus your thoughts and emotions. Michael Spertus suggests using this as a positive affirmation tool. Play with numbers, caps, and symbols to state thoughts such as my patients matter, I am doing my best. Use a special event, date, or quotation that reminds you of your desire to be a physician.


3.) Limit distractions, such as checking texts, while working on the EHR.


4.) Practice mindful task-switching. Again, before switching to a different task, check in and ask yourself, “ Is this a good time/moment to switch to a different task?”


“Is the switch caused by anxiety, boredom, or addiction to distractions?”


5.) At the end of a workday, schedule unplugged time on the drive home, while going on a run, or during dinnertime. Engage in a “slow practice” to balance the hectic pace of the day. David Levy, who lived in the “fast” world of computers, had a “slow” calligraphy practice. And me? I may give in to the temptation of opening my embroidery box again!