Mindful medical practice: just another fad?

A thoughtful colleague pointed out that over the past 50 years we have experimented with many different ways to humanize medicine. Recently, a few of our attempts have included explicitly promoting empathy,1 inculcating cultural competence,2 and offering courses on narrative medicine.3 This is not to say that any of these approaches have failed, but we are still searching—and recent evidence suggests that medicine retains powerful dehumanizing characteristics.4 The continuation of the problem might reflect the challenge that ongoing expansion of medical capabilities5 and demand poses to humane care, but it might also reflect an important omission in the humanizing initiatives—an explicit focus on self-care of practitioners’ own humanity. The increasing awareness of burnout and stress among physicians6 and how physician well-being affects patient care7 might explain the developing interest in mindfulness, one of the few selfcare practices for which there is empirical evidence of benefit.8 A PubMed search of the terms mindfulness and mindful revealed the following trend: 10 articles published between 1969 and 1978; 22 articles published between 1979 and 1988; 93 articles published between 1989 and 1998; and 300 articles published between 1999 and 2008 (including 80 in 2008). In addition, we found that 16 medical schools in North America, including Harvard, Duke, and McGill, offer courses on mindfulness to medical students and health care practitioners. Our purpose here is to point out some features of mindfulness that could threaten its long-term viability in medicine, while clarifying its potential role in improving medical practice.