Mindfulness and awareness: Tools we can use to become better orthopedic surgeons

August 11, 2009


Living ‘in the moment’ allows you to center on the tasks at hand and increase your awareness.

By James C. Esch, MD

John D. Kelly IV, MD
John D. Kelly IV

Do you find yourself listening to your patient with one ear and doing something else at the same time? Are you rushing through your daily activities without being attentive to them? Do you all too often seem to run on automatic? Is it difficult to stay focused on whatever you are doing? If these questions elicit a wincing “yes,” perhaps you need, like I did, a healthy dose of mindfulness in your daily life.

Mindfulness, or mindful awareness, is the moment-by-moment process of actively and openly observing your mental, physical, and emotional experiences. It is our attempt to be perpetually watchful and attentive. Mindfulness has earned its place in the scientific community as a means of reducing stress, improving activity, reducing our emotional reactivity and promoting a general sense of health and wellbeing.


As surgeons we earnestly focus during surgery when protecting a nerve during a difficult exposure, balancing ligaments in total knee replacement, choosing an ACL femoral tunnel location, or deciding on cuff repair tension. We are aware; we do not want to talk to the emergency room on the phone and be distracted. We know that if we are distracted, we do not concentrate as well. This awareness is mindfulness.

Not a new concept

Mindfulness is not new. Religious texts and poets have extolled mindfulness for centuries and it is central to many contemplative traditions such as Buddhism or in the writings of Thomas Merton, a Catholic mystic. Modern writers, like Eckart Tolle in The New Earth, speak of awareness or awakening — it is the “Eureka” moment. Jon Kabat-Zinn, PhD writes of healing ourselves and the world through mindfulness in his book Coming to Our Senses. Kabat-Zinn runs a stress-reduction clinic at the University of Massachusetts Medical School where he is Professor Emeritus. This is a far cry from the classes we took in medical school where stress was rarely mentioned.

Learning to focus our mind is a helpful treatment for the stresses and strains of our on-the-go multitasking lives. However, being mindful does not mean you never multitask. You can make multi-tasking a conscious choice. The key: your awareness that you are multitasking.

The literature indicates that distracting noise impairs orthopedic bone-drilling performance and the ability to execute drilling motions is part of our surgical expertise. Quietude, or the lack of distraction, is more important for novice surgeons than those experienced in performing routine procedures. I prefer a quiet, music-free environment. This is not so for many of my colleagues who favor a musical background and may select their own repertoire as a form of therapy or relaxation during surgery.

Living in the moment

James C. Esch, MD
James C. Esch

The ability to pay attention to what we are experiencing from moment-to-moment is the essence of mindfulness. We need to avoid drifting into thoughts of the past such as yesterday’s problems, or some difficulty with a child at home. Similarly, living in the moment avoids thinking of the future such as office hours, dinner time, or tonight’s operative case. Our attention to patients is compromised when we are not present for them. When we are not mindful and thinking too far ahead, our lives can quickly become problematic. We may see too many patients, trying to squeeze in a case over the noon hour, or using our IPhones between patients to check on whatever it is that we check on.

Yes, multitasking is the bane of living in the moment. In fact, the Blackberry has been called the “crackberry” in reference to its addictive power to pull our mindfulness away and steal our attention from our patients. When we are present for others, they get all of us; we in turn get all of them.

Buddhist Zen master Thich Nhat Hanh wrote, “The most precious gift we can offer others is our presence. When mindfulness embraces those we love, they will bloom like flowers.” In this case, we can substitute “those we treat” for “those we love.”

Sports psychologists and athletes speak of the being in the “zone” in basketball, baseball, and golf. Golf psychologists speak of one shot at a time. Can we carry this into our daily lives and our practices? Golf and other sports are modern teachers, much like religious gurus.

Mindfulness increases our enjoyment of life, John D. Kelly touched on this in his recent column in Orthopedics Today on happiness. Mindfulness improves our physical and emotional health by reducing our daily stress and enabling us to bring better care to our patients in the office, in surgery, or wherever it is needed. Mindfulness gives us a clear mind to make decisions.

So, how do we go about practicing mindfulness? Most of us do not have the time or the patience to meditate for 20 or 30 minutes a day, or focusing on breathing or other physical activities which allow the body and mind to let go of tensions and concerns. I begin by just taking three simple very deep breaths. I breathe in and ask for calmness and I breathe out and ask for happiness to move on with my life at that moment. As I do this, I am aware of the constant stream of my thoughts ranging from the office calling about a patient with complications or why I missed a 2- foot putt (other than because I’m a bad putter).

Applying it to work

We are quite aware of this in the operating room, but can we apply this to our office or clinic hours? Instead of looking forward to the work day or work week being over, can we allow our work to be a means for real happiness?

I like to think of life as a continuum rather than “life at work” and “life not at work.” We can all stay in the moment by a mindful approach to the workday and by remaining engaged in each task. Don’t rush. Don’t let your mind jump around or jump ahead to the appointment later in the day. Be present for your patient at any one time. Be present to your staff at any one time. Take encounters one at a time, stay in the moment.

If negative stress like a bad outcome or angry patient or malpractice suit crops up, take care of your negative feelings. Recognize the negativity and breathe with it. Look for help such as the American Academy of Orthopaedic Surgeons peer counseling program.

In summary, mindfulness is bringing alertness or awareness to every moment during the day. You will make your life as a surgeon in the office, in the operating room and at home more fruitful, productive and happier. Remember, when you die, there will still be things in your inbox.

For more information:
  • James C. Esch, MD, can be reached at Orthopaedic Specialists of North Carolina, 3905 Waring Road, Oceanside, CA 92056-4405; 760-724-9000 e-mail: jesch@shoulder.com.
  • John D. Kelly IV, MD, can be reached at can be reached at University of Pennsylvania, Department of Sports Medicine 235 S 33rd St., Philadelphia, Pa. 19104-6322; 856-985-0851; e-mail: johndkellyiv@aol.com.


  • The American Academy of Orthopaedic Surgeons peer counseling program can be accessed by contacting Robert H. Haralson III, MD, at Haralson@aaos.org.

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