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preventive health

Mindfulness and Stoicism for Doctors and Medical Trainees: Ancient Wisdom for Modern Challenges

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

Medical Director, Journal of Current Clinical Care and www.healthplexus.net, Adjunct Clinical Lecturer, Departments of Medical Imaging and Family Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Medical training represents one of the most demanding educational journeys, characterized by intense academic pressure, emotional challenges, sleep deprivation, and the weight of future responsibility for human lives. The prevalence of burnout, anxiety, and depression among medical students and residents has reached alarming levels, with studies showing rates significantly higher than the general population.

Key Words: mindfulness, stoicism, doctors, medical trainees.
1. The Dichotomy of Control (Stoic Foundation) Medical trainees must learn to distinguish between what is within their control (actions, preparation, responses) versus what is not (exam results, patient outcomes, others’ behavior). This fundamental principle prevents wasted energy on uncontrollable factors and channels effort toward areas where trainees can make a real difference, such as focusing on study quality rather than match competitiveness.
2. Present-Moment Awareness (Mindfulness Core) Developing the ability to stay fully present during patient encounters, procedures, and clinical tasks dramatically improves both performance and well-being. Rather than mentally rehearsing presentations or being distracted by anxiety, present-moment awareness allows trainees to engage completely with the immediate clinical situation, leading to better patient care and reduced stress.
3. Non-Judgmental Observation of Difficult Emotions Medical training inevitably involves criticism, failure, and overwhelming situations. Learning to observe emotions like shame, anxiety, or frustration without adding self-critical thoughts prevents the “secondary suffering” that compounds initial difficulties. This skill allows trainees to process feedback constructively rather than being paralyzed by emotional reactivity.
4. Integration Creates Synergistic Benefits Combining mindfulness and Stoic practices provides complementary tools: mindfulness creates awareness and space between stimulus and response, while Stoicism provides the ethical framework for choosing wise responses. This integration addresses both emotional regulation and meaning-making challenges inherent in medical education.
The 3-Minute Reset Between Patients Use the “3-Minute Breathing Space” technique between patient encounters: spend one minute noticing current thoughts/emotions without changing them, one minute focusing on breath as an anchor, and one minute expanding awareness to create perspective. This brief practice prevents emotional carryover between patients and maintains clinical presence.
Weekly Virtue Check for Professional Development Each week, systematically evaluate how you demonstrated the four cardinal virtues: wisdom (admitting knowledge limits, seeking feedback), justice (patient advocacy, treating staff with respect), courage (difficult conversations, admitting mistakes), and temperance (sustainable work habits, avoiding unhealthy coping). This creates a framework for character development alongside clinical competency.
Transform Routine into Resilience Practice Convert mandatory activities like hand washing into mindfulness anchors by focusing completely on water temperature, soap texture, and the present moment. This transforms mundane tasks into opportunities for grounding and presence throughout busy clinical days, building resilience without requiring additional time.
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An Ounce of Prevention

An Ounce of Prevention

Teaser: 

Who could argue against prevention? It is clearly better not to become sick or disabled. In caring for older adults, there is still scope for preventive medicine, and the concept of delaying disease and/or disability in older adults is of great importance. In fact, modern medicine and public health advances have already resulted in a delay in the time of death: life expectancy has dramatically increased over the last 100 years. Perhaps of even more importance is the fact that age-related disability levels have also declined dramatically. Older adults are fitter and more capable at advanced ages than were prior cohorts of older people. However, as long as mortality remains with us, there is almost certainly going to be a period of decline and disability for some people. This concept of the ragged fringe is clearly articulated in Theodore Roszak’s book America the Wise: Longevity and the Culture of Compassion, published in 1998 by Houghton Mifflin Company. (Roszak, an historian, is perhaps better known for his earlier, youth-oriented, book The Making of a Counter Culture.) There will still be a need for caregivers for frail older adults for the foreseeable future.

Preventive services are usually provided on a large scale to many people; therefore, if the intervention is ineffective, there is the potential for great economic and even health-related harm. The article “Critical Appraisal of Articles on Preventive Health Care” by Dr. Christopher Patterson and Dr. John W. Feightner is particularly important so that we can uphold that important principle primum non nocere. One of the most cost-effective advances in medicine has been the use of vaccines. Our CME article this month is on the topic of “Vaccines for Older Adults” by Dr. Mazen Bader and Dr. Daniel Hinthorn. Even among frail institutionalized older adults, there is still scope for preventive services, as discussed in the article “A Study of Falls in Long-Term Care and the Role of Physicians in Multidisciplinary Evidence-Based Prevention” by Dr. Victoria Scott, Dr. Shanthi Johnson, Dr. J.F. Kozak, and Dr. Elaine Gallagher. Our cardiovascular column this month also has relevance to prevention. It is possible that improving environmental pollution can prevent or delay the symptoms of cardiac disease as discussed in the article “Smog Alert: Air Pollution and Heart Disease in Older Adults” by Dr. Bailus Walker Jr. and Dr. Charles Mouton.

As usual we have a collection of other articles on important geriatric topics. Dr. Michael Gordon and Kayi Li describe an innovative program in their article “POWER in Osteoporosis: Descriptive Review of a Multidisciplinary, Community-Based Prevention and Management Program.” As new dementia medications become available, it will become increasingly important for primary care physicians to diagnose dementia at an early stage. A new method to achieve this goal is reviewed in the article “Screening for Early Dementia in Primary Care” by Dr. Ellen Grober. Finally, I am thrilled to welcome an article by a new colleague of mine, Dr. M. Bachir Tazkarji, a family physician with a geriatric fellowship, whom we lured away from the United States. His article is titled “Abdominal Pain among Older Adults.”

Enjoy this month’s issue.
Barry Goldlist