Featured Expert Q&A - Inpatient Care and Mindfulness
Dr. Mary-Amanda O’Neill started out as a biotech engineer but switched to medicine when she discovered she liked working with patients. She has been a hospitalist at Cape Cod Hospital since 2015 and sees adults in all stages of acute and chronic illness. She recently described how she uses mindfulness, meditation and yoga techniques in her practice of medicine and her daily life.
Let’s start by just talking about what a hospitalist does. When and where do you see patients?
We are the primary care, “head-to-toe” doctors, who see people on every floor in the hospital. Now, once an ER doctor establishes that you need to be admitted, we are there to gather the details and put in the orders to get you safely up to the medical floor. If you need a specialist, we call that doctor to ensure they know about you and can help your care while you are with us.
What’s the difference between seeing a patient as a primary care physician and as a hospitalist?
In a primary care office, docs see folks in their usual state of health, manage chronic issues, focus on prevention and have more continuity. Outpatient docs used to come to the hospital, see admitted patients, then go to clinic for appointments. But demands on docs have grown.
In the inpatient world, people come to the hospital when their life is threatened, and so things tend to be more critical. There's a culmination of all chronic factors at play: diabetes, hypertension, COPD, heart disease, cancers, ravages of addiction, etc.
Hospitalists now staff the hospital 24/7, so that when there are sick patients in the hospital we’re here and we’re on site. It’s a much safer, better way of doing things. We don’t have patients to see elsewhere, and see as many as 17 complicated people in a 10-hour minimum, usually 12-13 and sometimes up to 15-hour work day. Each day is akin to reading 17 short novels, having 17+ meetings, and writing the next chapter in every person’s story.
Although, frankly, everyone misses their primary care doctors coming to the hospital, and I can certainly understand that, since at times it’s a beautiful relationship established over years. Nonetheless, if you do outpatient medicine, you’re excellent at outpatient medicine, and if you do inpatient medicine, then you stay excellent at inpatient medicine.
You started out as a biotech engineer at a Boston company working on a smallpox vaccine in the aftermath of the Sept. 11, 2001 terrorist attacks. What made you give that up to become a doctor?
I got to meet actual patients [who were] taking the drugs that we were making. And then I thought to myself, what am I doing? I don't want to be sitting here managing capital projects, operating expenses, and contractors - I want to be able to actually treat patients. So I applied to med school. I always thought I would gravitate towards primary care, and it turns out I just like the more acute, more critical side of primary care.
You take yoga classes and you’ve studied meditation. How does that help you as you go through your work day?
It helps with getting ready for work. You have to feel physically as well as you can, and it helps to have a positive outlook before you even come to work, so you can help lift people up.
How does meditation help you?
In training, I developed this habit of literally walking through the halls of the hospital in my mind as I was lying down to rest, revisiting each patient, their stories, medications, lab tests, imaging and plan going forward.
That was a wonderful way to mentally organize what would need to happen with everybody, but it would sometimes cause insomnia. So now I do it in more of a focused way that allows me to organize my thoughts about every patient, followed by a meditation that's not related to work to trigger a good night's sleep.
How do you use meditation, yoga or mindfulness breathing techniques with your patients?
There’s study after study that shows benefits in cardiopulmonary rehabilitation, stress, anxiety, depression, multiple sclerosis and cancer treatments. Controlling your breathing can help you control your body and quiet your mind. So, I encourage it as a nice adjunct to guideline-based pharmacologic therapy. There are free apps to learn and so few downsides to doing it.
Around here is an amazing variety of classes, too. In addition to the most popular Vinyasa (which is a combination of stretching, strength and balance exercises), there is Hatha (Gentle), Yin (Restorative), Power (Strength) and Bikram (Hot). I particularly love the outdoors Beach Yoga, offered in the summer months. For the more adventurous among us, Acro Yoga involves many inversions and resembles what you might see at the Cirque Du Soleil. (Those days are behind me.)
There are classes which incorporate anti-addiction therapies, dancing and drumming (Pound), classes specifically tailored to Veterans with mental toughness, healing, forgiveness and resilience strategies woven into them. Prenatal Yoga helps moms-to-be with stress reduction, bodily changes, and maintaining fitness. Chair Yoga is available for those who need postural alignment but who also need to be safe from fall risk, from say, stroke, or osteoporosis. I don’t golf, but I do find it charming that there is such a thing as Yoga for Golfers.
You’ve described your Ukrainian grandparents and how they survived a Nazi labor camp during World War II before immigrating to Canada. How do they inspire you and what you bring to your patients?
It’s amazing that they survived the starvation and abuse. And once they settled in a peaceful land, they seized the opportunity to move forward. And they used every tool at their disposal to put it behind them and overcome all of that.
Yoga and meditation are not the only thing, but they are certainly things that can help everybody. I want my patients to feel empowered that they can, not just survive something, but overcome and thrive beautifully. Sometimes our minds get the better of us. But there are many ways to train yourself to put things in the past and focus on the future, and that only helps. It helps with people who have gone through the worst things imaginable and it can help all of us in our own journeys.