What Is Contemplative Medicine?

This transcript has been edited for clarity.

Kathrin LaFaver, MD: Hello and welcome, on behalf of Medscape Neurology. I'm here today with Dr Indu Subramanian, who is the director of the VA Southwest PADRECC in LA. I'm a neurologist here in Saratoga Springs, New York. If you have watched us before, you know that we both are movement specialists interested in exploring the edges of Western traditional medicine.

Fellowship in Contemplative Medicine

We previously talked about integrative medicine and lifestyle medicine, and we're here today to talk about contemplative medicine. Indu, I know you recently completed a fellowship in this specialty, so tell us how you got interested in this and what we understand on this topic.

Indu Subramanian, MD: Kathrin, we have talked about the fact that standard Western approaches are useful in many ways for how we practice medicine, but it's not the be-all and end-all. In our lives and in our practice, I think we've searched for other things.

I personally had my own health journey and ended up relying on some mind-body practices that I had been exposed to as a child. I got really interested in yoga and was trained as part of my yoga certification in mindfulness meditation and breathwork. I really found that helped me transform my body, deal with stress on the job as a working mom and in my personal life, and I ended up really delving more into mindfulness training.

I work at the VA and I run a Center of Excellence. They've been interested in whole health as a concept, and we've had the luck, I guess, of having some of the most, I would say, dynamic and amazing mindfulness teachers on the planet work at our VA who have been doing some of this work with meditation with patients and really making a difference even in depressed, anxious veterans with posttraumatic stress disorder. They had provided some sources through InsightLA and the VA on mindfulness. I did pretty much every mindfulness class that you could have offered in the workspace for healthcare providers.

I ended up being intrigued by this contemplative medicine fellowship that came about. It was run through the New York Zen Center for Contemplative Care, and there was a quite an interesting application process. I needed an academic reference and a spiritual reference. I've never had a spiritual reference written about me, but it was quite interesting to think about who could fill that role. I ended up applying and getting a scholarship, then doing this yearlong fellowship through the New York Zen Center.

LaFaver: Tell us a little bit more about the application process and fellowship. This is obviously done in addition to your regular clinical work.

Subramanian: I think they did a really good job of selecting 30 of us. It was a relatively competitive application, and I was thrilled to get a scholarship. We had to talk about a year-long project where we would use contemplative approaches, largely in the Buddhist tradition. The concept of learning about these contemplative approaches was not just for our patients but also to concurrently look at how they could improve our own minds and health.

We had to talk about our own journey we were on through medicine and even in my personal life, and then talk about sort of the sense of using these practices to support a community of other physicians or healthcare providers in my leadership role at the VA. I had written some essays about that.

Also, a disease process that you and I both love is Parkinson's disease, so the sense that we can use some of these mindfulness approaches to help patients living with chronic disease in this space. Sometimes, we don't have the answers for everything. We don't have a perfect pill or a perfect exercise to treat an affliction. Helping to understand how we can help patients outside of traditional medicine when we don't have a solution was actually a huge part of the process for me.

Integrating Into Clinical Practice

LaFaver: Yes. That sounds very intriguing. Tell me a little bit about how this looks in your clinical practice and how this extra training you did really translates in your in your day-to-day clinical work.

Subramanian: Just thinking back, we had 29 or 30 other people in the fellowship. In Buddhism and many traditions, there's this concept of a Sangha, where the people that you're around are an important part of your purpose and exploration. Our community would meet weekly doing different activities together. For example, we were supposed to check in on the phone with someone else who we were paired with every month to support each other. We also had a 1-day retreat, including meditation.

We also had some retreats in person where we would actually meet each other. We went to the New York Zen Center. Our graduation ceremony was actually in New Mexico at a rather spiritual location. We really had this process of learning and doing exercises that were very practical on a regular basis with the group. Sometimes, we would also have to do some poetry writing or journaling, shared exercises where we would think about a patient scenario, and discuss that with the group or, sometimes, smaller groups.

I think what was really profoundly interesting is that I'm a very subspecialized Parkinson's neurologist. I was the only neurologist in the whole cohort. There were huge numbers of other specialties that were represented. It was very diverse, with palliative care, frontline ICU workers that had been in the COVID-19 pandemic working in the ICU as pulmonologists or critical care doctors. There were some surgeons in our cohort, varied ages, some psychiatrists, and ob/gyns. It was a real mix of people.

One of the things that was really interesting was the shared experience in healthcare that we all have that was very universal of looking at the current healthcare environment and really not being so comfortable practicing in the status quo. There was a search for something different, something a little bit more meaningful, understanding the discomfort that we had and trying to pin it down in sizable ways through working with some of our mentors, some of the teachers, just to see if there was something that we could meaningfully do.

As a cohort, we grew close through the year and really have supported each other. I find myself, even today, thinking about different classmates and sending them something that resonates with me that I might have read that reminds me of them, like a poem, a song, or a prayer. Sometimes, I communicate about something that happened in my clinic, asking for advice as to how to handle it, or things like that.

One of the huge pieces was really this cohort of fellow healthcare practitioners. Then, this concept of contemplative medicine where we're being in the moment, in the present, looking at our own thoughts and trying to reflect has been very therapeutic.

LaFaver: As we mentioned, we're both movement specialists and see many patients with Parkinson's. You mentioned that there are many symptoms of Parkinson's that are not easily treated with a medication, and many people struggle with depression, sleep issues, or anxiety, where some of these contemplative approaches can really be helpful.

How do you approach patients in the clinic, or especially patients who maybe have never heard of approaches like that or might not be open to alternative approaches.? Give us some practical pointers.

Minfulness Moments and Just Being There

Subramanian: There's a concept that we have 20 minutes of meditation where we can sit on a cushion, reflect on our own thoughts, and be present in the moment. I think that's very daunting for many of our colleagues and many of our patients. There are ways that we can bring contemplation into our day-to-day lives.

One of the things that's really been resonant for me is just taking moments, simple moments. Sometimes it's just 1 minute of a pause in my day and just being with my own thoughts and going out in nature, for example. I work at a VA, and there are some beautiful rose bushes with beautiful aromas — the sense of getting out in the sunshine, being in the wind, feeling the sun on your face. I think many of these things we can try to incorporate, even in simple moments.

I've been taking some of my trainees outside. Originally, it was in the guise of social distancing, where they present the case outside. It's been a really nice way to get back out into nature a little bit with some of our teaching or trying to eat a meal outside in the sunlight and nature has restored a sense of presence, a sense of joy and gratitude. These are some simple things that we're able to do. We try to teach our patients similar things they can adopt easily in their own lives.

One of the things that I think has led to my sense of burnout is that I want to do everything I can all at once for the patient. I see suffering and want to fix their housing situation, their lack of food, or homelessness. It just becomes so daunting to take on all these problems, and I suffer with the patient and take on their suffering. One of the lessons that's been taught to me through this fellowship is the ability to just bear witness. I've learned how to come alongside and be with somebody in that moment of suffering, even in a space where this person may be in a palliative-care hospice setting, and they're dying.

I used to feel the need to do something and adjust the medicine or help the family in this way or that way or say things to comfort people. I've taken time to learn how to just be able to be there. Sometimes just being able to be with somebody who can talk to you about his or her problem, hearing them and seeing them through that shared human experience can actually be hugely therapeutic. I think that's part of the medicine that I never realized is something I can give my patients and myself no matter what the circumstances.

Resources

LaFaver: Wonderful. Thanks for laying this out. It sounds like this was really a meaningful experience personally, and it really might help other people, too. If someone is interested to find out more about contemplative medicine, where can they go? What resources do you recommend?

Subramanian: I think there are a number of spiritual teachers that I've really loved over the years. I think Jeff Cornfield is somebody that really speaks to me. Sharon Salzberg is another amazing teacher. She was a guest teacher in our fellowship.

The fellowship itself is an experience. It's a year-long, deep dive. They'll be accepting applications for next year's cohort

It's not for everyone, but I think, certainly, some of the principles could be learned from reading. The person who is probably the most knowledgeable is the New York Zen Center staff. You can look up their website. They also have a number of videos that talk about some of these topics and some resources on that website. I definitely urge people to look at that

You could look for a meditation center or find a colleague who is interested in some of this and ask them, in your own neighborhood, what is a first step to exploring some of this. I think there are many drop-in groups of meditation all over the place, sometimes in certain medical centers or university campuses. There are also free and often outdoor classes in cities across the US for yoga and meditation.

I urge you to test the water a little bit. Maybe drop in or read a book in a space. There are also some podcasts and apps if you're interested in a 5-minute meditation, maybe around sleep. There is the Calm app and, Ten Percent Happier is another app that I think is accessible. I urge you to test it out.

LaFaver: Thanks so much for that wealth of information. I hope you all find some moments of peace and contemplation in your medical and personal life. I think we're going to wrap it up. Thanks again for talking to me today.

Subramanian: Thank you, Kathrin.

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