Planes fly on autopilot. So do some cars, at least in a semi-autonomous state. While such systems offer advantages to pilots and drivers alike, routinely operating on autopilot isn't an ideal state for physicians where a lack of presence and mindfulness can lead to costly errors.
Operating on autopilot means doing something without thinking, such as driving to work using the same route. Other applicable terms include being "zoned out" or "mind-wandering." (Psychologists have even coined another term, automaticity, which they say is what happens when a behavior is "over-learned.") If you are on autopilot, you may have difficulty remembering exactly what you were doing or feel as if you have suddenly "woken up" and come back to your task.
Harvard psychologists Matthew Killingsworth and Daniel Gilbert found that the average person spends 47 percent of their time on autopilot, following automated behaviors while their thoughts wander from the task at hand.
The Pros of Automaticity
Slipping into autopilot for routine tasks does not exclude benefits. It enables us to function efficiently without utilizing mental or emotional resources.
Procedural memory, often referred to as “muscle memory,” happens when our brains learn and remember a motor skill, instead of facts or life events. Part of forming these types of memories stems from multiple repetitions of the same task over and over again, like riding a bike or performing a simple procedure.
Skill memories allow people to complete tasks without conscious thought, allowing instincts and training to guide us. While these memories come with distinct advantages, relying on them consistently for everyday tasks can often lead to big mistakes.
What Leads to Autopilot
Human brains are wired to go on autopilot when we are tired, overwhelmed, or depressed.
With heavy caseloads, long hours, routine practice, and a million things to think about on any given day, clinicians are ripe candidates for operating on autopilot. This combination provides fertile ground for mind wandering, increasing the likelihood of medical errors occurring.
An article from the British Journal of Clinical Pharmacology, "The pathophysiology of medication errors: how and where they arise," says the medical error rate increases when health care professionals are ... "inattentive, rushed, distracted, fatigued, or depressed."
Dangers of Operating on Autopilot
Autopilot is especially concerning for clinicians when relegating even mundane tasks to an autonomous state can lead to mistakes.
Let's say you are having a conversation with a patient but find yourself overwhelmed by all there is to do that day. You may be "technically" but not "authentically" present, distracted when you need to pay attention.
It's likely the patient will pick up on that and may feel you aren't listening. At best, it can lead to patient dissatisfaction. At worst, a medical mistake could put the patient's wellbeing at risk.
Types of Medical Mistakes
Many types of medical mistakes can occur when we give way to autopilot. Some of the most common include medication errors, failure to take necessary precautions when treating patients, incorrect diagnoses, treatment delays, and misreading records.
The lack of mindfulness, autopilot, or mind-wandering (whichever term you prefer to use) is not the only cause of medical errors, to be sure—Inexperience, miscommunication among staff, technical failures, decision biases, and inadequate policies also contribute.
As is the case with any medical mistakes, steps must be taken to avoid and reduce those that result from being on autopilot.
How to Combat Autopilot
If you find yourself operating on autopilot frequently, you may feel like someone else is driving, not you. It's time to get back in the driver's seat. These tips from the health and wellness site, Healthline, and the American Academy of Family Physicians (AAFP) can help:
1. Ground Yourself
A pilot who is deemed unfit to fly may be grounded. That's not exactly our intent here, however. Grounding simply means you take steps to anchor yourself (be fully attentive) in the present moment. Read SCP Health's mindfulness infographic for more self-care tips and app resources.
2. Keep Track of When You Zone Out Most
Make a note whenever you find yourself zoning out. "Logging these episodes can give insight into any patterns of mind wandering and help you take note of your thoughts before zoning out," Healthline says. "Once you have more awareness of these patterns, you can take steps to change them."
When reviewing your notes, reflect on your daily performance and circadian rhythms. It will help you know which times of the day and night are optimal and which might be less so.
AAFP calls zoning out a warning sign of burnout and advises physicians to note what is going on personally and professionally to resolve any issues that may be present.
3. Practice Mindfulness
Mindfulness practices can help you increase your awareness of what's happening at each moment. Be both physically and mentally present with the patient in front of you. Think about your surroundings and environment.
While it can be easy to fall back on what you automatically say with a particular complaint or diagnosis, try to break up that routine and tailor it to each person and situation.
4. Use Active Listening Techniques
Incorporate active listening when interacting with others. This technique includes summarizing or restating what you hear the person say to show your understanding and asking clarifying questions when needed to clear up any confusion.
Using active listening will help patients feel more connected and improve overall patient satisfaction.
5. Prioritize Self-care
Health care trends tell us the need to establish has never been more acute. Part of that balance is doing preventative self-care.
Self-care techniques, such as getting enough sleep, eating nutritious meals, exercising, and making time for family and friends, are all ways to keep yourself out of the fatigue fog that leads to autopilot.
6. Focus on the Patient's Agenda
As a busy physician, you may be consumed with your schedule and rush through the patient visit. Counter that by asking the patient about their agenda as well. "There has to be some give and take, some coming together of these parallel agendas, or the visit will not end in a satisfactory manner," AAFP says.
7. Be Careful with the Use of Technology
Use of laptops, smartphones, apps, and medical devices are necessary but don't allow them to distract you from giving the patient your full attention and making the patient encounter the best it can be.
8. Have a 'Ministry of Presence'
Pastoral care and counseling have made significant contributions to the concept of presence. While your patient visit may not involve a religious element, there can be a spiritual connection. "View your presence as a ministry," AAFP says. It can change your attitude and result in more compassionate care.
9. Cultivate the Habit of Presence
Any habit requires practice for it to become routine. Learning to be present is no different. It comes with benefits in patient satisfaction and wellbeing. "It can restore health and provide healing not only for the patient but for you as well," AAFP says.
10. Make a Checklist
Just as pilots use checklists to ensure the safety of their passengers, the book “The Mindful Nurse: Using the Power of Mindfulness and Compassion to Help You Thrive in Your Work” offers a "checklist" that any health care provider can use when treating patients.
The list focuses on tasks such as pausing before entering a patient’s room to take stock of your emotions and physical sensations, making sure to introduce yourself, and take a moment to chat and connect before moving into assessment mode.
You can modify these ideas to match what works best for you to remain ready to give the best possible care.
Operating in an autopilot state may be fine for routine tasks with little or no consequence. But for health care providers who hold the welfare of patients in their hands, being present and mindful is critical.
Give the patient your full attention during each interaction. Unhook from the busyness of your day, switch off autopilot, and put yourself back in the driver's (or pilot's) seat. Both you and your patient will benefit.
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