Finding Zen in medicine
Balance in practice
By Emily Margosian, assistant editor, May 1, 2020
“It’s something I would have never thought I’d do,” recalls Adam Rotunda, MD, assistant clinical professor of dermatology at the University of California, Irvine and a Mohs surgeon in private practice, in Newport Beach, California. Several years prior, Dr. Rotunda attended his first meditation retreat — nearly 10 days of total silence — at the recommendation of a friend and fellow dermatologist. “I’ve always had an interest in self-development, but mental health had never been something I focused on. Rather, I favored strengthening my physical health, goal setting, team building, and business skills,” he said. “So essentially for 10 days, a group of 100-plus participants from all walks in life were silent. From 4:30 a.m. to 9:30 p.m. we ate in silence, meditated alone or as a group in silence, and also had instruction on advancing our technique. We were taught to focus on our body sensations, our moment-to-moment experiences. By the third day, sitting still and breathing only, I had completely silenced my mind. This can be hard for any of us to conceive, because typically we have a near constant stream of thoughts, commentaries, images, etc. in our heads.”
It was during this retreat that Dr. Rotunda was struck with a breakthrough on what to do with additional office space he had acquired adjacent to his practice. Although the nearly 2,000 square foot office seemed ideal for five additional Mohs rooms, Dr. Rotunda had other ideas. “It had been giving me a lot of trouble, because frankly five or six additional exam rooms might have brought me more profit, but it didn’t feel right and it certainly wasn’t going to bring me any more peace,” he said. Instead, Dr. Rotunda decided to reconfigure the space as a commercial meditation studio offering to others what he experienced in a profound way on his retreat. Upon returning, he started a business and now calls the business (aptly) MDitate. The studio is one of the country’s handful of non-religious, commercial meditation studios, and with a team of about 15 guides (teachers), they offer about 20 weekly classes in different styles of meditation, qigong, reiki, and sound healing.
However, despite his experience managing a solo dermatology practice, Dr. Rotunda says the process of opening the studio came with its own set of challenges. “It took me on a deep dive into learning about entrepreneurship and business. I had seen similar spaces in L.A. and New York and wanted to be distinct from those,” he said. “What I learned is that you become unique by following your own vision, aligning with your value and goals. Hopefully commercial meditation spaces and similar businesses will fulfill their visions and become just as prevalent as yoga studios. I look forward to the day when a great number of people realize that working the mind, by quieting it and pausing our daily routine, can bring a real sense of sustained inner peace that nothing else can.” Dr. Rotunda’s studio currently offers free meditation classes to any University of California, Irvine students in health care studies, which he says is part of their effort to promote self-compassion and relief from burnout in future generations of health care professionals.
Dr. Rotunda personally meditates up to an hour each day, typically after work, before heading home, and describes his own meditation practice as being comprised of non-judgmental observation of oneself, and still in line with the techniques he learned on the retreat. “Meditation is a means to observe our mind and body — our thoughts, emotions, and sensations, as part of, but not wholly who we are,” he said. “Essentially, you are observing your thoughts and sensations without judging them or attaching to them. Such practice, over and over again, day in and day out, gives us a better sense of observing situations in life for what they are. I respond to situations more thoughtfully, with patience, I judge less, and I react more compassionately. I can distance myself from getting tied up in what can be a roller coaster of emotions during a typical day at practice.”
Since having begun a daily meditation practice, Dr. Rotunda says he has felt less rushed throughout the workday, and that the ability to step back and calmly respond to unexpected obstacles has been particularly helpful when dealing with patient workflow issues. “I had a patient who fainted and hit his head. That opens up a host of obligations — a neurological exam, a CT scan, and incident report, and an impromptu staff meeting — and most of that in the middle of Mohs surgeries and reconstructions and follow-up visits. Meditation opens up this realization that our unhappiness or discontent in life is because we’re attached to an outcome.”
While meditation is helpful to most people, Dr. Rotunda says doctors in particular can benefit, especially as a mitigating tool against burnout. “Typically, burnout involves a slow decay of someone’s self-worth. Physicians begin to question their efforts,” he explained. “Meditation has changed my expectations. I expect less from my practice — it’s just my practice! It’s a way to fulfill and express myself on some level, but it’s certainly not my full identity. Unless we think otherwise, we become attached to some imagined, sometimes unrealistic set of expectations. If regulatory or EHR issues hamper our practice workflow, staff issues distract us, our income is threatened, our clinical outcomes aren’t met, the list is endless, then we may become overwhelmed and lose our focus and motivation. I believe meditation can help us come back to the grounding principles that initially guided almost all of us into medicine. I am grateful and I am reminded not to take for granted the tremendous privilege of caring for our patients."
