What About the Self?
I once knew an eye surgeon who lived a life of misery when he retired. Years of hard labor and poor posture from hunching over his operating field led to painful and intractable back issues that plagued him for years after he had finished practice.
There are numerous anecdotes about healthcare providers who share similar stories. The healthcare industry has not traditionally placed a premium on the self or self-care. We talk about being “selfless” as though it were a good trait, to focus solely on the patient often while neglecting our needs. Television helps to perpetuate this stereotype for the sake of dramatic effect by portraying physicians and nurses who work tirelessly for their patients at the expense of themselves, their families, and their colleagues.
Look at the example in the photograph. It is a word cloud on medical professionalism that I found on the American Board of Internal Medicine website. Anyone can use software to process any document, such as an article, book, or white paper. The bigger the word is, the more often the word appears in the text, and therefore the software gives it more weight. In the current climate of patient-centered care, I think it makes sense that the words patient, compassion, and honesty are the largest.
However, what about that word highlighted in red which is almost too small to see? It is the word self.
Perhaps we can tolerate such thinking when it comes from our set of guiding principles or core values, but when an institution asks you to neglect or sacrifice the self for the greater good, then you run into problems. We understand the critical need to care for the patients, but how about caring for ourselves and each other?
When we talk about the Self, we can have many different discussions about implications of Self-Awareness, but in healthcare, Self-Compassion is the epicenter. Here is a passage from Daniel Goleman’s book A Force for Good. Quoting the Dalai Lama, he says:
"In the Dalai Lama's sense of the concept, compassion does not just imply sympathy or charity for someone else. It includes ourselves. 'You need a word in English,' he told a group of psychologists long ago, 'Self-Compassion.' To cultivate genuine compassion, we need to take responsibility for our own care and have concern for everyone's suffering - including our own."
Kristen Neff is a research psychologist and author who has done much research on Self-Compassion, and I find her definition quite user-friendly. Dr. Neff describes Self-Compassion as having three components: Self-Kindness, Common Humanity, and Mindfulness.
I believe this is an excellent construct for expressing Self-Compassion, however, when it applies to healthcare, I use slightly different definitions than Dr. Neff.
Self-Kindness: Dr. Neff uses this expression to describe self-acceptance and an end to self-criticism. In the healthcare setting, I use it to describe a stop to the culture of harmful self-sacrifice in the context of patient-centered care. It can also be defined as an acceptance of the situation when things go wrong, or when bad things happen to our patients.
Common Humanity: I use this term interchangeably with Community. Let's all acknowledge that the practice of medicine is very isolating. There is an obvious need to connect with our colleagues to share stories and recognize our shared experiences, and to lean on each other when times are rough. We need to understand that there is a level of mutual suffering that we can connect over, and help each other to find a solution.
Mindfulness: this practice can provide the glue and the foundation to changing the primary culture of healthcare as we know it. Furthermore, the practice of Mindfulness is in itself an act of self-kindness.
Certainly, the organizations we work in can do more to create the conditions for a Culture of Happiness at work. However, that is only half of the picture. Change must also begin with each of us individually. To quote the Mindfulness teacher Pema Chodron, "We work on ourselves in order to help others, but we also help others to work on ourselves."
© Edwin T. Ozawa 2017
