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Physician Health and Well-Being: Allowing the Awe in Medicine

Physician Health and Well-Being: Allowing the Awe in Medicine
By John A. Patterson MD, MSPH, FAAFP, ABIHM
Founding co-chair LMS Physician Wellness Program

The real voyage of discovery consists not in seeking new landscapes, but in having new eyes                                                                                         

Marcel Proust, French novelist

 

     Of all the sciences, medicine is the youngest and uniquely combines all domains of the human condition- biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace. And the more we learn about the physiological effects of the physician-patient relationship, the more we seek to harness the power of the placebo effect in the way we use words and communicate non-verbally with our patients.

     This humanistic trend in physician/physician relationships and physician/patient relationships can be nurtured without traversing the potentially hazardous terrain of conflicting religious or spiritual beliefs. An encouraging sign of this maturing transpersonal humanism in medicine is the respect and serious study being given to awe as worthy of our professional attention.

What is Awe?

     Most physicians never here the word ‘awe’ mentioned in medical training as something worth taking precious time away from more ‘serious’ study. Yet, some of our greatest medical and scientific minds have spoken about awe as a primary motivation for medical and scientific inquiry (William Osler, the ‘father of modern medicine’ — Francis Collins, past director of NIH and the Human Genome Project —Albert Einstein – physicist/pacifist — Carl Sagan – astronomer/cosmologist). Though awe is a transcendent, often reverential, experience filled with wonder that needs no logical rationalization, it is not necessarily rooted in one’s religion or spirituality, though these may be involved for some people. Researchers view awe as perhaps a uniquely motivating driver of the scientific search for truth and a hopeful environmental future as nature-based experiences of awe connect us to all of creation.

     Awe is an emotional experience- not an idea, thought, opinion, fact or cognition. It is often beyond words – ineffable. It is the experience of being in the presence of something larger than ourselves- something vast and unexplainable. In your own life experience, recall the ways you have been moved, touched and inspired by the depth of love, loyalty and commitment you have witnessed or experienced. Recall your response to the courage and the will to live you have seen in a patient, caregiver or your own family.

          Awe is an emotional experience- not an idea, thought, opinion, fact or cognition. It is often beyond words – ineffable. It is the experience of being in the presence of something larger than ourselves- something vast and unexplainable. In your own life experience, recall the ways you have been moved, touched and inspired by the depth of love, loyalty and commitment you have witnessed or experienced. Recall your response to the courage and the will to live you have seen in a patient, caregiver or your own family.

Cultivating Awe

     When given the opportunity to reflect on the experience of awe in medical training, most pre-med or medical students can easily give examples. Though their resident or attending physicians rarely do so , students talk (and often say ‘wow’) about the deeply moving experience of first hearing fetal heart sounds, delivering their first baby, observing a successful resuscitation, assisting in cardiac surgery or being with the dying.

     These experiences of awe are not typically validated and reinforced by the culture of medical training. Sadly, a female physician I knew was told by an attending physician that she had no business being a doctor – because she cried so easily. Medical electives, and occasionally required courses, seek to correct this deficiency in the training of the physician as a whole person. The Healer’s Art- Remembering the Heart in Medicine is an elective taught to students and residents at over 100 medical schools. I taught this elective at UK for 20 years as volunteer community-based faculty. Similarly, Mindful Practice in Medicine is an elective created for students and residents at the U of Rochester – where I serve on faculty.

     These courses cultivate the qualities of exemplary clinicians that transcend a purely biomedical model. They enhance the self-awareness, wellbeing and resilience of health professionals. They help medical learners prevent burnout by improving relationships with patients, colleagues, their own family —  and themselves. These courses help us create the conditions for experiencing moments of awe that we might otherwise miss. They can also give us tools with which to maximize and validate our experience when we find ourselves captured by moments of awe.

Double Vision

     To develop our exemplary physicianhood and humanity, it helps to develop a kind of ‘double vision.’ We must focus on the biological, physiological and pathological in the conventional medical scientific care of our patients. And we must simultaneously focus on the unique human being we are treating- especially being respectful, amazed and in awe of their ability to navigate the health care system and the many barriers and obstacles of disease, trauma, mental illness, family upheaval, financial stress, chronic illness, aging, dying and death itself.

     The developers of Mindfulness-Based Cognitive Therapy (MBCT) refer to this double vision as our doing mode and our being mode. As so many physicians can attest, we can learn from our patients how we ourselves might dwell more in our being mode, making the experience of awe more available and finding joy amidst our own suffering and healing – even when curing is not possible. 

Emotional Intelligence (EQ)

     In explaining our diagnostic processes and decision-trees, we usually rely on ‘clinical judgment,’ which is part linear/cognitive and part non-linear/intuitive. Most clinicians can recall a diagnostic workup that involved an intuitive hunch, a gut feeling – a feeling that ‘something’s just not right here.’ For me, it was the diagnosis of a leaking abdominal aortic aneurysm in a walk-in patient who complained of a cough and ‘having the flu.’ These were actually symptoms of internal bleeding. He had emergency surgery within 3 hours and lived.

     The future of medicine is bright, in part due to the growing emphasis on the training of emotionally mature and aware physicians and collaborative healthcare teams. Those in healthcare leadership and administration can also maximize their effectiveness, communication and career satisfaction by the intentional fostering of EQ through mindful communication training – nurturing emotional awareness, fluency and flexibility.

     Our entire societal education system is recognizing the importance of preparing learners of all ages to maximize their inborn skill of emotional intelligence- learning to feel their emotions without self-judgment and blame or wondering if it is ok to feel their emotions. We need to be prepared for the tears shed by patients and colleagues and feel ok if we shed our own- even in the presence of others- avoiding the dehumanizing effect of thinking that emotional expression is unprofessional.

Mindfulness

     Moments of awe may be fleeting. We can train ourselves to be ready for them. If we look closely, awe is as close as your own remarkable human physiology. The wisdom of the body is truly awe-inspiring. We must be able to pay attention and truly be present to that sunrise, sunset, music, newborn baby, child’s laughter or the good humor and devotion of the homeless woman caring for her child at the shelter. While some moments of awe demand our attention, we can also create the conditions for awe by intentionally practicing mindful presence- with intentional, nonjudgemental openness and curiosity- anywhere, anytime.

     The growing research applications of mindfulness include promoting resilience, managing stress, preventing burnout, cultivating compassion, growing our sense of gratitude, joy in medicine and the potentially life-saving experience of awe

 

References

Mindful Practice Program, U of Rochester School of Medicine

https://mindfulpracticeinmedicine.com/

Healer’s Art- Remembering the Heart in Medicine

http://www.rishiprograms.org/healers-art/

The emerging science of awe and its benefits

https://www.psychologytoday.com/blog/understanding-awe/201704/the-emerging-science-awe-and-its-benefits

Scientists are trying to solve the mystery of awe

https://www.thecut.com/2016/05/scientists-are-trying-to-solve-the-mystery-of-awe.html

 

About the Author

Dr Patterson is past president of the Kentucky Academy of Family Physicians (KAFP) and is a Longstanding Diplomat with the American Board of Family Medicine (ABFM). He is certified by the American Board of Integrative Holistic Medicine (ABIHM), Mindfulness-Based Stress Reduction (MBSR) and Physician Coaching Institute. He is on faculty with Saybrook College of Integrative Medicine and Health Sciences (Pasadena CA), Mindful Practice in Medicine (U of Rochester School of Medicine) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers mindfulness classes, coaching and integrative, mind-body consultations, focusing on burnout prevention and stress-related chronic disease. He can be reached through his website at www.mindbodystudio.org