Caring for Unique Individual Human Beings

     "I’m learning that it’s the WAY you communicate and present things that counts, and how to deal with different cultures and personalities. You can have all the right information but if you’re not being listened to, or people don’t understand what you’re saying, or think you care, it makes no difference. So, can I be honest here? In medicine, there is no accounting for differences in people, or how they might feel about something. There is no focusing on the individual. We need to learn more about this." medical student

       Walcher ME. A look in the mirror: Self-development and transformational learning in medical students. Dissertation Abstracts International Section A: Humanities and Social Sciences 2013; 73: 8-A.  

 

 

Shad Bay area, Nova Scotia, early morning, September 28, 2013

Wise vs Other Approaches to Life

     A lifelong intentional transformative maturation journey involves numerous transitions:

     • from self-centered reactivity toward altruistic response to others’ needs
     • from stuck in the past, or daydreaming of the future toward dynamic presence 
     • from rigidity & cynicism toward psychological flexibility, acceptance, humor & joy
     • from “I can’t handle this” toward increasing abilities to manage complexity, ambiguity & difficulty with competence & composure.

      These are NOT "shoulds", NOR things we "must do, or else", but intelligent, logical, mature changes we naturally, eventually make towards a more satisfying way of life. 
     The reinforcement is from DIRECTLY EXPERIENCING a higher quality of life. We seem to learn not from theory, nor other people's experience or advice, but by making our own mistakes (often repeatedly), then finally, we try something different that seems to work better. How long it takes for us to get tired of other directions depends on our individual tolerance for suffering & frustration.

     See also: http://healthyhealers.blogspot.ca/search?q=Sternberg
     and: http://mindfulnessforeveryone.blogspot.ca/search?q=wisdom     

Shad Bay area, Nova Scotia, early morning, September 28, 2013

Healing - a Calling, not just a Job

     Your life has a meaning far beyond simply performing a few techniques from which to earn a living. You’re following the calling to be a health-care professional. You’re on a lifelong intentional transformative maturation journey, from layperson – to – healer: 

     • from self-centered reactivity toward altruistic response to others’ needs
     • from stuck in the past, or daydreaming of the future toward dynamic presence 
     • from rigidity & cynicism toward psychological flexibility, acceptance, humor & joy
     • from “I can’t handle this” toward increasing abilities to manage complexity, ambiguity & difficulty with competence & composure

     This evolving consciousness is essential to form effective healing connections with patients, others, and yourself. Much of this may not immediately resonate with you. Nevertheless, tuck it away, carry these thoughts with you as open questions. Many other puzzling aspects of life, if held as open questions, will gradually become clear, important, and deeply meaningful.

Brooklyn Warehouse restaurant, Halifax, NS

Social / Emotional Intelligence

     Though highly intelligent and technically skilled, "physicians often lack skill levels in the social/emotional intelligence domain. In the context of this study, it was discovered that medical students tend to lack self-awareness and an empathic connection with others, but these emotional skills can be taught. ... people who possess a high level of emotional intelligence are liked more by others, rise to leadership positions, and when coupled with high technical skills are often on the high end of the income pay scale."

       Walcher ME. A look in the mirror: Self-development and transformational learning in medical students. Dissertation Abstracts International Section A: Humanities and Social Sciences 2013; 73: 8-A.

Reflection, Reframing, Perspectives

     "Reflection ... is a process of internally examining and exploring an issue of concern, triggered by an experience, which then creates and clarifies meaning in terms of self and results in a changed conceptual perspective. The ability for a changed perspective becomes an important skill in medical practitioners as it allows them to reframe a problem, question personal assumptions and look at problems or issues from multiple perspectives when necessary. When physicians or health care personnel use the skill to reflect on their own lives and experiences, or beliefs, values, and assumptions and how they might differ from others, this can raise the awareness of their own feelings and increase the capacity to respond empathically towards their own patients. Traditional medical education has mostly focused on the teaching of facts and clinical skills as the 'hallmark' of a good education and has 'undervalued reflection in learning'. The need to prepare students as life-long self-directed learners call for an approach to learning that reflection can foster, such as the ability to define their learning needs, goals and monitor their learning process. Moreover, the reflective process is crucial to facilitate moving through the physician's learning-episode stages where the ability to focus on how the problem fits within the doctor's life and scope of practice is a central feature."

       Walcher ME. A look in the mirror: Self-development and transformational learning in medical students. Dissertation Abstracts International Section A: Humanities and Social Sciences 2013; 73: 8-A. 

Professional Competencies - Half Hard, Half Soft

     "Professional competencies in medicine are physician skills defined (by Epstein & Hundert) as the 'habitual and judicious use of 1) communication, 2) knowledge, 3) technical skills, 4) clinical reasoning, 5) emotions, 6) values, and 7) reflection in daily practice for the benefit of the individual and community being served.' Students are expected to graduate with a working knowledge of these competencies in place."

       Walcher ME. A look in the mirror: Self-development and transformational learning in medical students. Dissertation Abstracts International Section A: Humanities and Social Sciences 2013; 73: 8-A.

       Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002; 287(2): 226-235. 

     Of the 7 competencies, how much of our time & effort do we devote to #'s 1, 5, 6 & 7?
    ... "And how's that working for us?"

Sound of Wings by Suezan Aikins   http://www.fogforestgallery.ca/bios/bio_aikins.html

Consciousness & Goodness

     “You do not become good by trying to be good, but by finding the goodness that is already within you, allowing that goodness to emerge,” a wise man told me. “But it can only emerge if something fundamentally shifts in your state of consciousness.”

       Matousek M. Ethical wisdom. What makes us good. Random House, Toronto, 2011.

In a Blue Moon by Werner Arnold   http://www.fogforestgallery.ca/bios/bio_arnold.html

Suffering, the Hippocratic Oath and ... Meditation?

     The Hippocratic Oath is our vow to relieve suffering. Interestingly, the Buddha is claimed to have said “I teach one thing and one only: that is, suffering and the end of suffering.” Could there be synergy between Buddhist-inspired secular meditation practices such as mindfulness-based stress reduction (MBSR) and modern health-care? What effect might meditation have on medical & dental students' idealism & compassion as they weather the corrosive effects of the "hidden curriculum"? See also: http://mindfulnessforeveryone.blogspot.ca/2013/11/432-i-try-and-i-try-but-i-cant-get-no.html

     "For Buddha, as for many modern spiritual leaders, the goal of meditation was as simple as that. The heightened control of the mind that meditation offers was supposed to help its practitioners see the world in a new & more compassionate way, allowing them to break free from the categorizations (us/them, self/other) that commonly divide people from one another."

     Researchers compared the reaction of a group ("meditators") who completed an 8-week meditation course, to those wait-listed ("nonmeditators") when observing a woman entering a waiting room, in pain, on crutches, finding no seats available. "... only 16 percent of the nonmeditators gave up their seats — an admittedly disheartening fact — the proportion rose to 50 percent among those who had meditated. This increase is impressive not solely because it occurred after only eight weeks of meditation, but also because it did so within the context of a situation known to inhibit considerate behavior: witnessing others ignoring a person in distress — what psychologists call the bystander effect — reduces the odds that any single individual will help. Nonetheless, the meditation increased the compassionate response threefold.
     Although we don’t yet know why meditation has this effect, one of two explanations seems likely. The first rests on meditation’s documented ability to enhance attention, which might in turn increase the odds of noticing someone in pain (as opposed to being lost in one’s own thoughts). My favored explanation, though, derives from a different aspect of meditation: its ability to foster a view that all beings are interconnected. ... any marker of affiliation between two people, even something as subtle as tapping their hands together in synchrony, causes them to feel more compassion for each other when distressed. The increased compassion of meditators, then, might stem directly from meditation’s ability to dissolve the artificial social distinctions — ethnicity, religion, ideology & the like — that divide us. 
     Supporting this view, recent findings by the neuroscientists Helen Weng, Richard Davidson & colleagues confirm that even relatively brief training in meditative techniques can alter neural functioning in brain areas associated with empathic understanding of others’ distress — areas whose responsiveness is also modulated by a person’s degree of felt associations with others. 
     So take heart. The next time you meditate, know that you’re not just benefiting yourself, you’re also benefiting your neighbors, community members and as-yet-unknown strangers by increasing the odds that you’ll feel their pain when the time comes, and act to lessen it as well." 

       The Morality of Meditation - David DeSteno - July 5, 2013

http://www.nytimes.com/2013/07/07/opinion/sunday/the-morality-of-meditation.html?_r=0

 

Child and Wave by John England   http://www.fogforestgallery.ca/bios/bio_england.html

Appropriate Rational Behaviour & How we Actually Live

     We've all scoffed at older people who insisted on doing things "the way they've always done it", disregarding the fact that it wasn't working. A popular definition of madness is "doing more of what doesn't work, yet expecting a different result." So what do we see objectively, that (some) "old folks" can't seem to?
     We clearly see that (some) old methods fail to address current problems; that continuing to use these is irrational; and that there's emotional attachment to or identification with these (now useless) methods.
     Interestingly, most of us - particularly physicians, dentists, surgeons - consider ourselves highly rational, scientific, "evidence-based." At the same time, we insist on doing things "the way we always do it", and avoid major aspects of life in which we have minimal training or competence. To become a more balanced, whole person, it's reasonable to actively train in areas in which we're deficient. Instead, don't we work more ("do more of what doesn't work"), to the exclusion of family, friends, hobbies, physical fitness, and a meaningful spiritual life?
     It's so easy to become completely identified with and emotionally attached to our work role in society. It's entirely our choice whether or not we balance our lives.

This Summer by Alexandrya Eaton   http://www.fogforestgallery.ca/exhibition.html

Emotions, Attention & Introspection are Trainable Skills - The Neuroscience of Mindfulness

     "Mindfulness is described as paying attention in the present moment, on purpose, & without judgment. Mindfulness, which is derived from centuries-old meditative traditions & taught in a secular way, has been linked to heightened activation in brain regions responsible for regulating attention & positive affective states including empathy & other prosocial emotions. Emotions, attention, & introspection are ongoing & labile processes that may be understood & studied as skills that can be trained, similar to others human skills like music, mathematics, or sports. Use of MBSR (mindfulness-based stress reduction) in the workplace has shown that 8 weeks of training for employees of a biomedical company resulted in significantly increased relative left-sided anterior activation of the brain, a pattern that is associated with positive affect & well-being. The intervention group also showed more robust immune response to an influenza vaccine & significantly decreased self-reports of anxiety.

     Mindfulness training enhances attention by bringing awareness to the object of attention whether it is the breath, other bodily sensations, external stimuli, thoughts, or emotions. Training may increase the ability to sustain engagement of self-regulatory neural circuits in the prefrontal cortex resulting in improved sustained attention and emotion regulation as well as alterations in functional connectivity of brain networks associated with attentional focus and reflective awareness of sensory experience. In mindfulness, attention can be deployed flexibly either in a narrow, focused way or broadly, to encompass a range of stimuli. From these practices a greater awareness of sensory experiences may arise. Training attention also enables the deliberate cultivation of positive qualities through specific practices designed to promote empathy and prosocial attitudes. This form of mental training is associated with increased activity in cortical areas responsible for empathy and compassion. Mindfulness may make individuals less reactive to negative experience and more likely to notice positive experience, resulting in a cascade of psychological and physiological benefits.
     Approaches to stress management interventions may operate at different levels by targeting either the intensity of stress at work, perceptions or appraisals of stressful situations, and/or ways of coping with stress. Mindfulness is likely to act on the latter two aspects, that is, perceptions of stress and coping with stress. Mindfulness does not directly act on the target of stress, though a shift in perception & response to stressors could conceivably alter the nature of the stressor itself. In this respect, mindfulness shares similarities with other approaches that have been successfully used to reduce workplace stress, like cognitive reframing, but it also has distinct differences. Whereas a main ingredient of cognitive behavioral approaches involves replacing ‘‘maladaptive beliefs’’ with constructive, positive beliefs, a key difference with mindfulness is that it entails observing & noticing without reacting to or intentionally altering direct experience in the moment. Certain practices are also specifically designed to cultivate an appreciation for & understanding of our interdependence with the world. A mindful approach to stress may involve noticing body sensations, observing thoughts, & emotions related to stress and practicing self-compassion."

 

       Flook L, Goldberg SB, Pinger L, Bonus K, Davidson RJ. Mindfulness for Teachers: A Pilot Study to Assess Effects on Stress, Burnout, and Teaching Efficacy. Mind, Brain & Education 2013; 7(3): 182-95. 

 

 

Harriet Irving Botanical Gardens, Wolfville, Nova Scotia

How our Quality of Life is Determined

     "People are not simply in or out of trance, but are constantly moving from one trance to another. We have our work trances, our relationship trances, and our parenting trances."
       Bandler R. Richard Bandler's Guide to Trance-formation: How to Harness the Power of Hypnosis to Ignite Effortless and Lasting Change. HCI, 2008.

     "studies on attentiveness show that people are only briefly & unpredictably attentive. Attention habitually diverts to unrelated thoughts & feelings, leaving any task at hand to be managed 'on autopilot.' These studies suggest that mindlessness ('mind wandering,' 'zoning out,' 'task-unrelated thought') is 'one of the most ubiquitous &  pervasive of all cognitive phenomena' and that it often occurs unintentionally, without awareness, occupies a substantial proportion of our day, and leads to failures in task performance."        Lovas JG, Lovas DA, Lovas PM. Mindfulness and Professionalism in Dentistry. J Dent Educ 2008; 72(9): 998-1009.

     IF we were aware of how mindless we are, who would accept this as a desirable way of living? BUT most of us are not aware of how mindless we are, nor its impact on our quality of life. 
ALSO, most of us hold the mistaken belief that our own attention is completely beyond our control.
     The focus of our attention can be compared to where a spotlight shines - we perceive whatever it illuminates. This spotlight is on a swivel, so it can point in any direction. Various conditions (wind, rains, earthquakes) move the spotlight around randomly - this is default mindlessness or autopilot - the product of an untrained mind. Most people deeply believe that this is simply how their mind works, it's how they were born (true), and how they will die (sadly true, though it doesn't have to be this way).
     We can all learn to hold the spotlight, and steadily direct its beam wherever, whenever we want. I myself choose, moment-to-moment, whether my awareness is in or out of my direct control. This is basic mindfulness training, which like any other training, depends entirely on practice (& proper instruction).
     How does one's focus of attention relate to one's quality of life? One's level of consciousness - which includes the capacity to intentionally direct one's awareness - is directly proportional to one's quality of life. Most of today's dire global problems are due to human beings behaving way below their current potential level of consciousness ie from brain-stem reactivity, instead of prefrontal cortex wise judgment.

      “No problem can be solved from the same consciousness that created it.” Albert Einstein 

      Mindfulness practice stabilizes attention & promotes normal psychosocial maturation - evolution of consciousness - towards greater empathic connection with others & environment. Mindfulness is increasingly being taught at the post-secondary level, in medicine, dentistry, dental hygiene, nursing, chiropractic, veterinary medicine, design / architecture, music, business, law, liberal arts, etc.          Lovas JG, Lovas DA, Lovas PM. Mindfulness and professionalism in dentistry. J Dent Educ 2008; 72(9): 998-1009.

 

In Kentville, Nova Scotia

Resilience - Meaning & Satisfaction without Burnout

     "To improve coping with the challenges of the medical profession, it helps to:

     • Align your practice with the values that support meaning or purpose in your life; 
     • Provide the self-care of adequate nutrition, sleep, exercise, and social interaction; and 
     • Develop insight into the behavior and motivation of yourself & others. 

     Resiliency concepts and skills can help you to retain that balance of meaning and satisfaction in one of life’s most rewarding professions without succumbing to the destructive aspects of burnout."

       Nedrow A, Steckler NA, Hardman J. Physician resilience and burnout: can you make the switch? Fam Pract Manag 2013; 20(1): 25-30.

from Nedrow et al's paper above

 

Questions for Self-Reflection, Self-Care, & Alignment to Values

    "How can I take care of myself so that I can be of service to others?

     How can I strive for excellence and at the same time have compassion for myself when I don’t have all the answers or I make a mistake?
     How can I offer my expertise in order to cure illness and at the same time stay open to what my patients have to teach me about their own healing?
     How can I maintain an empathetic connection with my patients and at the same time protect myself?" 

       Nedrow A, Steckler NA, Hardman J. Physician resilience and burnout: can you make the switch? Fam Pract Manag 2013; 20(1): 25-30.

     A regular mindfulness meditation practice is profoundly beneficial for all of the above. It helps to remember the wisdom behind in-flight safety instructions about putting the oxygen mask on yourself first, and then on your dependents. See: http://mindfulnessforeveryone.blogspot.ca/2013/09/392-both-anxious-confused-reactive-and.html

Crystal Crescent Beach, Nova Scotia

Hedonism & Eudaimonia - Important Concepts for Living The Good Life

     The desire for comfort & aversion to discomfort (approach-avoidance dichotomy) is a pre-conscious reflexive drive (brain stem). 

     Thinking and behaving wisely occurs by way of moment-by-moment series of conscious choices. We're aware of being conscious when we're conscious.

     Any lapse in this high level of consciousness, and we rapidly slip - by default - from this evolved mode of being (prefrontal cortex), into a very basic semi-conscious autopilot mode (brain stem). See: http://mindfulnessforeveryone.blogspot.ca/2013/09/391-comfort-seeking-moves-and-our-full.html

     "Within ethical philosophy, happiness has long been proposed as the ultimate goal of human functioning.

     Hedonic enjoyment refers to the positive affects that accompany getting or having the material objects & action opportunities one wishes to possess or to experience. The proponents of ethical hedonism ... contended that such pleasure is the sole good and that the ‘good life’ consists of maximizing such experiences.

     In contrast, eudaimonia has been defined not in terms of being pleased with one's life, but as the subjective experiences associated with doing what is worth doing and having what is worth having. Eudaimonistic ethics ... proposes that the goal of human functioning is to live in a manner consistent with one's daimon, or true self, where the daimon represents one's best potentials. ‘Living in truth to the daimon’ entails selecting life goals on the basis of one's inherent nature, with the pursuit of such goals giving purpose and meaning to one's life. Acting in a manner to advance or realize those life goals and personal potentials is held to be what is worth doing, and that which can serve to facilitate such self-realization is taken to constitute that which is worth having. Eudaimonia, as a subjective state, refers to the feelings present when one is moving toward self-realization in terms of the developing one's unique individual potentials and furthering one's purposes in living."

       Waterman AS, Schwartz SJ, Conti R. The implications of two conceptions of happiness (hedonic enjoyment and eudaimonia) for the understanding of intrinsic motivation. Journal of Happiness Studies 2008; 9(1): 41-79.

from Kelly McGonigal's excellent YouTube video: Authors@Google: Kelly McGonigal

Stabilizing Sound Judgment & Evolved Consciousness

     Mindfulness “consists of the development of a particular kind of attention, characterized by a nonjudgmental awareness, openness, curiosity, and acceptance of internal and external present experiences, which allows practitioners to act more reflectively rather than impulsively.”
       Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med 2009; 15(5): 593-600.

     With mindfulness practice, we behave less often from the brain stem level (impulsive, reactive), and more consistently from the prefrontal cortex level (reflective, judgment).
     We are directly responsible for intentionally evolving our own consciousness.

behind clouds, endless clear skies

Being Alive as a Chronic Condition

     Life in general has interesting similarities to chronic medical conditions, like chronic pain (non-cancer-related). A fundamental error patients (& many clinicians) make in dealing with chronic pain is to assume that rules for acute pain apply: 
     1) urgent call to cure;
     2) find & remove the (single) cause; 
     3) after which, everything will quickly be back to the way it was before. 

     That NONE of these apply to chronic pain (nor to life) takes an agonizingly long time to realize. So frenzied, useless activity masks the avoidance of the central issue.
     Accepting things as they are to permit a deeper, more profound understanding of the complexity of the problem is terribly unpopular. Like addicts - who are highly motivated to cure existential pain via their substance of choice - we all have a fervent drive to exhaust all avenues of escape, before we allow ourselves to open up to & embrace reality "with eyes wide open". Only NOW can healing begin.

     Life is similar, and of course more complicated. Yet, it's the rare individual among us who doesn't harbour "magical thinking": "Oh if only X, THEN I'd be fine." X can be any one or more of: toys, sex, wealth, looks, fame, health, luck, intelligence, etc.
     Life cannot be fixed / controlled by any of these "magic bullets." Life's too complex & ever-changing. We get used to & grow tired of any & every type of shiny thing. What we truly hunger for is profound evolution of our consciousness, a quantum shift in our state of being - which only happens as a result of consistent, prolonged, intelligent training eg mindfulness.

     See also: http://healthyhealers.blogspot.ca/2013/01/hope-expectancy-therapeutic-alliance.html

Crystal Crescent beach, Nova Scotia, September 2, 2013

Am I Strong or Weak, a Success or a Failure?

     Don't we feel that our family, friends, and society in general expect us to work very hard, be very busy, very successful, wealthy, famous (at the very least locally), and acquire as soon as possible, most but preferably all the signs of success: million+ dollar MacMansion home, prestige cars, designer clothes, prestigious club memberships, private schools for the kids, prestigious summer home, large sail boat, fine wine cellar, regular exotic vacations, etc? The need to be seen as knowledgeable, to be seen as competent are very much part of our personalities - to be seen as successful is almost certainly also part of our makeup.
     And if we never acquire most of the (above) obvious external trappings of wealth, will we be perceived - by others & even ourselves - as weak, lazy and perhaps even a bit dull - a failure? How do we deal with this? Can we allow it?
     Not long ago, showing off one's wealth was considered to be in bad taste, uncouth, crass, "nouveau riche."
     What proportion of health-care professionals can - from practicing good medicine - earn the money required to pay for all that "bling" above? And of the tiny proportion who do, how hard do they have to work to do so? What must they give up in the process?

     If one's top priority is to be seen as "very successful" by material standards, many things can, and do go wrong.
     Constant dissatisfaction with our possessions, is a nightmare created intentionally by big business through advertising. One would hope that health-care professionals are wise enough to realize that "the one who dies with the most toys wins" is a joke, not our true calling.

     See also: http://mindfulnessforeveryone.blogspot.ca/2012/12/250-presents-presence.html
     and: http://mindfulnessforeveryone.blogspot.ca/2012/11/220-hows-work-working-for.html

 

Photo: UncleFai   www.dpreview.com