Investing finite resources: Time & Energy

     In my youth, I had an amazing amount of energy. In retrospect, had I known better, a good deal of it could have been invested more wisely. However knowledge, and the psycho-social-spiritual developmental stage at which one can enact and integrate the knowledge, can be decades apart.

     Some of us work pathologically hard "so people will like me." Paradoxically, this very striving can alienate the very colleagues, patients, friends and family whose love & respect we crave. But since work may be our only well-rehearsed, trusted connection to the world, we keep pouring more and more of ourselves into our profession - even though at some level we realize that "doing more of what doesn't work, doesn't work!" We tend to have inadequate training, aptitude, interest & trust in inter- & intrapersonal "soft" skills.

     “Mulla Nasrudin was outside on his hands and knees below a lantern when a friend walked up. ‘What are you doing, Mulla?’ his friend asked. ‘I’m looking for my key. I’ve lost it.’ So his friend got down on his hands and knees too and they both searched for a long time in the dirt beneath the lantern. Finding nothing, his friend finally turned to him and asked, ‘Where exactly did you lose it?’ Nasrudin replied, ‘I lost it in the house, but there is more light out here.’”

     Kornfield, J. Feldman, C. Soul food. Stories to nourish the spirit and the heart. HarperSanFrancisco 1996.

     Of course it's never too late to take the less well-lit, but rich, essential path to mature adulthood. It comes through a mindful examination of one's personal and interpersonal life. 
     Hollis J. “Finding Meaning in the Second Half of Life.” Gotham Books, NY, 2005. 

     “It’s better to limp slowly along the right path than walk stridently in the wrong direction.”
         Marc Aurel

foosfotos   www.dpreview.com

"Soft Skills" Undervalued

     At a Dalhousie university workshop, Lionel Laroche stated the obvious - that in general, technical people eg engineers, value technical knowledge, but have little appreciation for "soft skills" such as interpersonal skills or introspection. 
     It seems health-care professionals, in general, are becoming progressively more technically- rather than people-oriented. Science & technology is displacing the art of healing, the doctor-patient relationship.
     "The medical humanities receive more than their fair share of students’ critiques in terms of both quantity and virulence. ... many refer to humanities teaching as pointless, boring, worthless, or just plain stupid. Even otherwise favorably disposed students are sometimes adamant about not making medical humanities required coursework." 
        Shapiro J et al. Medical humanities and their discontents: definitions, critiques, and implications. Acad Med 2009; 84(2):192-8. 
 
     When ( not if ) these folks get into trouble because of deficiencies in soft skills, they tend to further upgrade their technical knowledge "because they don't know, and don't know that they don't know".
     Laroche L. Managing Cultural Diversity in Technical Professions. Butterworth-Heinemann, 2002.

     See: http://healthyhealers.blogspot.ca/2014/02/allergy-allert-penicillin-peanuts-wisdom.html

Photo: evangelos k   www.dpreview.com

Mindfulness, Medicine & the Hippocratic Oath

     "Mindfulness is a way of relating to oneself and the world that is characterized by curiosity, openness, and acceptance." Is this not the basis of a scientific approach?
     "Mindfulness is a skill that can be cultivated through repeated practice, such as through mindfulness meditation, in which individuals continually bring attention to their breath while maintaining an open and gentle awareness of the present moment.

     Mindfulness and acceptance-based interventions are continuing to gain empirical support as effective treatments for a range of psychological disorders, as well as chronic pain and stress. In addition to decreasing physical and psychological suffering, mindfulness may increase well-being and quality of life ..." Echoes of the Hippocratic oath?

         Erisman SM, Roemer L. A Preliminary Investigation of the Process of Mindfulness. Mindfulness 2012; 3: 30–43.

     You may wish to try one of the short mindfulness meditation exercises supplied by the Ontario Medical Association:  http://www.phpoma.org/Mindfulness.html 

Halifax, Nova Scotia

 

Perpetually Chasing or Running Away?

     How do you feel when you're alone, with nothing to do, nobody to talk to, no laptop or smart phone in hand? Do you rarely experience the above? Is it largely because it makes you very anxious, irritable, "bored"?
     We feel good when "doing our thing" - practicing our specialty. But if we stray slightly away from it ... I once knew one of the world's top experts in renal pathology. I asked him a detailed question in his field. He said he didn't know the answer, then proceeded to give an eloquent, concise outline of the three dominant theories, the pros and cons of each, and ended by saying that he didn't know the answer. A short time later, I asked him a fairly straight-forward question about oral pathology, which was outside his area of specialized knowledge. He gave a curt simplistic answer and rushed away.
     The more specialized we are, the narrower our comfort zone, and the more threatened we feel when not "performing."
     Is it possible for us to learn to just be - with no sense of chasing after or running away from? Can we learn to sit quietly, alone, with a sense of timelessness, processing the restless anxiety and feelings of guilt over "doing nothing" churning in our guts? Can we learn to be mindful? How would this process of getting to know who we truly are affect our daily life?

Halifax, Nova Scotia

"Try harder"

     How many times have we heard versions of "You can do better than that!"?
     We come to believe that nothing we do is good enough, that we are not good enough - right? If we're not good enough as we are, then we must try harder in order to be accepted, to be loved.
     Parents, teachers, and society can unwittingly collude to turn children into perfectionists in one narrow specialized field eg idiot savant health care professionals. Are many health care professionals that different from Tiger Woods or Michael Phelps, whose parents channeled into single-minded superstardom?
     Did these folks have the encouragement, or even the opportunity, to devote the necessary time and effort to become well-rounded, balanced human beings? Did we?
     Tempus fugit.

Chester Golf Club, Nova Scotia

Clinician's mindfulness, quality of life & therapeutic effectiveness

     "health care providers’ own mindfulness practice can positively impact the therapeutic alliance with patients, assist therapists in cultivating critical therapeutic skills such as unconditional positive regard and empathic understanding, and improve overall provision of a variety of therapeutic interventions.
     It is thought that this positive treatment outcome is due to the development of the health care providers’ own attention and affect regulation, acceptance, and non-judging of patient experiences, comfort with facing difficult experiences, decreased reactivity to negative events, increased capability for empathic responding, increased metacognitive awareness, and overall improvement in the therapeutic alliance. These processes and therapist characteristics have been shown to be beneficial from an evidence-based perspective on psychotherapy.
     Based on this idea, one could conclude that health care providers’ mindfulness may eventually relate to a stronger therapeutic alliance and even better treatment outcomes."

         Escuriex BF, Labbé EE. Health Care Providers’ Mindfulness and Treatment Outcomes: A Critical Review of the Research Literature. Mindfulness 2011; 2:242–253.

Photo: Engberg   www.dpreview.com

Diagnostic categories, theories & "vague implicitly intricate living things"

     "I know Freudian concepts. I wouldn't want to practice without them. I know Jungian theory. I wouldn't want to practice without that either. And, I want every other theory I can get. But once I have them, then it's time to recognize that none of them could possibly be right. After I know them precisely, then it's time to let the vague thing that is actually in front of me take precedence over all the clarities. The person before me isn't any theory, isn't any set of concepts, and moreover is not finished. Even the small feeling the person has just then isn't finished. If I try to ossify it, what good am I being? Without precise theories I wouldn't notice a lot that I need to notice. I can try out every theory I know, but the vague implicitly intricate living thing has to be asked, and has to take precedence." Eugene Gendlin

www.focusing.org/gendlin/docs/gol_2232.html

Photo: MNet   www.dpreview.com

Mindfulness - for ourselves and our patients

     A qualitative study examined the effects of Mindfulness-Based Stress Reduction (MBSR) on stress & quality of life of nine 45-55 year old nurses. Five themes emerged: "strengthening of interpersonal communication through social support, increased personal awareness through becoming more mindful and reflective, a spiritual awakening, effective ways of dealing with stress, and living life in balance by taking hold of one’s life."
     Frisvold MH et al. Living life in the balance at midlife: lessons learned from mindfulness. West J Nurs Res 2012; 34(2): 265-78.

     "accumulating evidence ... suggests that mindfulness training, when used as part of an integrated approach to chronic disease management, may help alleviate associated psychological distress and improve patients’ quality of life."
       Page JP. Mindfulness training: an adjunctive role in the management of chronic illness? Med J Aust 2012; 196(2): 569-71.
 
     Not surprisingly, Canada's Royal College of Physicians & Surgeons' "2009 Objectives of Training in Psychiatry included the requirement for introductory knowledge in 'mindfulness training'." 
         Abbey SE. Mindfulness and psychiatry. Can J Psychiatry 2012; 57(2): 61-2.

Eliza & Gretel enjoying Conrad Beach, Nova Scotia

Meaningful Conversations & Wait Time

     “Under a wide variety of instructional situations and levels ranging from first grade through university level, from classrooms to museum and business settings [and doctors' offices], the quality of discourse can be markedly improved by increasing to 3 seconds or longer the average wait times used by teachers after a question and after a response. These pauses are ordinarily so brief, 1 second or less on the average, that an adequate exchange of ideas and the nurturing of new ideas cannot take place. Wait time, however, is just another technique if one does not understand why fostering more productive exchanges among us all is so important. Gwen Frostic, a poet and artist, tells us in her book Beyond Time

We must create a great change
in human direction –
an understanding
of the interdependency
by which the universe evolves
Know
– that knowing –
is the underlying foundation
for the life we must develop. …
We cannot leave it to the scientists –
nor any form of government –
each individual
must fuse a philosophy
with a plan of action.

     Wait time provides a context in which teachers and students [doctors and patients] may dialogue together in the service of that purpose.”
       Rowe MB. Wait Time: Slowing Down May Be a Way of Speeding Up. Journal of Teacher Education 1986; 11(1): 38-43.

     See also: http://www.johnlovas.com/2013/04/insight-dialogue-guidelines-for-kinder.html

Portia has time

Rationality depends on Emotional Intelligence

     “the rationality required for humans to prevail and endure should be informed by the emotion and feeling that stem from the core of every one of us. This view strikes a sympathetic chord, because my research has persuaded me that emotion is integral to the process of reasoning. I even suspect that humanity is not suffering from a defect in logical competence but rather from a defect in the emotions that inform the deployment of logic.

The evidence comes from the study of previously rational individuals who, as a result of neurological damage in specific brain systems, lose their ability to make rational decisions along with their ability to process emotion normally. Their instruments of rationality can still be recruited; the knowledge of the world in which they must operate remains available; and their ability to tackle the logic of a problem remains intact. Yet many of their personal and social decisions are irrational, more often than not disadvantageous to the individual and to others. … the delicate mechanism of reasoning is no longer affected by the weights that should have been imparted by emotion.

… The sociopaths about whom we hear in the daily news are intelligent and logically competent individuals who nonetheless are deprived of normal emotional processing. Their irrational behavior is destructive to self and society.

Thus, absence of emotion appears to be at least as pernicious for rationality as excessive emotion.”

Damasio AR. “Descartes’ error and the future of human life.” Scientific American 1994 October, p144.

Gretel thinking

Goal- or Quality-of-life- oriented?

     Odd question? Maybe, but I suggest it's a fundamentally important, yet neglected one. 

     We often hear the expression that someone's "on a mission" - single-mindedly, even recklessly pursuing a goal. An ambulance rushing a patient to hospital comes to mind. It's a tradeoff - temporarily ignoring everyone's quality of life to achieve a desirable future goal.

     Delayed gratification, however, can easily become a permanent way of life, and seep into professional culture. The scariest examples of this, oddly enough, appear in medical papers on physician burnout and suicide. These papers, written by physicians, are generally discussed in terms of costs to the healthcare system, coldly detached from the suffering experienced by affected physicians and their families. This is goal-orientation beyond the bounds of human decency and mental health.

        Health-care professionals can and need to learn to cultivate far greater compassion for ourselves and our colleagues.

     “With understanding and compassion you will be able to heal the wounds in your heart and the wounds in the world.”                              Thich Nhat Hanh 

Photo: nancy collins   www.dpreview.com

Introverts contribute far more than they take credit for

     Over a third of the population are introverts - "who prefer listening to speaking, reading to partying; who innovate & create but dislike self-promotion; who favor working on their own over brainstorming in teams. Although they are often labeled 'quiet,' it is to introverts that we owe many of the great contributions to society ..."  Yet current society undervalues introverts, and we lose much in the process.

       Cain S. Quiet: The Power of Introverts in a World That Can't Stop Talking. Crown Publishing, 2012.

     "Solitude matters. For some people, it is the air that they breath. In fact, we've known for centuries about the transcendent power of solitude. It's only recently that we've strangely begun to forget it." 

     Susan Cain's TED talk: Quiet: The Power of Introverts in a World That Can’t Stop Talking

Vincent Van Gogh, introvert

 

Professionalism - Basis & Effectiveness

      The American Dental Education Association's Task Force identified and developed the following six values-based components of professionalism in dental education: competence, fairness, integrity, responsibility, respect and service-mindedness. (Journal of Dental Education 2012; 76(7): 932-7)

     On the 7/8/12 "60-Minutes" program: "Jack Abramoff: Inside Capitol Corruption" convicted lobbyist Abramoff indicated that rules and regulations remain incredibly easy to get around. EXTERNALLY-imposed guidelines by themselves are meaningless.
     And from Wall Street: "When misconduct is common and accepted by financial services professionals, the integrity of our entire financial system is at risk." Jordan Thomas
http://ca.finance.yahoo.com/news/many-wall-st-execs-says-050334304.html

     If an individual's top priority is to quickly acquire wealth, then s/he will find the means to achieve this objective. If, on the other hand, the top priority is honesty and decency, s/he will adhere to that, even if it means living with a relatively modest income (by professional standards). It's exceedingly unlikely that one can be a decent honest health-care professional AND live the "lifestyle of the rich and famous".
     It's critical to be honest with ourselves, make our decisions CONSCIOUSLY, then TAKE RESPONSIBILITY for ensuing consequences! When the results of our choices make us feel lousy, we learn to choose more wisely. Most of us learn by making mistakes - it's how we mature psychosocially and spiritually.

     Individuals, professions, and societies evolve to the extent that we look within, care deeply about what makes life meaningful for each of us individually and collectively, then actively work towards becoming progressively more congruent with these INTERNAL values. The guiding compass of our lives is an inner one first and foremost. Morality is in the marrow. We FEEL it and KNOW it when we're heading in the right vs wrong direction.

Château des Charmes winery, Niagara region, Ontario

"It’s not like I’m an alcoholic or an addict or something"

     "in 2010, in the UK, one study reported that approximately 15% of dentists may have an alcohol problem. These numbers occur in a cultural context in which, the pop culture icon, Matt Groening, founder of the Simpsons, once stated, “here's to alcohol: the cause of, and answer to, all of life's problems.”
     It’s this paradox about alcohol and drugs that leads many people to remark, “I can handle it,” “It’s not a big deal, I don’t have a problem,” “It just calms my nerves,” and “I don’t drink (do) that much, it’s not like I’m an alcoholic or an addict or something.”
     These near cliché comments are echoed around the country by patients, dental faculty, dental students, dental staff and dentists. The social paradox that drugs and alcohol can help and hinder our lives is what may keep many from seeking out, securing and maintaining assistance and/or intervening in the lives of others or ourselves.
     Yet, dental students should get involved in assessing alcohol or drug use for patients, self, and peers because of its serious links to: hypertension, anxiety, depression, suicide, gastric and duodenal ulcers, poor diet, blackouts, hallucinations, premature aging, cirrhosis of the liver, cell death and shrinkage of brain cells and it’s a risk factor for oral cancer."

Stuart Schrader, PhD
Clinical Assistant Professor, Behavioral Sciences
Dept. of Oral Biology
Indiana School of Dentistry 

Photo: P. Michael Lovas