Mistaken Sacrifices

     I thoroughly enjoy reading W. Somerset Maugham. In the preface to his “Collected Short Stories Vol 4.” (Penguin Books, 1973) he says that these “were written long before the Second World War and I should tell the reader that the sort of life with which they deal no longer exists.” Later he describes a hotel that “should have been a depressing place, but somehow it wasn’t; its quaintness saved it. It had a faint aroma of something strange and half-forgotten.”
     From detailed loving attention alone, Maugham is able to rebuild the irretrievable past, even for readers not yet born, nor ever having visited the places he describes. This brings to mind two of my favorite quotes: 
     "Anything will give up its secrets if you love it enough."     George Washington Carver

      "You learn about a thing ... by opening yourself wholeheartedly to it. You learn about a thing by loving it." Barbara McClintock - Nobel prize-winning geneticist

     How radically different than the life of today's health-care providers and first responders: police, firefighters, paramedics & prison guards. It's shocking how much these fine people knowingly, but especially unknowingly, sacrifice. By maximizing their external actions ('doing'), they almost totally neglect their inner life ('being'), all because of a collective, unexamined ethos of 'traditional masculinity.' Anything 'soft', like self-reflection, self-compassion & appropriate self-care, is rigidly excluded to avoid any suggestion of weakness or lack of competence. This bravado continues despite a high incidence of primary & secondary traumatization, burnout, PTSD & suicide. 
     Socrates knew 2,500 years ago that the unexamined life is not worth living. Why do so many of us have to crash & burn to find this out for ourselves? How long will it take these professional cultures to intentionally evolve toward a wiser worldview?

     Traditional masculinity: http://healthyhealers.blogspot.ca/2017/05/traditional-masculinity-in-health.html 
     Sanity: http://www.johnlovas.com/2013/02/sanity-diligent-introspection-in.html

Traditional Masculinity in the Health Professions?

     What is the role of 'traditional masculinity' in medical & dental schools? How does 'traditional masculinity' relate to power, privilege & entitlement - vs those who consider health professions as their life calling?

     “In most western settings, including prisons, it’s ‘traditional’ masculinity that is dominant. Aggression, hardness, physical power and emotional reticence – not love and compassion – are the qualities most highly valued. These values are intimately connected to, and manifest in, power and systems of domination – governmental, financial, military and domestic – by which a small number of men secure the natural and economic resources of the planet for themselves, and protect their privilege by any and all means, including imprisonment, slavery and force of arms. 
     Many men who are raised to believe in these values, but who are denied access to the rewards such values supposedly offer – and who live without encountering alternative narratives – are angry, depressed, violent and destructive. 
     These are the young men who fill our prisons, who fight in the streets and in pubs, who beat their partners and their children, who fill the internet with misogynistic hate. Historically, they are also the men who are enlisted to fight for other men’s power. When we talk about finding new heroes and new models of masculinity, we have to talk about dismantling these systems of domination. 
     Power knows this, which is why voices calling for different models – valuing peaceful coexistence, mutual tolerance, caretaking of each other and of the planet – are most often marginalised and ridiculed, and sometimes exiled, imprisoned or killed.”

       Howard Cunnell. “Traditional ideas of masculinity are poisoning our society. There is another way.” 
         https://www.theguardian.com/commentisfree/2017/may/15/power-violence-define-men-peace-masculinity

       See: http://healthyhealers.blogspot.ca/2012/10/is-it-time-for-healing-can-we-let-war.html

Burnout BEFORE Admission to Professional Schools?

     "... burnout is when physicians feel emotionally exhausted, depersonalised (ie, cynical & detached), and ineffective; when they feel 'an erosion in values, dignity, spirit, & will'."

        Ronald M. Epstein, Michael R. Privitera. "Doing something about physician burnout."

        www.thelancet.com Published Online September 28, 2016 

        http://dx.doi.org/10.1016/ S0140-6736(16)31332-0 

     An excellent podcast: https://resident360.nejm.org/content_items/1423

     But what percentage of students entering health-care (& other professions) have ever paid appropriate attention to their "values, dignity, spirit, & will"? How much does our society, or for that matter professional school admissions committees, actually value these self-reflective, spiritual matters? 

     I suggest that very few in our society care deeply about this: http://www.johnlovas.com/2016/11/the-power-of-self-knowledge-and-self.html

     Even within professional schools, a corrosive segment of both students & faculty ("hidden curriculum") are actively hostile even towards standard courses in the humanities: http://healthyhealers.blogspot.ca/2012/07/soft-skills-undervalued.html

     But neglecting inner poverty does become debilitating sooner or later: http://jglovas.wixsite.com/awarenessnow/single-post/2016/12/06/Delusion-of-Self-estrangement

 

Experts Trying to Hide Deficiencies

     Health-care professionals strive mightily to become competent, then proudly display their competence - hence the popularity of specialization & sub-specialization. The more minutely specialized one's area of training, the more sought-after are one's services, and the less one is subject to criticism from patients & colleagues.
     Of course the more time & effort expended in gaining specialized competence, the less time & effort remains to acquire general life skills. As a result, most of us haven't lead a balanced life since we were kids. Physical exercise, sleep & nutrition are not the only areas in which we're deficient. See: http://healthyhealers.blogspot.ca/search?q=maturation
     Because we become so tightly identified with the persona of "the one who knows", we become increasingly sensitive about our ignorance of the many life-skills we've ignored. This is problematic of course, not only in our family & social life, but also professionally.
     Defensiveness of our ignorance about subjects outside of our specialized area is often manifested as swaggering condemnation of basically anything outside of our own sub-specialty - the humanities, mental-health, social work, nursing, physiotherapy, spirituality, etc - are all targets. See: http://healthyhealers.blogspot.ca/2012/07/soft-skills-undervalued.html
     Since such attitudes are politically incorrect, the condemnation happens behind closed doors - the "hidden curriculum" - it's toxic effects are part of professional socialization. See: http://healthyhealers.blogspot.ca/search?q=hidden+curriculum

     Fear of our own ignorance, hubris, and our unwillingness to step-up to acquire competence in practical wisdom, condemns too many of us to become grumbling backroom cynics - "nattering nabobs of negativity." Surely health-care professionals can rise above that!

The Big Bang Theory of Health Care

     On the TV series "Big Bang Theory", Sheldon is hilariously inept in all matters outside of theoretical physics, especially his total befuddlement about human relations. Doc Martin, on the British TV series, is Sheldon's medical counterpart.

     “Life’s central issues … are issues of quality, dealing with judgments regarding the value of our thoughts and actions – political, moral and aesthetic. They deal with evaluative choices regarding the nature of existence and our place in it, rather than simply with descriptions of life’s quantitative aspects, like those of distance, size and weight.
     ... science fails in the face of all ultimate questions, and consequently, leaves the problems of life … completely untouched.”
       Dana Sawyer “Huston Smith: Wisdomkeeper. Living the World’s Religions. The Authorized Biography of a 21st Century Spiritual Giant.” Fons Vitae, Louisville, KY, 2014.

     So what proportion of us dentists and physicians have had solid liberal arts educations? 
     Since most of us have almost exclusively been immersed in the sciences, how receptive are our dental and medical students (& faculty) to correct this deficiency?: http://healthyhealers.blogspot.ca/2012/07/soft-skills-undervalued.html

Oingt, France

Emotionally Intelligent Healthcare Professionals?

• Self-awareness and self-management skills. Identifying and self-regulating emotions, managing stress, and evaluating how emotions and behaviors may affect others; assessing personal strengths and limitations; seeking help and making effective use of external resources to achieve personal and academic goals.
• Social-awareness and interpersonal skills. Recognizing feelings and perspectives of others, including those from different cultures and backgrounds; effectively communicating and resolving interpersonal conflicts in constructive ways.
• Responsible decision-making skills. Making ethical decisions; evaluating the consequences of choices, and how virtue (e.g. honesty, justice, compassion, courage) enables us to recognize the needs of others when making decisions; recognizing how individual students can contribute to the well-being of the school and broader community.
- See more at: http://wisdomresearch.org/forums/t/1486.aspx#sthash.NmQwByzS.dpuf

• Self-awareness and self-management skills. Identifying and self-regulating emotions, managing stress, and evaluating how emotions and behaviors may affect others; assessing personal strengths and limitations; seeking help and making effective use of external resources to achieve personal and academic goals.
• Social-awareness and interpersonal skills. Recognizing feelings and perspectives of others, including those from different cultures and backgrounds; effectively communicating and resolving interpersonal conflicts in constructive ways.
• Responsible decision-making skills. Making ethical decisions; evaluating the consequences of choices, and how virtue (e.g. honesty, justice, compassion, courage) enables us to recognize the needs of others when making decisions; recognizing how individual students can contribute to the well-being of the school and broader community.
- See more at: http://wisdomresearch.org/forums/t/1486.aspx#sthash.NmQwByzS.dpuf

• Self-awareness and self-management skills. Identifying and self-regulating emotions, managing stress, and evaluating how emotions and behaviors may affect others; assessing personal strengths and limitations; seeking help and making effective use of external resources to achieve personal and academic goals.
• Social-awareness and interpersonal skills. Recognizing feelings and perspectives of others, including those from different cultures and backgrounds; effectively communicating and resolving interpersonal conflicts in constructive ways.
• Responsible decision-making skills. Making ethical decisions; evaluating the consequences of choices, and how virtue (e.g. honesty, justice, compassion, courage) enables us to recognize the needs of others when making decisions; recognizing how individual students can contribute to the well-being of the school and broader community.
- See more at: http://wisdomresearch.org/forums/t/1486.aspx#sthash.NmQwByzS.dpuf

Self-awareness and self-management skills. Identifying and self-regulating emotions, managing stress, and evaluating how emotions and behaviors may affect others; assessing personal strengths and limitations; seeking help and making effective use of external resources to achieve personal and academic goals. - See more at: http://wisdomresearch.org/forums/t/1486.aspx#sthash.NmQwByzS.dpuf

     Documents listing minimal competencies for graduating healthcare professionals are peppered with references to emotional intelligence (EI). Yet students and faculty alike continue to strongly resist attempts to include EI-related subjects in the healthcare curriculum. Their reasons typically include: 
          • no room in an already packed curriculum; 
          • it's already covered (presumably by parents, places of worship, & earlier education); 
          • not directly applicable to the "science" we teach;
          • outcomes from teaching such "soft subjects" can't be measured; 
          • "we're not training them to be social workers".

     Students continue to gain admission to coveted spots in health-care professional education almost entirely by obtaining high marks on multiple-choice tests (MCTs). Even in science-related subjects, MCTs poorly assess depth of knowledge. How much do we know of these students' self-knowledge, character, psychosocialspiritual maturity? Embarrassed avoidance *** is how admissions & curriculum committees "deal" with these critically important characteristics. Then why are we repeatedly surprised when a proportion of these students "handle their stress" in outrageously dysfunctional ways?
    
      "Ignoring the shadow side of our personalities can only lead to what Freud once called 'the return of the repressed'.”                    Mark Epstein MD

     Comprehensive, integrated Behavioural Sciences curricula could provide students in health-care professions with explicit guidance & practice to intelligently deal with their own & others' emotions - a MUST in order to minimize the frequency & gravity of grossly unprofessional behaviour, not to mention a host of mental health issues, burnout, and suicide. 

     Professionalism includes being explicitly aware of & embodying the highest level of EI and practicing appropriate self-care. Unfortunately, students only take these matters as seriously as their educators.

     *** more on avoidance: http://healthyhealers.blogspot.ca/2014/11/avoidance-is-easier-than-wisdom-hows.html
          fearing introspection: http://mindfulnessforeveryone.blogspot.ca/2014/12/608-fearing-shallows.html
          ethical infants: http://www.johnlovas.com/2013/09/do-we-need-more-nuclear-giants-who-are.html

koasiausad.blogspot.com

Avoidance & the Health-care Professional

     Don't we just love to think, talk about & act on biomedical scientific minutiae - details. After all, compulsiveness is one of our defining characteristics - see: http://healthyhealers.blogspot.ca/2014/04/a-call-for-greater-self-awareness-in.html
     Mention anything about the bigger picture of the psychosocial realm, and most of us become as uncomfortable as young children in a sex-ed class. And those of us who try to initiate mature conversations about the psychosocial "elephant in the room" are avoided as carefully as our elephant. See: http://healthyhealers.blogspot.ca/search?q=avoidance and: http://healthyhealers.blogspot.ca/search?q=Medical+humanities+and+their+discontents
     Trying to avoid life's complexity, constant change & other mind-blowing challenges, is immature, ineffective YET sadly typical, even within healthcare education. Inevitably, it becomes impossible. Like trying to ignore the "oil is low" warning light on our car's dashboard, sooner or later, all hell breaks loose - see: http://healthyhealers.blogspot.ca/2012/09/when-our-whole-world-collapses-around-us.html
     Sooner or later, we have to learn that deep self-reflection & self-awareness is safe, unavoidable and essential. We must get to know & live from our core values, for our deepest most meaningful essence is our actual operating system. See: http://healthyhealers.blogspot.ca/2012/05/time-to-re-set-operating-system.html and:
http://www.johnlovas.com/2014/04/allowing-elephants-to-pass-through.html and: http://www.johnlovas.com/2014/04/core-purpose-philosophy.html 

A Call for Greater Self-awareness in the Health-care Professions

     "... there is no doubt that compulsiveness is the hallmark of the physician's personality. In a poll of 100 randomly selected physicians, ... all 100 declared themselves to be 'compulsive personalities.' Eighty percent possessed three of the five criteria for the diagnosis given in the DSM3, while 20% satisfied four of the five criteria, which include 

     • restricted ability to express warm & tender emotions,

     • perfectionism, 

     • insistence that others submit to one's way of doing things, 

     • excessive devotion to work & productivity to the exclusion of pleasure & the value of  interpersonal relationships, &

     • indecisiveness. 

     While it would be an exaggeration of the truth to declare that all physicians are diagnosable as having compulsive personality disorders, it is probably accurate to assert that compulsive traits are present in the majority of those individuals who seek out medicine as a profession. Hence, the normal physician may be described as a compulsive physician.

     ... another grand paradox on which to reflect is that those individuals (ie we) who are so vulnerable to feelings of helplessness choose a profession where they are repeatedly reminded of their inherent impotence in the face of disease and death."
 
       Gabbard GO. The role of compulsiveness in the normal physician. JAMA 1985; 254(20): 2926-9.

     Existential issues in healthcare: http://healthyhealers.blogspot.ca/search?q=existential

PEB   www.dpreview.com

Is Avoidance Enough?

     Are we living our life completely passively? Is what we do and whom we do it with simply the left-overs from what we didn't manage to avoid? Is avoidance the main choice we make in our lives? See: http://healthyhealers.blogspot.ca/search?q=avoid
      If so, are we not failing to actively go after what truly matters to us, what really has meaning in our lives. Our brief, precious time must be managed carefully to ensure that it is as deeply meaningful as possible.
     All our lives have a certain momentum (inertia - very much like an addiction). To change it towards a deeper, more meaningful direction requires constant awareness. Mindfulness mediation will continually surprise.

Clinical Hypnosis Workshop - Newfoundland - October 24-27, 2013



HYPNOSIS Workshop in Newfoundland - October 24-27, 2013

The Canadian Federation of Clinical Hypnosis:  Atlantic Division

Autumn Workshop

October 24^th to 27^th  2013

Marble Inn Resort, Steady Brook, Corner Brook, Newfoundland

Oct.  24^th to 26^th, 2013 --  Introductory Workshop

A 20-hour approved basic and experiential workshop.

Aim: to acquire the skills to use hypnosis within your area of clinical expertise.

Oct 27^th  --  Intermediate / Advanced Workshop

This workshop will explore the use and place of Hypnosis in Anxiety and many of its manifestations --- Panic attacks, Phobias, PTSD and Hypnobirthing.

Faculty Clinicians: have extensive clinical experience in hypnosis.

Aim: To demonstrate the role of hypnosis in the treatment of Anxiety in many of its manifestations. 

To provide evidence for clinical techniques, and practical demonstrations of different techniques.

Requirement for this course is a previous introductory course.

Registration for these workshops is open to any Health Care Practitioner who has a valid license issued by a Provincial Licensing Body.

A detailed brochure will be available by early September.

For more information please contact below.

Dr. Ian Simpson

Box 2108, RR1 

Corner Brook NL. A2H2N2

Email:   iansimpson@bellaliant.net

Armand Huet DeGrenier, Ed.M, C.A.G.S., F-CHSNS

Phone daytime: (902)-543-9376, Phone evening: (902)-677-2243

Email:  novaquest@eastlink.ca

Beautiful Newfoundland   http://www.canadabbhosts.com/NF.htm

How Open-minded am I? Paradigms & Dogmas

     “A paradigm, most simply, is both a model of and a template for reality. Complementary terms include ‘belief system’ and ‘worldview.’ Just as a fish cannot breathe outside of the water it swims in, so an individual operating within a paradigm is subject to the illusion that the paradigm represents the whole of reality. But no paradigm does. All models of reality, no matter how complex, are bound to leave out some aspects of the ‘reality’ they are attempting to model. Many paradigms come to constitute relatively closed conceptual systems that discount or exclude incompatible information, regardless of its potential validity within another paradigm. In the Structure of Scientific Revolutions (1970), philosopher Thomas Kuhn demonstrated that, far from being an accurate model of reality, the most a paradigm can be is a set of beliefs about the nature of an ultimately unknowable universe.

     The limitations of paradigms are counterbalanced by their advantages: paradigms provide clear conceptual models that facilitate one’s movement in the world. In acting not only as models of – but also as templates for – reality, paradigms enable us to behave in organized ways, to take action that make sense under a given set of principles. ‘To paradigm,’ if you will, is to create the world through the story we tell about it. We then can live as cultural beings in the organized and coherent paradigmatic world we have created. We cannot live without paradigms. But we can learn to be conscious and aware of how they influence our thoughts and shape our experience, to understand that they open some possibilities while closing others. That awareness can bring a rare kind of freedom – the freedom to ‘think beyond.’

     Davis-Floyd R, St. John G. “From doctor to healer. The transformative journey.” Rutgers University Press, London, 1998.

     “… the open-minded person is one who is able and willing to form an opinion, or revise it, in the light of evidence and argument.” William Hare
       Sellman D. Open-mindedness: a virtue for professional practice. Nurs Philos 2003; 4(1): 17-24.

     “persons who exhibited ‘intolerance of ambiguity’ were disinclined to think in terms of probability, tended to favor stereotypes and showed a marked discomfort with ambiguity by escaping into whatever seemed concrete. … intolerance for ambiguity (has been defined) as ‘the tendency to perceive situations that are novel, complex or insoluble, as sources of threat.’ Moreover, intolerance of ambiguity has been associated with a constellation of other personality traits including rigidity, authoritarianism, dogmatism and ethnocentrism, with socially relevant phenomena such as religiosity and conventionality, and with the inability to adapt to cognitive stimuli that are at variance with conventional reality.”
       Geller G. et al. Measuring physicians' tolerance for ambiguity and its relationship to their reported practices regarding genetic testing. Med Care 1993; 31(11): 989-1001.

      See also: http://www.johnlovas.com/2013/02/managing-uncertainty-re-creating.html

View from Wolfville, Nova Scotia

"The wisdom of no escape"

     Most of us realize that the problem-solving approach Arnold Schwarzenegger used in his movies was meant to be comedic. "The war to end all wars" (WW I) didn't. And yet, the public continues to support equally useless wars on drugs, terrorism, crime ...

     To (attempt to) eradicate something, it's first demonized - made utterly hateful AND foreign to ourselves individually and collectively to "our tribe", then it's fine to swat it like a mosquito. It's awkward of course when "one of our own" commits a reprehensible act - then we have to "disown" the unfortunate - an outcast, left behind to fend for himself in the wilderness. Most awkward is when we ourselves mess up! Then we have to disown the act - through lying, denial, repression, suppression, avoidance, temporary insanity ... "The system" or one's parents are also handy targets to deflect the blame.

     We each have to take personal responsibility - start looking at our self deeply and honestly. What is our role in this mess? This is infinitely more complex and challenging than diagnosing and treating patients' physical illnesses. Most of us have minimal training in psychosocial matters, and deep self-reflection is uncharted territory for us. Nevertheless, if we wish to fully engage the complexity of our single, short, precious life, then it's worth really serious effort.

     A personal / professional "shipwreck" can suddenly force this inward journey. For this liminal experience to be a productive growth experience, for externally-oriented perfectionists, it's a really good idea to have professional guidance. In Nova Scotia, we have a free, confidential Professionals' Support Program for dentists, physicians and veterinarians, operated by Doctors Nova Scotia. The two fine people behind it are:

Tracy Scott MD  and  Carolyn Thomson MD
Confidential help line: 902-468-8215
E-mail: professionalsupport@doctorsns.com

        Title of today's blog is from the excellent book:         Chodron P. “The Wisdom of No Escape.” Shambhala, Boston, 1991.  

Welcome! Join the conversation

     We give our patients solid advice in living a healthy life, but tend to infer: "Do as I say, not as I do." It's as lame as when spoken by parents.

     How can we learn to "walk the talk"?

     How can we live healthier, more balanced lives?

     How can we embody the ideals that inspired us to be healers in the first place? 

     How can we heal our culture?


     YOUR ideas are needed - students, residents, as well as practicing health-care professionals - WRITE your COMMENTS.

     "Enlightened health care invites patients and caregivers into a relationship of healing that is a mutual journey towards wellness.  During the journey both parties are encouraged and enabled to grow, to learn, and to heal.  Such a journey includes acceptance, respect, mindfulness, compassion, and humor."          Harvey Zarren MD       http://www.healinghealthcareassoc.org/learningmodules.htm

RESOURCES:

Rachel Naomi Remen's excellent links:
http://rachelremen.com/links.html

Rachel Naomi Remen's workshops:
http://rachelremen.com/workshop.html

NY Times article on Medical Student Wellness:
http://well.blogs.nytimes.com/2011/12/22/a-medical-school-more-like-hogwarts/

Wellness initiatives from Medical / Dental Students at McGill:
http://students.med.mcgill.ca/events/annual/wellness%20week

McGill's "Whole Person Care" program
http://www.mcgill.ca/wholepersoncare/

Postgrad Medical Student Wellness at University of Toronto:
http://www.pgme.utoronto.ca/wellness/physician.htm
 
Canadian Physician Wellness:
http://ephysicianhealth.com/

ADA Policy Statement on Dentist Health & Wellness (p115-6):

http://www.ada.org/4497.aspx

CMA Center for Physician Health & Well-being:

http://www.cma.ca/living/centrephysicianhealthwellbeing

Authentic Medicine blog:
http://authenticmedicine.com/

Physicians' Mindfulness Website from Plymouth UK:
http://slowmedicine.weebly.com/index.html

Redfield's restaurant logo, San Diego Hyatt hotel