Two posts ago, I related my friend’s experience of feeling unseen and dismissed during a visit to establish care with her new primary care doctor. I blamed the doctor for not listening, for not exercising his relationship power with enough responsibility. Last week I described how I see medicine as a complex system, in which each of us is both a contributory and affected member. I alluded in both posts to forthcoming ‘solutions. ‘
If you have read the last two posts, what were you expecting here, in the last installment? Quite honestly, the closer I came to writing, the more nervous I got, as if I had promised to deliver some groundbreaking algorithm for instantly fixing physician-patient relationships and our healthcare system at large. Um, no, sorry. Hopefully what I write will still be useful.
Events these past weeks have really highlighted for me the profound importance and vulnerability of relationships in a system. At my kids’ school, a veteran and beloved teacher was terminated suddenly. No students, staff, faculty or parents were given any warning. Communication was sparse and poor, and few if any in the community saw evidence of a plan for instruction and emotional support of students in the aftermath. Students, faculty, and parents alike have raised questions and concerns, all, in my opinion, met with evasion and deflection. Worst of all, the administration repeatedly refused to acknowledge or own the profoundly negative impact of their actions on their relationships with the school community—a community which they proudly claim to steward.
Once trust has been violated and relationships damaged, the road to recovery looms long and ardent. Apologies—sincere and heartfelt—serve a necessary and vital role in repair, but they are only the beginning. We all make mistakes. But too few of us own up to them and take full responsibility, especially when we have hurt others. In a medical or educational community, I think we focus too much on scientific and objective decision making, and too little on relationships. That is to say, we manage the former very intentionally and critically, and the latter only in passing. This is how, for instance, a surgeon ends up saying to patients, “I can’t help you,” when surgery is not a viable treatment option. We can always help.
In recent months I have listened to and read myriad resources that point me to some simple (and not easy) guideposts for relationship cultivation and repair. I have listed the guideposts and their references below. None of them will surprise you. You may even roll your eyes and think them cliché. And yet, all of us in all of our overlapping systems and tribes could do a little better at these practices—physicians and patients, teachers and students, leaders and those they lead. Which one will you attune and attend to now? What else should be on the list?
By its nature, curiosity makes us open and willing to see more, learn more, and understand more. What if we got more curious about other people’s feelings and their origins? What if we did that for ourselves? Why, for instance, do I get angry when I perceive someone trying to tell me what to do without asking first what I’m thinking? Could they be motivated by something other than a desire to control and oppress me? How else could I respond if I thought they were trying to help me solve a problem, if I interpreted their actions as caring rather than interfering? Check out the distinctions between diversive, epistemic, and empathic curiosity described by Ian Leslie below. Then the next time you feel conflict coming on, consider these questions (asked in a truly curious tone):
What is this about?
Huh, what else?
Curious, by Ian Leslie
The Art of Possibility by RS and B Zander
Rising Strong and Dare to Lead by Brené Brown.
Smiling at a stranger, extending a hand to shake, holding a door, saying hello—small acts of kindness go such a long way. They benefit not only the recipient and the actor, but also bystanders and witnesses. Kindness is a primary currency of connection, and reserves can be infinite. We should never underestimate the potential tidal waves of global benefit from our dropping a pebble of kindness in the waters of humanity. When a stranger holds the door or my patient asks about my kids, in that moment I feel seen. I connect with you, my kind counterpart. My heart lifts ever so slightly, and I am grateful.
Forgiveness can feel infinitely harder than small acts of kindness. Will my friend forgive her doctor? Will I forgive my kids’ school administrators? What good does it do to carry around grudges, does that get us what we want? Where else can we direct the energy we expend holding so tightly to resentment? Could we use it instead to ask, honestly, “What is this about?” or to utter a kind, compassionate word? Can we see people as people, flawed and trying their best, rather than objects, obstructions, annoyances, and unworthy?
Leadership and Self-Deception and The Anatomy of Peace by The Arbinger Institute
When I hit and dent a parked car, I should leave a note owning my mistake and offering to make up for it—even if I slid on ice, or my child was crying in the back seat, or the other person’s car was parked poorly. If someone damages my car, I expect the same. The more we can all/each take responsibility for our own part in any conflict or situation, no more and no less, the better off we will all be. The key here, when we show up to others, is to do it without qualification. It’s not, “Yes, I hit your car, but…” It’s, “I hit your car. I’m sorry. How can I make it right?” I may think you were also in the wrong, but pointing that out in the middle of an argument will not help you own your part, which I need you to do for us to connect and heal. You may never own your part, and I have no control over that. But perhaps my example will influence you or others over time. Humans tend to reciprocate, and mutual exchange of accountability can heal many relationship wounds.
Nobody knows everything, even experts. And certainly when meeting another human, we cannot possibly know all that has shaped their beliefs, values, and emotions, both in the past and in the moment. In medicine we have never known more than we do today, and it seems to me that for every new piece of knowledge we acquire, we also discover a hundred new things we didn’t know we didn’t know. So what gives me the right to assume I have all the answers—that I have nothing to gain or learn by asking curiosity questions? Why should I feel the need to appear all-knowing? The opposite of humility is arrogance, and we all know how hard it is to be around people like this. Turns out students and leaders alike, who practice humility, succeed more than their less humble peers. Makes sense—humility connects us to others, while arrogance separates. It’s vulnerable, though, and that can be uncomfortable. But if we have already cultivated our relationships with curiosity, kindness, forgiveness and accountability, perhaps humility can come a bit more easily.
“The Benefits of Admitting When You Don’t Know” by Tenelle Porter
In the end, I believe empathy will save us. It is the bedrock on which the other skills are built. Google dictionary defines empathy as “the ability to understand and share the feelings of another.” It will save us because this is how we truly connect to one another. But it’s not enough to just have the ability to understand and share others’ feelings. In order for empathy to connect us, we also need to effectively express that understanding and share the emotions actively. Active empathy allows us to take another person’s perspective. It keeps us out of judgment and blame. It helps us recognize others’ emotions by recognizing our own familiar experiences—empathy is how we relate. It is the medium of relationship. Some people possess the gift intuitively. And it can be learned! Medical training programs across the country have taught doctors how to be more empathic. Patients of more empathic physicians do better. And, physicians themselves do better, too–we feel less burned out and more fulfilled in our work. We all do better when we connect.
Watch a cartoon and hear Brené Brown explain the importance and benefits of empathy.
“How to Teach Doctors Empathy” by Sandra Boodman
The Empathy Effect by Helen Reiss, MD
Please forgive the length this time, friends.
What did you think? In your next encounter with your doctor or your boss, what do you anticipate? What do you fear? How does it feel? What is that about? Which of these skills could help? How will you acquire/hone it? What help do you need? What will be better if you achieve it?
What else should be on the list?