Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Cultivating Caring

Saint Brides Bay (Bae Sain Ffraid), Pembrokeshire, Wales, Author's Photo.


Compassion begins with caring for ourselves and working to grow as full human beings. It is not just the lives of our patients that depend on us learning this component of caring, the quality of our own lives depend upon learning this as well.

“One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” ~Francis Peabody, MD


Peabody taught that to be good healers and physicians we must be interested in and care for the humanity of our patients. However, there is another secret, and that is how to cultivate one’s capacity for caring, not just for the patient, but for oneself as well. Cultivating caring is a therapeutic resource that we must tend to with as much diligence as we study the latest scientific studies and protocols.


Caring as a state of being

In contemporary medicine we are faced with clinician burnout rates of 25-50% How can we care for our patients when we have lost the capacity for caring? One way we can approach this is to think of caring as a state of being, rather than a technical skill to be performed. Caring is not something that we dispense, but something we embody. Native American healer Joseph Rael writes that “becoming a true human” requires us to be “listeners” and to become “greater heart people.”


I have been aware of the cost of caring since I was a medical student and worked with Deb Klamen on a paper we published, “Posttraumatic Stress Disorder Symptoms in Resident Physicians Related to Their Internship.” As physicians, we suffer as a consequence of trying to provide care in environments which do not support an interest in the humanity of either patients or ourselves. Burnout, compassion fatigue, secondary traumatic stress, even PTSD can be occupational hazards of being first responders of the heart.


The counter-curriculum of self-care

A concept I have developed is the idea of a “counter-curriculum of self-care.” In medical education we have a strong curriculum in the evidence-based care of disease, but we learn almost nothing about caring for ourselves. We have great evidence-based medicine, but have we developed a corresponding human-based medicine? This is what I focus on with the counter-curriculum of self-care. This means looking at ourselves as holistic, multi-dimensional beings, and attending to our bodies, emotions, minds, hearts, creativity, intuition, spirituality, and our relationship to the human and natural world.


Making time to be a full human being

To be experts in care, we need more than to be armed with the latest EBM protocols, we also need to be hearted with resources for caring. For me, the counter-curriculum means developing myself as a full human being: reading literature, poetry, books on spirituality, being in nature, meditating, painting, listening to music, looking at art, and coming into relationship with other people who are cultivating their fully human being. The counter-curriculum is not optional if we want to cultivate caring, it is an occupational requirement of continuing human-based education.


The compassion revolution

Many clinicians are working to bring about a revolution in compassion in medicine. This is what is happening at VAs across the country implementing Whole Health. When we teach Whole Health we become the thing that we are teaching.


The compassion revolution begins with caring for ourselves and developing ourselves as full human beings, because true humans are reservoirs of caring and compassion. It is not just the lives of our patients that depend on us learning the secret of caring, our own lives depend upon learning this secret as well.


Here are a few things you can do to get started with a counter-curriculum of compassionate self-care:


1) Remind yourself why you went into healthcare. Take five minutes to write out what comes to you. Look at what is missing from your ideals/dreams and see if you can build those back into your professional or personal life.


2) Is there something you gave up along the way of your professional training? Painting, guitar, exercise, outdoor sports, reading novels, or poetry? See if you can bring one of these things back into your life to bring new vitality into your life and work.


3) Schedule a get together with a colleague and have a dialogue about why you both went into healthcare and what struggles you have now.


4) Start a meditation practice, maybe a Loving Kindness Meditation practice. See if you can do this 2-3 times a week for 10-15 minutes, maybe this will help you reconnect to the flow of compassion. Here is a great link with a number of different meditation practices, including Loving Kindness: http://www.sharingmindfulness.com/audio/.


5) Get nine index cards. Write on top of them: Body, Emotions, Mind, Heart, Creativity, Intuition, Spirit, Context (Environment & Relationships), and Time (Stage of Life). These are the nine fully human dimensions that I use in my book. Write down something in each of these domains that you would like to develop or add into your life. On the back write down a plan for how you are going to grow this domain of your full humanity.