What a Monk Taught Me about Medicine and Compassion.

A guest post courtesy of my good friend DocB. Check it out!

I recently returned from a very unique conference – more of a retreat than anything – called Medicine and Compassion. Put on by Dr David Shlim and a Tibetan Lama (who flew in from Nepal to this amazing ranch in Wyoming) and stemming from their book “Medicine and Compassion“. The book is essentially a marrying of medical work and Buddhist philosophy, and the conference pushed the question, “can physicians learn compassion or is it just something some people have and others not?”.

Tibetan monks believe the former to be true. I shared my synopsis with some colleagues who enjoyed it, so thought I would share a few key take aways with you.

NOTE: Of course you do not have to be a Buddhist to gain from mindfulness or meditation — I’m an agnostic and would never push a religion! Monks themselves will be the first to tell you the whole point of their work is that training in compassion be non-religious.

A definition to start?

Compassion is the desire to ease suffering in others. (basically, what we do every day)

1. Every patient is suffering, just try and reduce it a little bit.

Lamas have put in their 10,000 hours of training, meditation, and thinking, in order to ease suffering of others. No different for us. Patients are after your 10,000 hours of expertise. Every single patient (even a drug-seeker, yes… you gotta dig deep here) has come to you to ease a suffering, even if just temporarily and even if it doesn’t match your definition of suffering. It is their suffering. And your goal should be to just bring it down a little bit. 

Patients are extremely sensitive to even the slightest bedside sigh, ‘hmm’, eye-brow raise on our part. They really experience our bedside manner to a heightened degree than we cannot fully perceive. So even showing a tiny amount of compassion is received exponentially on the patient’s end. A little really does go a long way (and we can often forget this on our last few patients each shift).

2. Compassion-fatigue. 

We talk a lot about compassion-fatigue (or burnout) in the west. However, there is no Tibetan word for this concept.  In fact, this idea confuses them. Almost like an oxymoron. In western thought we view compassion as a battery that depletes over weeks (or many shifts in a row) and then needs a recharge (which trust me, I have always held as my view too). But this is a non-sustainable practice as we would need to take a 2-week vacation every 6 weeks in our field!

Tibetans view compassion as your background, your true nature…. something considered limitless (ie so you cannot ‘run out’ of it). It is not viewed as something you ‘attain’ through practice — rather the opposite — you always have it, you are training to remove obstacles that make their way in front of it over the course of your life (ie ego, judgement, distorted thoughts etc).

Does this mean you’ll never need a recharge vacation again? Absolutely not. Plenty please. But it’s a different way to view yourself in your career… that compassion should flow more effortlessly in life and is not something that needs to be ‘turned on’ for a shift, per se.

3. Treat the patient, not the condition. 

Remember that there is often a disconnect between why the patient has shown up that day and what we think we need to do for them. Often a presenting complaint initiates reflexive/routine practices in us to make sure the patient is safe (chest pain: check the ECG, see the patient… trop negative.. great, they can go…), but it may not be at all why they came to the ER. And so you may miss easier opportunities to ease suffering (low hanging fruit)… if you do not remember to simply ask, “what is it you are most worried about today?”. This can reveal something that wasn’t on your radar and can be a major suffering for the patient that is then aided.

4. Fake it till you make it. 

A question came up a few times, “I think I’m just a moody person… what if I’m just not that compassionate? Can the patient tell if I’m faking a bedside manner? Should I even do that??”.

The Lama’s response surprised me .

Yes the patient will likely sense you are faking it, but yes you should still fake it.

Compassion practice – even if somewhat contrived at the start – will eventually transition into true compassion. Practice the neuronal circuits you wish to strengthen, don’t practice the ones you would rather dissipate.

5. The mindful pause. 

Whether you meditate or not, just taking that one moment to focus on one breath when you feel yourself getting into that headspace we’ve all been in, can help. You all know it. 4am, tired, juggling eight patients, CT scans aren’t read, patients are getting antsy… and the pager goes off ONE MORE TIME! Take that one moment to focus on one breath before responding. Calm the mind. You are trying to get away from reactionary behaviour, and give some space for compassion to come through (as opposed to letting the asshole come through).

Realize everyone’s working to the best of their ability in a very challenging environment, with a common goal to ease suffering.

Thanks for reading. Did this resonate with you? I’d love to hear back!