Cultivating clinical compassion with cultural encounters

Jeffrey Lee
Philadelphia, PA (Winter 2018)

 

Sunset along the beaches of Sant Antoni de Calonge

The calm waves of the Mediterranean played a lullaby as I walked along the beach, the fine-grained sand gently caressing my toes. I noticed a small group of women massaging each other’s backs. I awkwardly watched them from the corner of my eye and wondered what was going on. Every minute or so, one of the women would ring a bell, and the members of the group would rotate to find new partners. Eventually, they gathered in a circle and surrounded a single woman standing in the middle. Silently, the women stretched their hands out to hold the one in the middle. At that moment, their smiles seemed to flow through one another, and they laughed exuberantly like innocent, carefree children.

The intimate interactions shared by these women on the beach was profound. I had never witnessed an exchange like this before, and the scene struck me as a stark contrast to my first year of medical school. The women lovingly massaged each other’s muscles with warm hands and took in the shore breeze, whereas I spent the year dissecting muscles with cool precision in the anatomy lab, bathing in the fresh fumes of formaldehyde.

During my first year of medical school, I found little opportunity to create similar moments of genuine human interaction; after all, I spent most of each day caved up in my room. So, when summer drew near and I stumbled across a program where I could teach English while living with a host family in Barcelona instead of spending my summer in a research lab, I leapt at the opportunity. I spent the summer talking to and photographing strangers from diverse backgrounds. These people treated me with a kindness and warmth similar to what I witnessed with the women on the beach. There was the animal rights activist who painted himself a symbolic blood-red, the Pakistani man who was simply trying to save up enough money to reunite with his family, and the local Islamic community leader who sought to provide opportunities for new immigrants to integrate into Barcelona’s culture. These people I met cared strongly for something beyond themselves, whether it was a community of animals or human beings.

After my time in Spain, I wondered if I could bring a similar kind of compassion to the medical field. However, I may face serious obstacles in achieving this ideal. These obstacles include misperceptions created by hospital dramas like Grey’s Anatomy, which portray doctors as superheroes who can simultaneously restart still hearts and snatch guns out of the hands of hostage-holding criminals. This fictional ideal helps cement the perception that health care professionals ought to strive to reach a state of perfection. This perception is echoed within the medical field itself in the countless tests we must pass as medical students and the board exams required after graduation. The constant assessments tell us where we must improve, and we obediently follow their mandate. Of course, reaching for perfection is not necessarily a bad thing; doctors must learn the biochemical pathways and the pathologies behind disease in order to successfully diagnose and treat their patients. However, a myopic focus on perfection may overwhelm other values, such as developing compassion. Compassion allows us to recognize the suffering of another human being and nudges us to accompany our patients as they face an uncertain future.

Plum Village, a meditation retreat
started by Thich Nhat Hanh 

After only one year in medical school, my thinking has already been molded in a very particular manner. The unrelenting barrage of timed multiple-choice tests foster a mindset that there is only one right answer and that we need to get to that answer as quickly as possible. There is too much information to learn every possible detail, so students listen to lectures with the purpose of getting the “high yield” information – in other words, what might show up on the test. As practicing professionals, we are encouraged (or even mandated) by hospitals to continue this trend of focusing on efficiency: we must do as many surgeries as we can in a day or as many consultations as possible in an hour. This can lead to disastrous consequences when we bring this mindset to the realm of the provider-patient relationship. Doctors may fixate on the ends without fully considering the means. For example, doctors typically ask for a number to evaluate the severity of pain – “How bad is it out of 10?” We become so focused on getting a number to use as a means for diagnosis and treatment that we forget that there is a human being in pain sitting in front of us. In doing so, we may miss the chance to heal by witnessing and truly being present for our patients in their pain and frustration. By being a witness for our patients, we remind them that they are not suffering alone.

Nevertheless, doctors must face the realities of medicine, from fifteen-minute office visits to the tedious charting that forces us to stare at the monitor rather than the human. However, we can still be witnesses for our patients within these confines. Not long after my time in Barcelona, I traveled to France for a week-long meditation retreat. One evening, I found myself walking and chatting with Thich Gioi Dat, a Buddhist monk I had befriended. Suddenly, he stopped in his tracks and turned to face me. “Jeffrey, there is a time to focus on walking, and there is a time to focus on talking. Right now, I want to focus on you, so can we stop walking?” It was such a simple action, but its effect was profound. His words were a warm blanket that made me feel safe and cared for, and they reflected his genuine desire to listen to what I had to say. It only took him a moment to communicate all of this; it was not just the words, but also the way he put his hand on my shoulder and the way we respectfully bowed to each other after this exchange.

This kind of communication is quite distinct from the platitudes we are taught to mindlessly repeat when confronted with a patient in pain: phrases like, “I hear you” and “I understand what you are saying.” We use these phrases to simply fill the uncomfortable silence rather than use them as an expression of our presence, like Thich Gioi Dat did for me. These phrases certainly have the potential to profoundly uplift and comfort a patient, but we must first question our intentions. Do we feel a desire to care for this person? Is this patient just another diagnosis to make, an interesting case with which to hone our clinical skills? Or do we see this next patient as a fellow human being in pain and recognize our sacred opportunity to ease that suffering? We must each undergo an honest self-reflection if we truly desire to be more compassionate doctors. I now realize what the women on the beach had: a genuine love for one another that eased whatever suffering they might have felt. Ultimately, I want to stand in that circle of humanity for my patients, offering my own hands if they need the support.

 


 

JEFFREY LEE is a second-year medical student at Sidney Kimmel Medical College. He graduated from the University of Washington, where he studied neurobiology and philosophy. He has an interest in using photography to reflect on how medical professionals can authentically engage with their patients, especially those from different cultures. This paper reflects on a few moments of true care and compassion which are used to observe how the medical community’s focus on achieving perfection may present obstacles to developing compassion.

 

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