In a recent issue of the Journal of the American Medical Association (Nov 28, 2012), David Wu MD wrote a beautiful, reflective piece entitled “Virtual Grief”. The article is a tribute to a patient whose death Dr. Wu learned about through an impersonal message conveyed over email. It is also a lament about the “slippery slope” we can find ourselves in when improvements in the system such as EMR (Electronic Medical Record) or the Medical Home also result in unintended changes to how we think about and relate to our work.
While Wu praises the benefits of the system, he soberly reflects on its other effects:
“..I fear that, under this system, I’m not as good a doctor as I once was. What I mean is that I’ve come to prize what the system prizes: efficiency over human contact, computerized data over stories, virtual reality over authentic life. I may be pretty efficient at processing and acting on data, but I’m not as compassionate, not as good a listener, not as human.”
What he is speaking about here is the experience of “being caught in the drift”, the unconscious ways we can lose touch with the deeper purpose of our work in the effort to meet the countless demands of day-to-day practice. This process of ‘drift’ is cumulative. It seems as though we start with the purest of intentions in professional school. The more we immerse ourselves in the technologies and routines required to responsibly meet the standards within the medical model, the easier it is to forget the human dimensions of healing and care or the importance of our own self-care. At some point, we find ourselves wondering whether we have, as anthropologist Angeles Arrien refers to it, “normalized what is abnormal and abnormalized what is normal.”
How this process comes about should be no surprise. It is, in large part, a matter of biology. Neurobiology. We become what we practice. This is both the good news and the bad news of what has come to be referred to as “neuro-plasticity.” The “bad news” is that what we practice unconsciously becomes habit – a way of being or thinking or responding that we don’t necessarily intend but unconsciously cultivate through repetitive behavior. The “good news” is that when we set out to change something consciously by practicing a new skill or paying attention or interacting in a new way, we can develop mastery. This is how doctors become doctors or nurses become nurses – by attending to and performing certain things over and over again.
In his JAMA reflection, David Wu speaks to how his practiced use of the EMR has enabled new efficiencies (a new kind of mastery) while, at the same time a new ‘habit’ of attention, reinforced through the multiple demands of email, has supplanted the more affective sensitivities in his clinical repertoire.
It does not have to be this way. Dr. Wu’s reflective self-awareness is the starting point for making a change if what he wants to do is preserve compassion, listening, authenticity and human contact as important dimensions of his practice life. What will need to follow is a certain daily resolve about what is important, the setting of intention, the conscious inclusion of desired behaviors and attitudes as a regular practice and the sharing of values and ‘best practices’ with supportive others. This is not easy by any means – nothing that is ultimately transformative, especially if it goes against “the drift,” ever is.
We have designed the upcoming urban retreat for health care professionals – Making the Shift: from Surviving to Thriving in Health Care – as an opportunity to step back from “the drift” of daily practice and reflect upon the habits of looking, thinking, being and doing that inevitably shape and influence our practice experience and who we are as practitioners. We will come together with committed others to examine and renew intentions and re-ignite professional purpose. We will re-imagine our practices – what it is we need to practice – in order to become the caring and skillful professionals we aspire to be.