I just gave Grand Rounds at One Medical in San Francisco. For those of you not familiar with Grand Rounds, it’s a lecture where all the doctors gather in the hospital to learn about the latest research. The lectures tend to be dry- lots of data, lots of slides, lots of science- and it’s not the sort of format that lends itself to debate or discussion afterwards.
I’ve been speaking all over the country on my book tour for Mind Over Medicine, and most of the audiences are a mix of empowered patients, conscious doctors, alternative health care providers, and hospital staff. I’m also training very open-minded doctors in the Whole Health Medicine Institute, so I have some experience speaking to doctors.
But giving Grand Rounds is a whole different ball game. Frankly, I was terrified.
My talk was titled “How The Doctor Can Be The Medicine,” about how rather than simply prescribing drugs, as doctors, our presence can be a force for healing. I loaded these doctors up with scientific data from our most respected journal, The New England Journal of Medicine, to support my point, sharing the data that demonstrates that the doctor can be either the placebo or its evil twin opposite, the nocebo, depending on whether, as doctors, we are kind, compassionate, and optimistic versus rude, rushed, and pessimistic.
I taught them 15 Ways The Doctor Can Be The Medicine:
My dear friend and mentor Dr. Rachel Naomi Remen and I have been talking a lot lately about how to heal our broken health care system. The New York Times just wrote an article Medicine’s Search For Meaning about The Healer’s Art program that Rachel created, which is taught in half of all medical schools in the US and in other countries across the globe. I was lucky enough to be part of a pilot program years ago that allowed me, as a practicing physician, to participate in The Healer’s Art program at UCSF, right alongside the medical students. It was life-changing for me, as it has been for countless medical students.
This New York Times article spawned such a flurry of comments, largely from doctors, that the New York Times published a follow up article Who Will Heal The Doctors? Last I checked, there were over 800 comments between the two articles and Rachel is reading every single one of those comments. The conversation happening in the comments section is even more fascinating than the articles. The reporter ends the article with this:
Could physicians come together to overthrow the current order — to start a movement to, say, Occupy Medicine? If they did, what would be the unifying cry? Down with health insurers? Tort reform or bust? Or would it begin by expressing the thing that is most precious to them that has been lost: the opportunity to practice medicine in a way that is worthy of their dedication and love. Reclaiming a sense of meaning in medicine could be the first step to rescuing the profession.
Rachel and I have been watching this unfolding conversation with more than a little awe. Rachel and I are planning to lead a teleclass together in January, so we’ve been noodling all of this and brainstorming what we, as a profession, can do to reclaim medicine.
Here are some of my thoughts in the wake of these conversations.
The Lineage of Medicine
The current medical system requires most doctors to sell their souls to some degree. Doctors were called to the lineage of healing that is as old as our species, much as priests are called to the priesthood. They endure a decade's worth of traumatic medical education that leaves them with PTSD. Then they enter a system that asks them to violate their ethics. It goes against our very ethics to be expected to see 40 patients per day. It goes against our ethics to have to spend so much time filling out paperwork or entering data into a computer that we don't have any time left to listen to the patient. It goes against our ethics to betray the sacredness of the doctor-patient relationship.
When I was still seeing patients in the system, I often went home and cried because I knew how much more I could have offered to my patients if only I had had more time with them, time to sit at the bedside and hold a hand, time to be present with their pain, time to really appreciate the honor it is to have a front row seat on life and death.
How We Learn Helplessness
I knew I wanted to practice medicine differently, but I felt helpless and hopeless and victimized by a system that had corrupted my ability to practice in alignment with my ethics. The feeling that I was selling my soul in the way I was practicing medicine got so strong that I had to finally leave medicine. I couldn't keep my integrity and practice medicine that way anymore, but leaving medicine didn't feel right either because the calling to the lineage hadn't gone away. It felt wrong to quit, but it felt even more wrong to keep selling out my soul.
I'm not alone in feeling this way. Some of the best doctors are quitting, because like me, they can't bear to have their ethics violated anymore. But we don't want the best doctors to leave medicine! We need to find a way for doctors to, once again, practice in alignment with their ethics.
I know many doctors feel this way. They are allowing the system to violate their ethics, and the pain of the betrayal is almost impossible to bear. Yet why are doctors just rolling over and letting this happen? (Read my thoughts on letting go of victimhood here).
A friend of mine called me to confide in me about how she was struggling in her marriage, and after listening to her story and meeting it with compassion instead of the judgment she feared, I confessed that my marriage wasn't going so well either. I shared with her the struggles Matt and I have been dealing with for several years now, and her response was, “I would never have guessed that in a million years. You two just seem so perfect together.”
A week later, the same friend called to tell me that she had finally opened up to a few other friends about her marital struggles, and lo and behold, every single one of them had confided in her about their own marital struggles. She said, “Lissa, why have I not known I wasn’t alone? Why have I been suffering, thinking I was the only one whose marriage was screwed up, when I’m surrounded by people I love who are going through the same thing?” We pinky promised to talk openly with people about the ways in which the “perfect” image others might have of us is complete BS.
I was talking to another friend who is also going through a rocky patch in her marriage, and she was telling me how much it pains her to drop off her kids at school and see all the happy mothers with perfect families. I told her all she’d have to do is dig one layer deep to find some way in which everyone in the school yard was suffering in at least a small way. The ruse is the lie that leaves us all thinking everyone else has it together- except us.
Show Us Your Imperfections. I Dare You.
Earlier this week, I posted this on Facebook:
I grow tired of people who are so invested in their image that they pretend to live perfect lives, which only leads others to compare themselves and judge themselves as not perfect enough by comparison. Why can't we all just admit that we're perfectly imperfect- and that our imperfections and scars make us beautiful and unique and relatable? Just in case I've pulled the wool over your eyes, I am FAR from perfect. I'm in marriage counseling. I have hairs on my chin and stretch marks on my butt. I battle my own ego. I can be bossy and demanding. I have to tame my ambition to avoid being a workaholic. So please don't put me on a pedestal, and please don't put yourself on one either, since it only distances you from those who would connect more if only they knew that you were as beautifully flawed as they are. Tell us one thing about you that keeps you off the pedestal- one perfectly imperfect way thing that makes you real!
213 of you beautiful people revealed who you really are in response to the invitation. (You can read the awesome responses and add your own here.) Reading everyone’s responses just left me feeling so connected, so understood, so accepted, in spite of my flaws and growth edges. It makes me sad to think about how much of my life I wasted feeling lonely and disconnected because I was too busy trying to project some sick, twisted image of perfection. I was so afraid people would reject me if only they knew who I really was that I presented this sanitized version of myself in order to try to please people. Of course, it backfired. Not until I finally stripped off the masks and revealed who I really am under the false image I was projecting did I actually start to attract the love and acceptance I so desperately desired.
You were abused as a child.
Your husband left you for another woman.
You were fired for no good reason when you’ve got three kids at home depending on you.
You got diagnosed with a scary illness.
You lost someone you love when that person was WAY too young.
The patriarchy violated you.
The person you love doesn’t love you back.
You were physically hurt by another person.
Because so many have been harmed at the hands of patriarchal oppressors, sex offenders, abusive family members, and abusive leaders within broken establishments, it’s easy to feel victimized by life when things don’t go our way. When bad things happen to good people with pure intentions, it’s tempting to get angry at our circumstances, angry at God, angry at the world.
But to embrace such helpless, hopeless, pessimistic views is to dismiss the notion that, as Margaret Mead said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."
The Temptation To Feel Victimized
It’s so easy to fall into victim mode. I know. I speak from personal experience. I recently wrote a new book, a spiritual self-help book dressed up as a memoir, called The Anatomy Of A Calling. Because it includes my personal story, I went back to the unpublished memoir I had written six years ago, right after leaving clinical medicine. I thought maybe I could copy and paste some of what I had written into my new book. But I was aghast to discover that I couldn’t use a single word of what I had written. The entire story had been written through the lens of someone who felt victimized- by the many losses I suffered during my “Perfect Storm,” by my abusive failed marriage, by the way our broken health care system hurt me.
Throughout the book, the way I had written my story was disempowering and helpless. I failed to take responsibility for my part in the dysfunction. And when I wrote it, I was still blind to the ways in which I was giving away my power to those who hurt me, rather than resolutely reclaiming my power.
I wound up ditching the whole thing and starting from scratch. Even still, I found myself still falling into old patterns as I tried to tell the story of what happened to me. It’s only natural to feel victimized when something bad happens, especially when you feel powerless in the face of the tragedy. But this time, I tried to view my story as though my soul intentionally chose every single painful thing that happened to me as a way to teach me lessons I’m here on this earth to learn, as a way to make me a better person, capable of transcending the bad things that have happened in the past.
The Third Story
In Barnet Bain’s The Third Story, he describes three ways to respond to what happens to us. In the first story, we live through the woundings and tragedies that leave us in tatters, falling into the “poor me” victim story. The second story is the hero’s journey, wherein we seek to put ourselves together again after we’ve been wounded, valiantly overcoming our challenges and obstacles.
Many stop at the hero’s journey. The hero gets the call to adventure. The hero goes on a journey. The hero finds the holy grail. The hero brings the grail back home and enjoys a hero’s welcome. End of story, right?
Or maybe not. Some are willing to transcend the victim story, move beyond the hero’s journey, and step fully into the third story. The third story is a response to a call from deep within the self. It is an extraordinary state that inspires us to live our own dreams and to intimately know our real purpose and meaning. It’s the post-heroic story, full of paradox and uncertainty and no guarantee of happy endings. But it is real and rich and full of meaning and accountability and the desire to be of service, without attachment to agenda or ego or pleasing others.
As you walk a spiritual path, do you ever struggle in relationships with those who are not in the same place in their personal/spiritual evolution as you might be? In his online program Integral Enlightenment, spiritual teacher Craig Hamilton breaks relationships into three categories:
1) Those who have no interest in your personal/spiritual evolution or their own
2) Those who are curious and interested in personal/spiritual evolution, but who aren’t as committed as you to the spiritual path
3) Those who are totally committed to doing their own work and growing with you in an active partnership (what he calls “evolutionary relationships")
So what is an “evolutionary relationship?” Craig teaches that an evolutionary relationship need not be about romance or sex at all. In fact, that dimension can often complicate things. He says many of us have sense that there’s a potential for an extraordinary type of human relationship, marked by an unprecedented level of intimacy, vulnerability, authenticity, and transparency, essentially being with each other without any boundaries or barriers, being together truly beyond ego. Many have sensed the potential to be in a relationship that’s always moving, not getting stuck in old patterns, but always vital, dynamic, and thriving, resisting the urge to rest on familiar, known ground.
You may have tasted this kind of dynamic in a relationship, but it’s challenging to stay on this edge, to keep moving forward without sliding into destructive patterns, which might leave you thinking this kind of relationship isn’t possible. Very few relationships will ever evolve to the third level. How will you know the people willing to go there with you? And what would a relationship like this be like?
Craig teaches us how to be proactive about cultivating such relationships. To do this requires essentially establishing a sacred contract, setting up what he calls “an evolutionary partnership", which can be governed by the following radical principles.
Principles of an Evolutionary Partnership
1. The very context and organizing principle of the relationship is conscious evolution beyond ego.
This is the very purpose of why we’re in the relationship. Instead of organizing around comfort, survival, mutual benefit, comfort, and connection, in this kind of relationship, we explicitly commit to coming together for a higher purpose. That’s the “why” of the whole thing. We have a shared agreement for why we’re here. Instead of colluding together to protect and preserve the status quo of the relationship, we’re willing to put the relationship at risk, to constantly challenge the relationship, as a way to evolve spiritually together, as a way to avoid falling into stuck, habitual patterns that lead the relationship to go to sleep.
2. We agree to be mutually accountable to something higher than ourselves.