Compassionate Healthcare - Wisdom and Compassion in Medicine
Wisdom and Compassion as Buddhist Concepts
The dual cultivation of wisdom and compassion is a central theme is Buddhist teachings. In order to discuss the application of these concepts in the world of healthcare, I must say something about them in general. Wisdom and compassion are not separate. They feed and support one another. True wisdom in action becomes compassion, and compassion must be steeped in wisdom if it is to be of benefit to others. We can have all of the knowledge or wisdom in the world, but if we do not understand how to apply it for the betterment of others, how can it be of any use? At the same time, we can think that we are as compassionate as can be, but if in trying to help others we cause only harm because our lack of wisdom, then how much good is our compassion really doing?
Wisdom means seeing the true nature of something; compassion means acting in a way that benefits others, which implies knowing how to do so. This does not mean that we have to be perfect or have every answer in order to be of benefit to others. It does, in my opinion, mean that compassion should drive us to search out the answers to how we may be of benefit. When faced with a puzzle, compassion is the motivating force that causes us to seek the solution. This process, in turn, is one aspect of the cultivation of wisdom.
Compassion is, by its very nature, active. It is an impetus. If the impetus or intention does not result in an action, then we have ceased, in that moment, to be compassionate. It cannot be just a fleeting thought or feeling. It is the actual doing of something for the benefit of one or many sentient beings, even if that is a simple meditation practice or prayer.
With this in mind, we can see in a very practical way that these two do indeed require dual cultivation. Cultivation is the key. We do not all of a sudden just become wise or compassionate. We must orient ourselves in their direction and then put one foot in front of the other on that path. There are many routes to developing these two, and all of them require a kind of curiosity or inquisitiveness of mind. I view this inquisitiveness as being the link between wisdom and compassion.
Wisdom and Compassion - Dual Cultivation Required
Imagine a doctor who had only ever performed lower leg amputations and knew nothing of other modes of treatment. If a person came to him or her with a sore throat or a psychological problem and out of a deep desire to help them, and thinking that leg amputations were the only existing method of treatment for an illness, he or she amputated that person’s leg. Regardless of how much he truly wanted to help that person, we could hardly say his act was compassionate. Now, if in seeing his error, his compassion brought about curiosity that motivated him to seek out a more effective method of treatment, then that would be a different story entirely. This may seem like splitting hairs, but it is this kind of continuous development and unwavering dedication that allows us to be of more and more benefit or, to view it from the other side, to do less and less harm. A single attempt is simply not enough.
Our ability to provide compassionate care begins long before any particular patient walks into one of our offices. Because compassionate care at its purest involves doing what is best for the patient and their illness on the day they come to see us, we can only achieve this/offer this if we are constantly cultivating ourselves, studying, deepening our understanding, and honing our skills.
Authenticity
Self-cultivation, in my mind, ties directly into the idea of authenticity. I think about authenticity as operating from a base of experiential understanding that is created by a combination of the things I just mentioned: disciplined study, experiences in a relevant environment, exploring on one’s own, extracting meaning from all of this, and then testing that out in the real world. If we are dedicated to developing our clinical skills and continuously strive to come from a place of authenticity or experiential understanding, then we will succeed in providing compassionate care.
To be authentic, in my opinion, means to be honest with ourselves about who we are and where we are coming from. It means to operate with those things that we understand experientially as the basis for our actions. It is only through this type of honesty and by operating from this base that we can bring ourselves fully to the world and continue to grow as a result. This may be different than what some view as authenticity, but it rings true for me. I recall a scene in one of the Ip Man movies in which a young Ip Man spars with an old master, after which he says, “Hey, that’s not authentic Wing Chun!” The old man replies, “Whatever comes from my fist is Wing Chun!” What he was saying was that he was operating from that place of experiential understanding, so everything he did was a true expression of himself and his embodied understanding of the art. This is my view on authenticity. To hide from oneself or to be unclear about one’s foundation of experience and the meaning derived from it can only lead to confusion and uncertainty. I do not believe it is possible to act authentically if this is one’s mental state.
Pressure as a Positive Force
Often, pressure acts as a necessary mirror to show us how strong or shaky our foundation is, therefore improving our ability to be authentic. In taiji, push hands is a good example. When practicing the form, we may feel that we have developed a solid root and a degree of sensitivity, but we can only truly test this when making contact with another person. It is this test that reveals the level of our development. In the field of medicine, patients provide that pressure. The direct feedback I receive from patients regarding the improvement or lack thereof in their conditions is another example of this. It is something that is right there in front of me at all times – I cannot hide from it. If someone is not getting better, I can, of course, make excuses or come up with reasons other than my own shortcomings or misunderstanding of the situation for why that may be, but that is a slippery slope.
Change Is Constant
The Yi Jing, also known as the Book of Changes, is the text that serves as the theoretical foundation for the entirety of classical Chinese philosophy. As I heard one of my teachers, Andrew Nugent-Head, say many times, it can be summed up as follows: Everything changes, everything causes change, and everything is the result of change. When we think deeply about this, it becomes clear that how we orient our minds at a given moment shapes our subsequent thoughts (and, therefore, actions). If we fall into a pattern of thinking in a certain way, we create momentum, so to speak, that encourages us to think and behave in that way. The further we go down any one path, the more engrained our habits of thinking/behaving in that manner become.
Each moment consists of changes that are producing a cascade of more changes. We may not notice the effect of each decision itself, but when we look back after a period of time, we can see the accumulated effect. Little by little, the dust alights. This is why I say that the aforementioned way of thinking about patient outcomes is a slippery slope. It is not a mental rut in which I want to be caught. In the Chinese/Taoist way of thinking, when considering something, it is important to also consider its opposite. So, if I say that it is a slippery slope to regard ones clinical failures as being outside of one’s control, then I must also recognize that if I do not understand the mechanisms of my clinical successes and how to repeat them reliably, I am also equally in the dark.
Staying Present - Treating the Person in Front of You
If we lose sight of the patient at the moment of treatment and become lost in the theoretical, then we will not be able to give compassionate care. I had a classmate in school that was treating an elderly woman – I was observing his treatment at the time – she was very distraught about a number of things that had occurred in her life recently. It was obvious that she needed a human connection more than anything, someone to recognize her suffering and tell her that it would be okay and that they could help. He was a very intellectual type of person and not very good at making connections with patients. As the two of them interacted, the woman became more and more irritable. Even after he finished the treatment, she was not noticeably better. He went back into the clinic conference room afterward and racked his brain to figure out what was wrong with his treatment. He simply could not see that even though the theoretical aspect of his diagnosis and treatment were valid, he had lost sight of the patient and was not actually present. He was not treating her as much as he was treating the theory of her.
Softeness
I would like to finish by saying a bit about the concept of softness. We are told in the practice of taiji that a key concept is that of softness overcoming hardness. This is not just pretty poetry. We can analyze this from the viewpoint of the martial arts, medicine, or even everyday interactions. In terms of the martial arts, this principle is a recognition that if fighting strength with strength, hardness with hardness, the stronger person is bound to win. There is always someone stronger, so we are setting ourselves up for failure. If, on the other hand, I can be so soft when someone attacks that there is no place for their blows to land, and so sensitive that I can use their own force against them, then I can overcome much greater strength with greater softness and skill.
In medicine, softness is the foundation of physical and psychological health—healthy tissue is supple and pliable, not rigid. Tissues that become hardened have poor circulation, and illness develops in those areas. The same principle applies to mental softness and flexibility versus rigidity. When with a patient, softness is what opens us up to being present, which is fundamental to providing compassionate care. It also allows us to be clear about our experiences and the information we gather from those experiences, which is key to the development of wisdom. If we allow ourselves to become hardened, or if we operate from a place of fear, pride, or insecurity, it is much more difficult to give the type of care we are talking about now. Of course, we all struggle with or experience fear, pride, insecurity, etc, but we must strive to keep them out of the clinic as much as possible.
Finally, when relating to other people, if we take too strong of a stance or are overbearing in our demeanor, we are bound to meet with opposition; however, if we soften ourselves and can come from a place of calm compassion, then there is nothing for them to resist. They will follow our example and soften as well. This idea of softness is also, in my opinion, one of the most important ways we can judge if our personal practice is truly beneficial. My most important indicator of how I am doing in general, as well as with my practice, is how soft I am with myself, my loved ones, and with the world around me. If I am open and soft, I know that I am actually more resilient and can be of more use to others. If I am rigid, I know that I will suffer and cause harm to others. While I certainly do not always succeed, this is my guiding principle.