Skillful Action

Action is at the core of what we do in medicine. But how can we take the most skillful action to alleviate our own and others suffering? One helpful way is to understand the difference between reaction and response. Reactions are quick, reflexive decisions. Whereas, response allows for a bit of time and thought being put into the action. This difference is an important key to taking action and practicing compassion.

In the hospital we rely on having a set of labs and findings that elicit a certain set of actions. This typically occurs in a set of patterns - a patient who presents with cough and fever, gets a specific work-up and when they are diagnosed with pneumonia a treatment plan is started based on a variation of an algorithm. This standard approach to treatment saves lives. It is essential. Yet, if we only react to the data and not respond to the situation we may miss an opportunity for compassion.

A skillful action requires leaning into a deeper understanding and recognition of suffering. The common definition of suffering is feeling or enduring pain, illness or injury. As a physician our territory  is to understand what causes pain, illness and injury - in fact, we can often describe it at a cellular or organ level. To recognize our patient's suffering at this level is an amazing ability. This is the basis of healing.  Yet, there is also the possibility of a deeper understanding of suffering  - that suffering can come in existential forms, or struggling against current circumstances. Recognizing and addressing this type of suffering is hard in medicine for many reasons. Yet, the ability to take action and try to alleviate suffering comes with benefits for both the patient and the person practicing compassion.

Remember, that whether we choose to see it or not, suffering is present. When we can turn towards it, address it, we can alleviate it. It does not mean that we have to take on the burden of all the suffering we encounter.  I admit - when I first started exploring this concept of applying compassion in medicine I was overwhelmed. The suffering we have proximity to in medicine is immense. Yet, because we so often don't talk about it or explore the root cause of suffering, any small amount of action can make a difference. This can happen at many levels - from finding a moment to explore how a patient is navigating their illness, to reflectively listening while taking a history, to a comforting gesture when someone is in distress, to providing words of comfort for a difficult moment. It can also happen with larger gestures and those in between. Taking action builds the capacity for more action and the practice of compassion deepens over time.

In summary, action is essential to what we do in medicine.

  1. Action requires getting to the root of the cause of suffering

  2. Taking action does not mean we take on all of the burdens of our patients - we recognize and use the skills we have to alleviate the portion we can.

  3. Compassion is a practice, that takes time and repetition to grow and develop.

  • It is very easy to get caught up in reacting to data. Often our days require it. When time and space allow, explore the difference between “reacting” and “responding”.

    Envision this scenario to start to see the difference:

    • The lab pages with a critical lab value.

    • You experience a sinking feeling in your stomach. You call back.

    • The critical lab value is a potassium of 6.5 in a patient with end-stage renal disease who is due for hemodialysis in the next hour.

      • Reaction: “Ugh, thanks, we have the patient scheduled for dialysis.”

      • Response: Take a breath. Let whatever emotion you are experiencing pass. Then decide how you can skillfully respond. It might still be a call back, and quick follow-up with nephrology team but it gives you a bit of space between the emotional reaction and action.

  • Having words and phrases for difficult moments before you need them is incredibly helpful.

    Words that can help alleviate suffering recognize the difficulty of the situation, and rather than focus on advice or a personal viewpoint they provide a thoughtful reflection that shows support for the person experiencing the difficulty.

    Here are a few examples to explore:

    • Offer clear and concrete observations about what you notice when someone shares their difficulties with you.

      • “This is a really difficult situation, and I can see all of the thought and time you have put into trying to find the best solution.”

    • You can offer empathy, gratitude, and support for the person sharing their difficulty with you.

      • “I imagine it has been really hard (or name the emotion you see them experiencing), thank you for sharing with me.”

      • “Wow, what you’re going through is really hard. I may not have any answers right now, but I want you to know that I am here to support you.”

    • Actively listen and reflect back on what you hear.

      • “I want to make sure I understand what you’ve just shared, would it be OK if I share with you what I think I heard you say?”

  • Explore Dr. Kristin Neffs work on Fierce Self-Compassion. She talks about the two forces within self-compassion - one that is nurturing and the other that is fierce. She argues when we empower ourselves with protection, resources and motivation, that we can find a new source of energy to alleviate our own and others suffering.