Non-Judgmental Awareness

As physicians, we process vast amounts of information every day. We often combine all these pieces into a cohesive history of the patient's illness. We tease out details that will help us work up, treat and manage physical conditions. Managing these pieces of information and stories is essential clinical work.

There is also the reality that these histories are full of suffering. The etymological origins of the word patient go back to the Latin verb, pati, which means suffering. So, the term patient means "one who suffers." A quintessential part of our work is to gather a history of physiological suffering – pain, physical manifestations of illness, and other symptoms. But history gathering also often gives us a glimpse into the suffering of the human experience. The burdens and pains that patients bear because of illness or life circumstances.

The suffering of the human experience is both a universal and profoundly individual experience. This means every single person on this planet suffers, but we each experience it individually. The histories that patients provide are full of examples of this - a broad spectrum of manifestations of illness. They are also full of a broad range of personal suffering – the inability to get needed medications due to cost, the loneliness or neglect that happens in old age, difficult life circumstances impacting health – the tiny but difficult moments that make up the human experience.

A typical reaction to this type of suffering is to look away from it. This seems reasonable when we have not been given the skills to alleviate or bear this type of exposure to human suffering as a profession. Another way to react to proximity to this type of suffering is to be overwhelmed or consumed by it – paralyzed by its weight. I know I've experienced both reactions, often on the same day. In some ways, this paradox has been present since the early days of medicine - how do we alleviate suffering in patients and honor the impact it takes on us as we practice medicine?

A possible first step is that we embrace awareness and recognize that proximity to suffering is a part of our work. Non-judgmental awareness can be used to identify our patient's suffering and our suffering when we grapple with the complexities of practicing modern medicine. Because the reality is that suffering will be present whether we choose to recognize it. When we bring gentle and curious awareness to difficult moments, we can meet suffering with kindness and compassion.

So this is where the often maligned word "mindfulness" comes in. Mindfulness and meditation are important ways to increase the skill of non-judgmental awareness. I confess that I struggled with mindfulness and meditation for many years. I felt like a failure because my brain constantly ran off into tangents, so I tried many different programs to ensure I wasn't missing something. Then I realized the practice is not the moments of calm (as lovely as they can be), but the practice is returning again and again to attention. Slowly with time, this increased my ability to redirect my mind and provided me just a bit of space in how my brain processed information.

How does this help us practice compassion as physicians? Remember that compassion is rooted in recognizing suffering and being compelled to take action to alleviate it.

  • Through the process of recognition of suffering, we can find more opportunities for compassion

  • Recognition of suffering may at first seem paradoxical. It's A LOT. But recognize it is there whether or not we choose to see it. And, through recognizing it, we can gain some control over how we respond to it.

  • In particular, we can find opportunities for self-compassion, moments when we can recognize our own suffering and be kind to ourselves in those moments rather than beating ourselves up.

Ultimately, bringing awareness into our clinical day means we can start to tease out important signals. And, this awareness allows us to tap into a well of compassion. For our patients and ourselves.

  • Consider a way to practice meditation or mindfulness daily. Apps can offer a great introduction and many include daily reminders to engage with the practice. Check out: Calm, Headspace, Insight Timer, Ten Percent Happier, Simple Habit or Waking Up as a place to start.

  • Ask yourself how you can bring a moment of awareness into your clinical day or into an encounter. For example:

    • A formal meditation at the start of the clinical day

    • A deep breath and moment of reflection before a patient encounter

    • A phrase that helps you bring awareness before an encounter or answering a page, such as: “May I be of help. May I meet this moment with compassion.”

    Explore and adapt an option that works for you.

  • You may have a very common condition that you see as a physician. In those situations, being curious and bringing non-judgmental awareness to the patient's experience may help you see things in a new light and with a more compassionate perspective.

    • Before the encounter, recall the name and medical condition of your patient.

    • Welcome a curious mindset - what about their condition is unique to them? What is their experience of the condition? How does that differ from what you commonly see? Is there something about their circumstances that makes the experience more bearable or less bearable?

    • During an encounter, explore some of those questions.

    • As you start to get into clinical reasoning, think about how your medical knowledge may be able to address the patient's unique experience. Sometimes the recognition of the experience is enough or minor adjustments to plan to make it fit the patient's may be able to make a profound impact.

  • Self-compassion is applying the lens of compassion towards our own suffering. As physicians, this is a hard habit to develop, but developing a kind inner voice can helps us harness our strengths and manage the great difficulties we may face. One of the difficult things we may face is not having enough time in the day to do all of the things that we feel we need to accomplish.

    It takes practice and time to develop a kind inner voice to counter our constant critic. Below is an example of a self-compassion exercise that helps you develop this skill.

    Self Compassion to Not Having Enough Time (Adapted from Kristen Neff, PhD)

    • Recall a recent time when you wished you had more time and focus to be aware of what was going on inside you and around you.

    • Write out the details - thoughts, feelings, the barriers you were up against, etc. Don't hold back, this is only for you!

    • Now, recognize the struggle and difficulty you faced in that moment.

    • Recognize this is part of the experience of life and practicing medicine.

    • After you've reflected you can ask yourself, what do I need to hear right now to express kindness to myself? Imagine what you may tell a friend.

      • Some example statements:

        • May I give myself the compassion that I need

        • May I learn to accept myself as I am

        • May I forgive myself

        • May I be strong

    • Feel free to tell yourself what you need to hear! Be kind, be constructive. Remember that great growth can come from nurturing.