Have you ever beaten yourself up over making a small mistake?
Have you ever called yourself stupid, incompetent, or a failure?
Have you ever pushed yourself harder than you would expect of a coworker or a friend?
That was me throughout my training and early years as an attending. It's still me occasionally, depending on how well I am taking care of myself. It's taken me a long time to buy into the concept of self-care. Not only does society expect healthcare professionals to be perfect, but we also have that expectation within the culture of medicine. "Patients come first" has always been the motto and it has been taken to an extreme at the expense of the caregivers. I also believed that it was the system that was the problem and fixing the system would make everything better.
Now I realize that there is a collective responsibility of individuals and the systems and organizations we exist in.
We have a responsibility to show up to the best of our capabilities, which involves taking care of ourselves, but there's only so much we can give before our resources are depleted. We like to believe that we can go on giving and giving and giving. However, we are not endless wells of energy and compassion. And don’t get me wrong—I still completely believe that we need to change the system and culture of medicine, but we also have a part in making that happen. As president of the Association of Academic Surgery, Dr Carrie Cunningham says, “Self-care is a professional responsibility.”
Self-compassion is the hardest element of self-care for me. It requires me to be kind to myself. I've been so good at beating myself up for so long that the idea of taking a step back and being gentle and accepting myself is very foreign. It's also not the message that we've received in healthcare. Instead, we're told to suck it up or just deal with it.
It turns out self-compassion is really effective and is associated with decreased depression, anxiety, stress and burnout. Self-compassion is also associated with increased healthy behaviors, like increased physical activity, healthy diet, seeking needed medical care, and improved sleep and resiliency. That’s because when we are kind, can accept our feelings for what they are, and feel connected to humanity, we are able to learn from the experiences and move forward. (2)
According to Kristin Neff, a psychologist who has devoted her research to self-compassion, there are three elements of self-compassion:
Self-kindness vs. Self judgement: How do we treat ourselves when we are suffering? Do we speak to ourselves with kindness and support? Or do we speak to ourselves with criticism and judgement?
Common humanity vs. Isolation: How do we perceive our suffering? Is it something that others experience and connects us to all other human beings? Or does it isolate us and make us feel alone?
Mindfulness vs. Over-Identification: How do we recognize and respond to our feelings? Can we see what is happening and acknowledge our feelings without judgement? Or do we latch on to the feelings and let them take over?
I participated in a mindful self-compassion training course for healthcare professionals (4) and learned how the elements of self-kindness, non-judgement and connection increased my ability to learn from my experiences and progress in all aspects of my life. Instead of battling the negative emotions that I imposed on myself, I can accept what is occurring and grow and be a role model for others to do the same thing. When I have more compassion for myself, I have more capacity to show compassion to others. When students and residents rotated with me in clinic, they remarked on how much my patients liked me as their physician. I told them that my “secret sauce” with patients was simple: Be nice and treat them with kindness and respect. Is that too much to ask? And is that too much to ask for myself?
I am a human being worthy of kindness, love and belonging… And so are you.
Resources
AAS 2023 Presidential Address https://www.aasurg.org/
Neff KD. Self-Compassion: Theory, Method, Research, and Intervention. Annu Rev Psychol. 2023 Jan 18;74:193-218. doi: 10.1146/annurev-psych-032420-031047. Epub 2022 Aug 12. PMID: 35961039.
Kristin Neff Selfcompassion.org
Center for Mindful Self Compassion https://centerformsc.org/