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The power of connection shines a light on the hidden culture of medicine

Dr. Angela Cooper's story on Safe Spaces
Dr. Angela Cooper
Assistant Dean, Faculty Wellness Faculty of Medicine, Dalhousie University Assistant Professor Department of Family Medicine Department of Psychiatry

Recently, I gave a presentation called ‘Why Wellness Interventions Don’t Work’, to explore how the culture of medicine creates barriers to wellness.  As a follow up, we gathered a group of 30+ physicians in a virtual workshop to reflect on the culture of medicine and their internalized expectations.

First, we began by recognizing how the ideals of medicine e.g., ‘Doctors don’t make mistakes’, ‘Doctors don’t complain’, ‘Doctors work until the work is done’ become internalized through medical training. These ideals become one’s identity e.g. ‘I don’t make mistakes’, ‘I don’t complain’, ‘I work until the work is done’. As physicians discussed their work environments, they gave many examples of failing to live up to such standards, resulting in feelings of shame and inadequacy. While the values in medicine of working hard and aiming for perfection are not ‘bad’, they are idealistic. Like the Northern star, principles are meant to guide us. However, when the ideal becomes internalized e.g. ‘I am the Northern Star’, we are set up to fail.  When we fail to reach the impossible, we say ‘It was my fault’, and this is how the culture becomes embedded within us.

Next in the workshop, we considered the cost of pursuing unrealistic standards. This is where people started to experience their emotions. Some felt sad about the lack of energy left for their family, some felt angry about the sacrifices they have made, and some admitted for the first time, the weight of their exhaustion. There were sighs of relief as stories came up for collective processing. There was a dawning of awareness that perhaps it didn’t need to be like this, that perhaps the cost of giving everything is too much, perhaps new ways need to be found.  The more each person shared, the more others stepped up to support them. Contrary to our fears, emotions do not mean weakness. Emotions are ‘energy in motion’, they create the momentum for change. Emotions don’t lie, but impossible ideals stop us from listening to them.

“Contrary to our fears, emotions do not mean weakness. ”

Next, I asked the group ‘when you see yourself as having done your very best today, what do you notice?; ‘can you see all the goodness you have offered’? Sadness and exhaustion started to shift into lighter feelings. One person said ‘pride’ the next said ‘I did a good job today’, another said ‘it feels easier to breathe when I think of the good I did’, one more said, ‘we need more positive affirmations of what we DO do’. As people realized they are human and imperfect, they recognized the same is true of the systems they operate within. Like a light switch flipped on, self-generated solutions started to arise! Ideas on how to set boundaries, prioritize self-care, and the holding of complexity started to emerge.  Even in this virtual space, genuine warmth and connection could be felt and tears were shed as people let in some of this warmth.

As the session closed, there was gratitude and thanks for the realness and connection offered.  Somehow, through the process of acknowledging reality, participants began to see that change is possible and can start from within. They realized that emotions aren’t the enemy and connection with others is what has been missing. There were final calls to find a way to ritualize this kind of sharing and a longing to honor those who have served in medicine when it comes their time to retire.

The level of vulnerability shown was unexpected and yet deeply restorative. My sense is that, when we create a psychologically safe environment, magic can happen, stories can be told and emotions can flow. When we shine a light in the dark, we recognize our collective pain AND strengths. The power of seeing the good in ourselves and each other restores humanity to the culture of medicine, where it belongs.

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