Creating a Culture of Humanism: Reconnecting Soul and Role PJP

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Creating a Culture of HumanismReconnecting Soul
and Role (PJP)

• David C. Leach, M.D.
• Former Executive Director
• ACGME
• September 25, 2008

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• Originality does not consist in saying what
• no one has ever said before, but in saying
• exactly what you think yourself.
• James Stephens, Poet

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Two Kinds of Intelligence

• Rumi

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Two Kinds of Intelligence

• There are two kinds of intelligence
• One acquired, as a child in school memorizes
  facts and concepts from books and from what the
  teacher says, collecting information from the
  traditional sciences.

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Two Kinds of Intelligence

• With such intelligence you rise in the world.
• You get ranked ahead or behind others in regard
  to your competence in retaining information.
• You stroll with this intelligence in and out of
  fields of knowledge getting always more marks on
  your preserving tablets.

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Two Kinds of Intelligence

• There is another kind of tablet, one already
  completed and preserved inside you.
• A spring overflowing its springbox.
• A freshness in the center of the chest.

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Two Kinds of Intelligence

• This other intelligence does not turn yellow or
  stagnate. Its fluid, and doesnt move from
  outside to inside through the conduits of
  plumbing-learning.
• This second knowing is a fountainhead
• From within you moving out.
• Rumi

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Perhaps you know this man.
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After the graduation ceremony I felt a deep
empty sadness, tears came to my eyes as I
realized that from now on whenever I would hear
the word heart Id think first of a pump and
last of a valentine. Dan Duffy
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Years later I realized that at graduation I
had lost my soul. Instead of a soul I had
plaques. Dan Duffy
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How Does It Happen?

• Unintended consequence of higher education
• False beliefs
• Language
• Pseudo Quality and Insurance incentives
• False communities

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How Does It Happen?

• It begins in school

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How Does It Happen?Four False Beliefs (Dan Duffy)

• Everything is knowable and controllable through
  scientific knowledge
• Self-sufficiency, competition, and hard work can
  accomplish anything
• Self-examination, seeking counsel, and admitting
  mistakes are signs of weakness
• Feelings and emotions have no place in the
  scientific profession of medicine.

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How Does It Happen?

• How did you learn that healthcare is not really
  about caring for patients? (PBB to senior
  student)
• Easy its in the language. (student to PBB)

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Some Examples

• This is (or is not) a good teaching case.
• Thats the way we do things around here.
• Thats not why theyre here.
• We dont have time to go into that.

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Measurement

• How many shrimp cocktails this week?

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Brenda Zimmerman

• Simple - Recipe
• Complicated Rocket to Moon
• Complex Raising a Child

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I-in-Me
I-in-It
I-in-You
I-in-Now
After Scharmer
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Self
I-in-Me
Downloading
Habitual
Voice of Judgment
I-in-It
Seeing
Rational
Voice of Cynicism
I-in-You
Sensing
Relational
Voice of Fear
Authentic
I-in-Now
Presencing
After Scharmer
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Time
Self
Downloading
I-in-Me
Habitual
Disembodied
Voice of Judgment
I-in-It
Seeing
Chronos
Rational
Voice of Cynicism
Sensing
Slowing Down
I-in-You
Relational
Voice of Fear
Kairos Stillness Presencing
Authentic
Presencing
I-in-Now
After Scharmer
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Org. Action
From within org. boundaries
(Re-enacting patterns from past)
From periphery of boundaries
(Facing exterior data)
From beyond org. boundaries
(Sensing through social mental fields)
Across open boundaries
(Connecting to source)
After Scharmer
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Self
System
I-in-Me
Downloading
Habitual
Autistic
Voice of Judgment
I-in-It
Seeing
Rational
Adaptive
Voice of Cynicism
Relational
Reflective
I-in-You
Sensing
Voice of Fear
Presencing
Authentic
Generative
I-in-Now
After Scharmer
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Theory U Otto Scharmer http//www.ottoscharmer
.com/programs/
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Five Things That Might Help

• Invite the inner teacher to show up.
• Attention to small group formation
• Broaden, reframe, and align the work with human
  nature
• Acknowledge suffering in ways that are human
• Socialize to master rather than to cope

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A Poem for Residents (and all of us)
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The Guest House This being human is a guest
house. Every morning a new arrival. A joy, a
depression, a meanness, some momentary awareness
comes as an unexpected visitor. Welcome and
entertain them all! Even if theyre a crowd of
sorrows, who violently sweep your house empty of
all its furniture, still, treat each guest
honorably.
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The Guest House (cont.) He may be clearing you
out for some new delight. The dark thought, the
shame, the malice, meet them at the door
laughing, and invite them in, Be grateful for
whoever comes, Because each has been sent As a
guide from beyond. Rumi
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Becoming Fully HumanWorking with Human Nature

• Intellect Object is Truth
• Will Object is Goodness
• Imagination Object is Beauty

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Reframing and Realigning the Work

• How good a job did I do discerning and telling
  the truth?
• Did I put what is good for the patient first?
• Was I creative in my clinical judgments did I
  harmonize generalizable knowledge and
  context-specific knowledge in ways that are
  beautiful?

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Suffering is at the heart of our work. How do we
create a culture of humanism within the context
of suffering?
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How is the Soul Found and Restored?

• Suffering is the touchstone of spiritual growth
• Dan Duffy

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Kindness Relationships in Suffering When
Sympathy is not enough

• Anticipation of suffering
• Suffering
• Humility
• Endurance
• Death

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We are our institutions

• Socialize to Master not to Cope.

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We are our Institutions

• Community is the antidote to institutional
  toxicity.

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The Journey One day you finally knew what you
had to do, and began, though the voices around
you kept shouting their bad advice- though the
whole house began to tumble and you felt the old
tug at your ankles. Mend my life! each voice
cried. but you didnt stop. You knew what you had
to do.
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The Journey (cont.) little by little, As you
left their voices behind, The stars began to
burn Through sheets of clouds, And there was a
new voice Which you slowly Recognized as your
own, That kept you company As you strode deeper
and deeper Into the world, Determined to do The
only thing you could do- Determined to save The
only life you could save. Mary Oliver