Page numbers in italics refer to figures.
acceptance, combining with defiance, 55–57
accountability for actions, 78–79
adolescence, prolonged, 26
adverse childhood events, 78
against medical advice (AMA), patients leaving, 98–99
ambivalence about entering profession, experience of, 1, 2
appreciation, expecting from patients, 117–19
“arm’s length” care, 87, 87–89. See also detached professionalism
Association of American Medical Colleges, 110
assumptions about people, making, 69–71, 74–81, 114, 125–26
attending physicians: experience as, 9–10, 74
medical students and, 119–20
Auster, Simon: caring example of, 113–14
conversations with, 18
on disrespect, 30
engagement example of, 40–41, 92
as fully actualized physician, 177–78
graciousness of, 32
on judgmentalism, 79–80
maxims from, 55
on medical decision making, 138
open door policy of, 26–27
at Uniformed Services University of the Health Sciences, 58
basic goodness, belief and trust in, 179–80
behavior: attributing to character traits, 77, 135–36
boundary clarity and, 46
caring as, 112–15
disrespectful, 65
judgmental, 74–75
organizing principles as reflected in, 172–73
perfectionist and obsessive, tendency toward, 19–20, 28
Bhalla, Naina, 143–46
boundary clarity, interpersonal: advice related to, 7
appreciation of human experience and, 13
caring and, 121–23
with “difficult” patients, 89–90
disregarding patient preferences and, 137–38
of healers, 178–82
in infancy, 22
maintenance of, 36–37
opioid prescribing and, 99–101
in personal sphere, 94–96
reactions to behavior of patients and, 46
respect and, 91–92
spanking as violation of, 72. See also engagement with others
boundary violations, professional, 86–87, 90–91, 91
Buber, Martin, 23
burnout: factors leading to, 85, 102, 117–19, 171
research on, 143
self-care and, 180
career aspirations, 57
caring: as actions or gestures, 112–15
boundary clarity and, 121–23
in clinical settings, 123–27
contextualizing, 11–12, 37–38, 136–39
curiosity and, 65
empathy compared to, 111–12, 113–14
learning about, in medical schools, 53
link between engagement and, 115–21
catheters, inserting in necks, 56
character traits: of patients, attributing behavior to, 77, 135–36
of physicians, and discontent with job, 163
chasing diagnoses, 129–30
chelation therapy, 46
children: dealing with abuse of, 78–80
intervening to protect, 79
chronic conditions, caring for patients with, 28–29
clinical state, in medical decision making, 129, 132, 135
communication with patients: classes teaching, 38–39
about end-of-life care, 106–7
healers as establishing, 169
models of, in medical schools, 32–33. See also engagement with others; healing interactions
communities, tackling problems of, 150–52
compartmentalization of life, 54
compassion, definition of, 110
competence and confidence, 168
conflict, interpersonal, dealing with, 64
conformity: drawbacks of, 61
pressure for, 24–25
connection with others. See engagement with others
constant comparison, 127
context: in medical decision making, 131–32, 133–37, 138–39
contextual errors, 10–11, 158–59
contextual factors, 136–37
contextualizing care, 11–12, 37–38, 136–39
contextual red flags, 134–35, 136
Conway, LaMenta, 150–53
coping mechanisms, of medical students, 170
crying, dealing with, 106
cultural competence, 126
culture of medical schools and residency, 54, 57, 67
curiosity: definition of, 69
education and, 62
of medical students, 119–20
patient context in medical decision making and, 136
about patients, 9–12, 47–48, 69–70
decision making, medical: context and preferences in, 133–39
types of information to consider in, 129–33, 133
depersonalization and burnout, 117–19
detached professionalism: engaged interaction compared to, 84–89, 86, 87
example of, 40
fear of engagement and, 72
reasons for, 105–6
of technicians, 70–71
diagnoses, chasing, 129–30
“difficult,” labeling patients as, 41–47, 89–90
discontent with job: analysis of, 163–64, 165
engagement and, 164
leaving positions and, 166
productivity requirements and, 157–58, 164–65
discrimination in health care, 123–24
disengagement: from others, reasons for, 12–13
from patients, intentional, 90
disrespect, behaving with, 65
distractions, dealing with, 176–77
distrust and suspicion, vibe of, from patients, 97
doctor and patient: bridging divide between, 2, 8–9
negative interactions of, 169–70
stepping outside conventions of encounters between, 68–69. See also boundary clarity, interpersonal; engagement with others; patients; physicians
Doctors Without Borders (MSF), work for, 143–46
“drug seeking,” labeling patients as, 12, 42, 82, 101
duration of visits: constraints on, 157–60
contextualizing care and, 38
obtaining psychosocial information and, 48
emergency medical technician, work as, 1–2
emotional issues: of caring for elderly or persons with chronic conditions, 28–29
healing interactions and, 36
in medical school, 26–27
in personal sphere, 95–96
self-awareness of, 102
trauma, repackaging and inflicting on others, 29–33
ways of dealing with, 27–28
of young adulthood, 5. See also trust in others
emotional labor, 28
empathy, 110–12, 113–14, 121–22
end-of-life care, talking about, 106–7
engagement with others: advice related to, 6
attachment, fulfillment, and, 29
becoming healer and, 178–82
building rapport compared to, 38–41
caring and, 41–42
contextualizing care and, 11–12, 37–38
curiosity and, 22, 23–24, 47–48
detached professionalism compared to, 84–89, 86, 87
discontent with job and, 164
equality and, 31–32
importance of, in medicine, 182–83
link between caring and, 115–21
motivation for, 116
openness to, 31–32, 36, 72, 94, 103–4
patient context in medical decision making and, 135
in personal sphere, 93–97
physicians as impediments to, 36
in professional sphere, 4–5
purpose of, 78
and reasons for disengagement, 12–13
respect for boundaries and, 36–37
self-trust and, 13
setting and context of, 91–92
time constraints and, 158–60
vulnerability of, 39, 88, 106. See also boundary clarity, interpersonal
environment, belief in rising above, 77–78
equality of all people, belief in, 65–66
escapist coping mechanisms of medical students, 170
expectations: of medical school, complying with, 56
of parents, 96
of patients, 84
unrealistic, 141–43
external validation, reliance on, 60, 67
failure, being okay with, 57–61, 66–69
false positives, risk of, 130
families: relationships with, 7–8, 45–46, 64, 75–76
fear of patients, 41–42
friendship, self-care and, 181
From Detached Concern to Empathy (Halpern), 40, 111, 113
“From Empathy to Caring” (Weiner and Auster), 40–41
fundamental attribution error, 135–36
genetic potential, belief in rising above, 77–78
Greene, Alan, 23
grounded theory, 126–27
growth, as healer, 101–7, 181–82
harm to patients: from boundary violations, 86–87, 90–91, 91
from productivity requirements, 157, 164
healers: growth as, 101–7, 181–82
patients as in need of, 169
as realists, 143–53
in society, 182
technicians compared to, 139, 169–70, 173–74
healing, as organizing principle, 169–78
healing interactions: characteristics of, 3–4
engagement with boundary clarity as, 92–93
fulfillment through, 28
judgmentalism as antithetical to, 77
as mutually nourishing, 34–36
relating in the moment and, 48–49. See also engagement with others
hidden curriculum of medical schools, 51
homelessness, interactions with persons experiencing, 123–24
hubris and judgmentalism, 80–81
hypothesis testing, 127
I Am Abel Foundation, 151, 152–53
idealism and disillusionment, 141–42, 144, 155
identity as healer, 168, 169–70
“I-It” mentality, 21
illogic of judgmentalism, 77
impairment of capacity to form connections, 120–21
implicit bias, 123–24
inquisitiveness, 22–24
insecurity: conformity and, 61
in interpersonal relationships, 30
interactions outside medical context, 90. See also healing interactions
internship. See residency
interpersonal boundary clarity. See boundary clarity, interpersonal
“I-Thou” mentality, 21
judgmentalism: overcoming, 74–81, 101
patient context in medical decision making and, 135–36
Julian, Joe, 141–42
labeling patients: as “difficult,” 41–47, 89–90
as “drug seeking,” 12, 42, 82, 101
as “noncompliant,” 12, 46, 77, 97–99
learning disability, experiences of, 5, 26, 55–56, 58–60, 67
“Learning Medicine with a Learning Disability” (Weiner), 58–59
leaving positions, 166
legal meaning of rendering judgment, 76
lessons for living, 13–14
limitations, awareness of, 154–55
Listening for What Matters (Weiner and Schwartz), 11, 17–18, 133, 135–36, 164
lives of patients: asking questions about, 124–27
context of, in medical decision making, 131–39
contextual errors and, 10–11, 158–59
contextualizing care and, 11–12, 37–38, 137–39
curiosity about, 9–12, 47–48, 69–70
disinterest in, 9–10
Mead, Margaret, 155
Médecins Sans Frontières (MSF), work for, 143–46
medical schools: anatomy curricula in, 62
communications skills curricula in, 38–39
complying with expectations of, 56
conformity and, 24–25
curiosity of students in, 119–20
debt from, 161
failures of training process in, 170, 171
“hidden curriculum” of, 51
interview for, experience of, 1
models of communication in, 32–33
personal struggles in, 26–27
proposed welcome to, 52–54
struggle during early years of, 5–6
survival, self-care, and, 180
White Coat Ceremony in, 51–52. See also survive and thrive principles
medical students: attending physicians and, 119–20
coping mechanisms of, 170
sleep deprivation of, 19, 56, 57
socialization of, 7–8, 12–13, 21–25. See also residency
Mental Health First Aid, 152–53
modeling judgmental behavior, 74–75
motivation to engage, 116
MSF (Médecins Sans Frontières), work for, 143–46
narrowing differential, 127
Nepal, study of health care in, 2
“noncompliant,” labeling patients as, 12, 46, 77, 97–99
norms, professional, stepping outside of, 40–41
obesity and judgmentalism, 80, 90
objectification of patients, 20–25, 34–35
opioid prescribing, 99–101
organizing principles: competing or conflicting, 173–78
healing as, 168–72
as reflected in behavior, 172–73
of residents, 173–75
ostomy, responses to, 34–35
“other,” seeing patients as, 4–5
panic attacks, experience of, 15, 95, 104
parents, impact of, 30–31, 32, 72
patient context, in medical decision making, 131–32, 133–37, 138–39
patient continuity, 92–93
patient preference, in medical decision making, 129–31, 132, 137–39
patients: distrust vibe coming from, 97
doctors as being like, 53–54
expectations of, 84
expecting appreciation from, 117–19
fear of, 41–42
meeting for first time, 84, 102–3
objectification of, 20–25, 34–35
personal boundaries of, 86–87
seeing as “other,” 4–5
teaching communication with, 38–39
unannounced standardized, 80, 159. See also doctor and patient; harm to patients; labeling patients; lives of patients
pediatric clerkship, feedback from, 7–8
peer counseling program, 3
perfectionist and obsessive behavior, tendency toward, 19–20, 28
persona, adopting, 93–94, 170, 176
personal sphere: engagement in, 93–97
openness to engage with boundary clarity in, 171
skills in, 169–70. See also emotional issues
pharmaceutical representatives, 162
physician recruiters, 162–63
physicians: choices available to, 165–66
destination for, 26
fully actualized, 177
identity as, 171
pipeline that produces, 24–25
primary care, job security for, 160
reduced pay for reduced volume and, 162
as in seller’s market, 160–61
stresses of work of, 14
suicide of, 120
suicide of patients of, 105
trustworthy, 97–101
white coats worn by, 54. See also discontent with job; doctor and patient; healers; technicians; work environment
pragmatists, healers as, 147–48
preconceptions, challenging, 70–71
preferences of patients in medical decision making, 129–31, 132, 137–39
premeds, as peer counselors, 3
prescriptions, writing, 56, 99–101
primary care physicians, job security for, 160
procedures, supervision for, 56
productivity: income based on, 163
valuing above quality of care, 157–58, 162, 163–64
prostate cancer screening, 131–32
questions, asking, as hallmark of caring, 114–15, 123, 124–27
rage, approach to, 40–41
realists: as healers, 153–55
healers as, 143–53
refugee work, reasons for volunteering for, 141–42
relative value units (RVUs), 163
Remen, Rachel Naomi, 34–35
research evidence, in medical decision making, 129, 132
residency: application essays for, 142
experience of, 19–21, 25, 174–76
experience of supervision of, 9, 21, 30, 74, 106, 114
organizational skills for, 180–81
organizing principles of, 173–75
regulation of, 57
responses to, 55
task completion as driving force in, 20–21, 25–29
work duty hours for, 147–48
respect: boundary clarity and, 91–92
without external validation, 60
openness to engage as show of, 36–37
in work environment, 65–66
sacrifice, caring framed as, 117
saturation, 127
Schwartz, Alan, 10, 135–36, 164
self-awareness, 102
self-judgment, 80
self-knowledge, 27
self-reflection, 72
Serenity Prayer, 149
Shine, Kenneth, 166
shortcomings, facing, 179
sickle cell crises, engagement during, 41–46
socialization of medical students, 7–8, 12–13, 21–25
social workers, involvement of, 45, 134
spanking of children, 29–30, 72
state authorities, involvement of, with children, 75–76, 79
Stockholm syndrome, 56
stresses of physicians’ work, 14
struggles of patients, clues to, 114–15
substance abuse issues, and leaving against medical advice, 98–99
success: responsibility for, 81
suffering, responding to, 88, 106–8
suicidal ideation, responding to, 68
suicide: contact with physicians prior to, 105
of physicians, 120
supervision of residents, experience of, 9, 21, 30, 74, 106, 114
support in work environment, fostering, 65–66
surgery, careers in, 28
survive and thrive principles: overview of, 71–72
“stay focused, but don’t lose curiosity,” 61–65, 69–71
“strive to succeed, but don’t fear failure,” 57–61, 66–69
“take crap, but don’t pass it on,” 55–57, 65–66
sympathy, 110–11
symptoms, focusing on, not on person, 104–7
task completion: as driving force in residency, 20–21, 25–29
focus on, 105
as organizing principle, 170
teaching and engagement, 154
technical skills, as set of tools, 168–69
technicians: description of, 159
healers compared to, 139, 169–70, 173–74
medical training and, 21–25
physicians functioning as, 158
task completion and, 25–29
theological meaning of rendering judgment, 76
thinking, judgmentalism as extinguishing, 75
time constraints: contextual errors and, 158–59
engagement and, 159–60
productivity requirements and, 157–58
tool kit, medical training as, 84
trauma: in childhood, 78
repackaging and inflicting on others, 29–33
Trollope-Kumar, Karen, 117–18
trust in others: breakdowns in, 64
emotional outbursts as sign of, 45, 66
engagement with boundary clarity as leading to, 92, 97
learning, 15
patients who have lost, 47
trustworthy physicians, 97–101
unannounced standardized patients, 80, 159
Uniformed Services University of the Health Sciences, 58
“us-them” mentality, 22–23
VA (Veterans Affairs) clinic, work in, 114
visits: first time, with patients, 84, 102–3
quality of care provided during, 67–68
time constraints on, 157–60. See also duration of visits
vulnerability and engagement with others, 39, 88, 106
weaning patients off narcotics, 99–101
White Coat Ceremony in medical schools, 51–52
white coats, wearing, 54
work environment: creating positive, 66
hassle factors in, 163–64
leaving, 166
mitigating factors in evaluation of, 161–62
stresses in, 14
support in, fostering, 65–66
time constraints in, 157–61. See also discontent with job
work-life balance, 117