by Matthew Zwerling, M.D.
What thoughts come to mind, what feelings arise when you wonder about the mystery of medicine, during those times when you are unable to explain something you have witnessed, or when struck by a seemingly magical insight or response to treatment? Have you ever spent an evening with a group of physician colleagues exploring concepts such as joy, compassion, trust, anger, forgiveness, or dreams? What would it be like to sit together informally, sharing thoughts and stories that connect you with the experience of being a physician, of being human?
A group of local doctors has been meeting once a month for the past few years to explore these and other questions, and to contemplate the meaning of medicine and service through the medium of story. Known as The Gathering of Physicians, the group is modeled after the Finding Meaning in Medicine groups started by Dr. Rachel Naomi Remen, author of the best-selling books Kitchen Table Wisdom and My Grandfather’s Blessings.
“There seems to be a deep river of meaning,” writes Dr. Remen, “that runs beneath the events of our daily lives … especially the lives of physicians. Through these groups we have found a very simple way of tapping into this river, and we are witnessing profound results. Most doctors have had rich and unusual experiences, but have never had the opportunity or the encouragement to reflect upon them or discuss them with medical colleagues. There are certain experiences that only another physician can fully understand. Having the opportunity to share unreservedly with colleagues is a remarkably fulfilling experience and often allows us to heal many of our professional wounds. It certainly has inspired those who have participated and enables many to recover a greater sense of meaning and satisfaction in this work.”
Dr. Andrew Wagner and I, having benefited both personally and professionally from regular attendance at Dr. Remen’s gatherings, believed a similar model would be valuable in Sonoma County. Once a healthy, vibrant, quality enterprise, our local medical community has undergone a painful fragmentation in recent years. Bitter rivalries have developed among physicians and between physicians and hospitals. There is disturbing competition for services (and survival). New physicians are reluctant to consider practicing here, both for financial reasons and because of the pervasive sense of unhappiness among local practitioners. Joy and satisfaction are distant memories for many physicians.
Some choose rhetoric and legislative redress to fight the “saber-toothed tiger” of managed care, government regulations, and the like. Some have left our county for the presumed greener pastures of other communities or administrative work. Many hope for change, some just for survival. And some are choosing to reexamine their response to the external stressors and uncertainties physicians face, to search inwardly for ways to reconnect with the meaning of medicine.
The monthly meetings of the Gathering of Physicians are organized as a conversation and discovery process, focusing on a specific topic chosen the previous month. Topics chosen over the past three years include boundaries, stewardship, privacy, ritual, renewal, and fear, as well as joy, compassion, trust, anger, forgiveness, and dreams. Participants are invited to bring a story from their personal or professional life, a piece of writing from world literature, a poem, a work of art, or an exercise, and to share this gift of experience as if sitting in a living room with a group of close friends.
Our conversation on privacy, for example, explored invasions of privacy through the Internet, with telemarketing, and in the hospital setting. One physician spoke of his ongoing discomfort with the lack of privacy when taking a history in a hospital room or in the ER. We explored the challenge of balancing privacy with expediency, and privacy with security. As we looked at the obligation of a parent to honor the privacy of a child, one physician was reminded of a recent experience when his teenager came home drunk one evening. The physician shared the concerns he and his wife had about the “rights” of parents to invade the private space of a child.
Physicians in the group bring poetry from Rumi, Hafiz, and Dickinson, while others bring music or musical instruments. The group often reads short stories, some written by local physicians, some by well-known writers such as Kahlil Gibran, Jack Kornfield, or Dr. Remen. Our personal, unwritten stories provide another rich source of shared experience. On one occasion, when the topic was trust, a physician spoke of the painful experience of a divorce, and its impact on personal and professional life. The individual had never shared this very personal story with other physicians, and stated that the group’s attentive listening felt extremely supportive.
At another gathering, three of us realized that we had each lost our mother within the past six months. We spent the evening sharing reflections on our mothers, our relationship with them, and the experience of the loss —even though neither loss nor death was the specific topic for the evening. Our conversation expanded and segued quite naturally, aided by the collegiality that had developed within the group. What is shared at the meetings is often quite moving, and it touches our hearts deeply.
A few simple rules govern the group’s interactions. Participants are asked to respect and maintain the confidentiality of the group if and when they consider sharing the experience with others. The intent of the gatherings is to be respectfully attentive to what others have brought, rather than to fix a problem, offer advice, or jump in to tell our own story. We are there to offer support, to share insights that arise, to reflect on what touched us. There is no requirement to speak, only to share the gift of one’s attention, to trust the wisdom that is being shared.
Quiet reflection at The Gathering of Physicians allows for a greater awareness of the power and importance of silence, of listening. In his wonderful book The Healing Companion, Dr. Jeff Kane writes about the importance of listening: “The Chinese written character for listen is compounded of those for attention, ear, eye, and heart. You’ve already ’listened’ to the illness story with your ears and eyes. To make sense of it, you’ll need to listen with your heart —that is, with your insides. Listening with your ’heart,’ then, means staying tuned to precisely what you feel.” Physicians are typically not trained to listen with their heart, to elicit a personal story, to explore the meaning of an illness, or to value silence. Instead, much of our training focuses on the medical history, the scientific, objective data: “Just the facts, ma’am, just the facts!”
At one gathering, a physician shared a short story he wrote about his own internship experience. Visiting a home where an infant had just died, most likely from crib death, the physician realized that he had “never witnessed a death outside the hospital,” nor had he “broken the news of death to a patient’s loved ones.” He also realized that he had not received even one lecture on how to deal with the interpersonal relationships surrounding death and dying. He knew immediately that he was in “uncharted waters and must proceed entirely on his own.” This powerful story inspired the group to share their own stories and responses to death and dying experiences.
There is also no place in medical education where physicians are taught the value and power of sharing their own stories, feelings, or experiences as a way of humanizing the doctor-patient relationship. Many physicians deeply value and respect relationship skills in their personal lives, and some believe that the mutual sharing of stories can be therapeutically healing for both patient and physician. Barry Lopez, in Crow and Weasel, writes, “The stories people tell have a way of taking care of them. If stories come to you, care for them. And learn to give them away where they are needed. Sometimes a person needs a story more than food to stay alive. That is why we put these stories in each other’s memory. This is how people care for themselves.”
Burnout is defined here as a lack of harmony between our personal and professional values, between what is meaningful in our lives as human beings and as physicians. It is the antithesis of well-being and wholeness. By re-forming the community of medicine, the Gathering of Physicians honors the importance of wholeness and healing, and provides an opportunity for physicians to “care for themselves.” We have also created a safe, supportive space that serves to counter the sense of isolation and burnout felt by many physicians. The Gatherings of Physicians models a way of appreciating what gives meaning to the lives of our patients and, at the same time, reconnects us with the meaning of our work, of service, of healing, of our own wholeness.
—From Sonoma Medicine Magazine: Well-Being, Volume 54, Number 2, Spring 2003