My wife has a card posted on our refrigerator door. It reads: “My true religion is kindness,” a quote from Thich Nhat Hanh, a Vietnamese Buddhist monk. As I ponder what is important in the education of our healers, this quote stands out.
I know in part that my education as a physician began as a patient. At the age of 14, I developed a very severe case of acne vulgaris, which not only affected my face, but expressed its aggressive graffiti on my back, chest and arms as well. I was taken to a dermatologist’s office. When I took off my shirt, the doctor frowned, stepped back, looked away and appeared annoyed. He said: “With a case of acne like that, you won’t qualify for the military.” I felt ashamed, isolated, afraid and angry. He prescribed an assortment of soaps, ointments and antibiotics, and dismissed me. The treatments were not helpful.
A year or so later, my acne now much worse and secondarily infected with staphylococcus, creating a widespread disfiguring infection that caused considerable pain and embarrassment, I was taken to a second dermatologist’s office. When I removed my shirt, he stepped toward me and put his hands on my shoulder, despite the open, crusted, oozing sores. He said in a warm, reassuring tone, “I see how much you are suffering. I think I can help you get over this.” I felt a kind of warmth inside me, which I now know to be the relief that accompanies hope. He prescribed a similar course of treatment to the first doctor, but this time I healed.
I wonder now about the education of these two doctors. How was it different? How was it the same? How could both be certified specialists in the same field and approach my illness so differently? Is it simply a matter of personality differences? I don’t know.
I ultimately completed a four-year course of study at Duke University School of Medicine. My education – like yours – was characterized by academic rigor, long hours, attention to detail and the highest standards of medical care. We wore white coats, studied hard, read the latest journals and went without sleep when necessary.
We were taught to be “objective,” to consider the pertinent signs and symptoms of an illness without an emotional response. We were trained to do potentially painful procedures on patients without letting our feelings for the patient interfere with our work. The result of this was to make us feel special, aloof, emotionally cool and distant.
Now I teach Duke medical students. I tell them that although “objectivity” is important in the practice of medicine, it is often misunderstood. When the great physician Sir William Osler (1849-1919) wrote his treatise on the importance of “objectivity,” he used the Latin term “aequinimitas,” which can be translated as equanimity.1 To practice with equanimity, we must cultivate inner peace.
I teach my students that medicine is a service, a sacred service in my opinion. I teach them the value of listening not only with our ears, but with our hearts, being ever mindful not to lose sight of the innocence and the wholeness of those we serve. I teach the value of kindness.
I hope the students who have spent time with me will turn into physicians who embody the qualities of the second dermatologist I saw as a scared and scarred adolescent. Ultimately, it is kindness that heals our deepest wounds.