I am not a regular reader of Harvard Business Review, but frequently there is wisdom about leadership, personal and professional growth and personal and organizational sustainability that is directly applicable to our lives as clinicians, teachers and researchers. One that I cut out, printed and have on my desk is advice from Peter Bregman, who coaches CEOs of large corporations They, like health professionals, have too many tasks, too many decisions, too many distractions, and too many requests, and have to make implicit or explicit choices about where direct their energy.

In the chaos and frustrations of the seemingly endless pandemic and societal upheavals, it’s so tempting to look for someone or something to blame, the “evil other” who, by virtue of differences in perspective or beliefs, is crafted into a justified target for anger. Whatever your beliefs about the pandemic, racism, guns, reproductive health, government and money, more than ever in recent memory, there’s a target – it’s them, not us.

In her book, God’s Hotel, physician-author Victoria Sweet contrasts “fast medicine,” with its emphasis on reversing pathology through medication and surgery, and “slow medicine,” with its emphasis on close attention to individuals’ unique illness trajectories and optimizing the conditions that help the body heal. According to Sweet, practicing fast medicine is more like being a mechanic whereas practicing slow medicine is more like being a gardener.

For many of us, amid the fears and uncertainties of the past year, the pandemic has been a time of reflection and re-integration of our life vision, purpose and meaning. The pandemic has brought many of us face to face with what really matters, and, for many of us, the things that mattered most before the pandemic matter even more now.

A few months ago, at a master class, I played a movement from Bach’s first English Suite. I was focusing on the details, as if each note mattered more than anything else in the moment, which, of course, in Bach’s exquisite complexity, is not an unfair assumption. Mark, the teacher whom I was meeting for the first time, said to me that the notes didn’t matter, it was the figures that mattered. He explained that figures are the next level, groups of two or three or four or five notes. If you listen for the figures, you’ll hear them here, then there, then you realize that they - the figures – form the warp and weft of the music. Think of Beethoven’s fifth - da da da duhhhh. You hear that little figure over and over again. It doesn’t matter whether the da or the duh is a high note or a low note, a loud note or a soft note, a slow note or a fast note, an e-flat or a b-natural; it’s the pattern. My mantra became, “The notes don’t matter, hold onto the figures.”

Earlier this month, David Brooks, a NY Times columnist, published a truly inspiring op-ed piece, Nine Nonobvious Ways to Have Deeper Conversations. As I read through this short piece, I was again reminded that the work we do as clinicians and educators often comes down to listening – listening to others and to oneself in a deep, undistracted, caring and compassionate way. He frames his article as a preparation for family gatherings – now mostly virtual – for this extraordinarily poignant holiday season, but its implications extend much further.

The past few years have seen a proliferation of literature on programs for health professionals, and here I’ll be highlighting three by colleagues in the USA, Canada, the Netherlands and the UK and published in the past few months.

Terror Management Theory describes what happens when we, as vulnerable humans, experience “mortality salience,” that feeling when the possibility or reality of our own death becomes close enough to cause discomfort. I experienced this, just as described, several years ago when a conscientious ultrasonographer incidentally found an 8 cm liver mass while investigating a recent kidney stone. She was hovering over my right upper quadrant for a long time, far from the affected kidney. I asked her what was going on and she indicated that the radiologist would have to explain. Everyone was very clear, concerned and kind.

Several months ago, Paul Han, a physician colleague in Maine, asked if I’d review his book – then in preparation – about uncertainty. Uncertainty seemed like a timely topic for doctors and remarkably little has been written about it over the years. In his articles, Paul has taken uncertainty from a superficial discussion (“Do I know enough and where can I find the answer?”) to new depths. Paul talks about two kinds of uncertainty. 1. The first is stochastic uncertainty. For someone who is critically ill, we might find statistics that indicate that 80% of patients with a similar presentation recover from XYZ, but no one can say whether they will be one of the lucky 80% or the unlucky 20%. While this kind of not-knowing can be anxiety-provoking, we have some idea of what is known and what is not. We have some sense of the terrain, some idea about the possibilities. We can calculate risks and then decide whether we want to take them.

“Cultivating presence in chaotic clinical environments”
Ron Epstein, MD, FAAHP, FACH