Why I Teach Medical Students About Self Compassion

As part of my work on the volunteer clinical faculty at the UC Irvine School of Medicine, I co-facilitate an elective for first year medical students.  The elective is entitled “Patient Stories/Doctor Stories,” and usually draws a group of about ten to fifteen new medical students.  In this elective, we use various creative media, such as stories, essays, poetry, art, to learn about the fundamentals of how to be a doctor.  Through reading, writing, discussing, these physicians in training explore different ways of thinking about history taking, physical exams, anatomy class, and the physician-patient relationship.

During the months when this elective runs, the class becomes my favorite part of the week.  I often say to myself, when the class ends, that I have benefited more from the students than they have from me.  They keep me in touch with what it is like to experience doctoring for the first time.  The fear.  The vulnerability.  The ache.  The loss.  The joy.

As first year students, they have not been fully socialized yet, and so they are able to speak their truth without filter.  How it is alienating and yet awe inspiring to lay their hands inside the human body during anatomy.  How strange it feels to examine a standardized patient.  What it is like to feel like one knows absolutely nothing, and has an entire body of knowledge to gain within a few short years.

During the elective, I teach a class to these students on the subject of self compassion.  It feels like a strange topic to discuss with medical students.   I often preface my talk by saying that I hope it is not the last time that they ever hear a physician speak to them about the importance of self compassion in medicine.

These students, as early in their careers as they are, can be incredibly hard on themselves.  This can manifest in comparison, self criticism, and even shame.  The constant feeling that one doesn’t know enough, will never know enough, is ubiquitous.  This feeling can eventually evolve into struggling with allowing mistakes, trying to find forgiveness for oneself when things go bad, lack of self care, and a loud, self critical voice that is difficult to ignore.

We read stories written by physicians who have made mistakes, and how they struggled to come to terms with their own fallibility as doctors.  And we discuss this incredible perfectionism that somehow got them to medical school, yet holds them with a death grip that only seems to tighten with time.  Somehow in the midst of this, self compassion must come through.

Self compassion is a necessary skill that must be consciously practiced and cultivated with time.  It is only in allowing compassion towards ourselves, that we can learn and grow in a safe enough environment, for it is the only way we can examine our errors.  It is the only way we can share our errors with others so that we all learn and grow.  It is the only way to escape from a culture of shame in our hospitals and offices.  And it is the only way we can care for ourselves, so that we can keep doing this work.

It is only once we find compassion for ourselves, that we can extend that to our colleagues, our staff, and ultimately, our patients.

I can see my students wrestling with the idea.  Do we really deserve our own compassion?  Is our struggle worth our own empathy when our patients are dying?  I urge them to stay with me despite how foreign this idea feels.  It is the only way we can be sustainable.  It is the only way we can hold on to our own humanity and touch the pulse of our patient’s suffering.

There is not a finite amount of compassion or empathy in our hearts.  We have enough to hold our own pain, and the pain of our patients.  We do not have to give up one for the other.

Last week, we held the final class of this year’s elective.  The final class is always my favorite, because the students bring in creative work of their own, and discuss what it means to them.  In this particular closing session, one student shared her love of numbers, and her ability to translate numbers into beautiful conceptual designs.  Another shared her unique ways of journaling to notice and commemorate the events of the first days and months of medical school.  One student shared a story about a physician’s experience of losing a patient, and how she felt as she read it.  Yet another student shared her own personal journey with illness, and how it impacted her ability to empathize with patients.  At several points, I saw eyes well with tears, and I felt my own tears rise as well.  There was a certain rawness, a palpable honesty, within the room.

What I wanted to say, but somehow didn’t, was that I hope these young doctors never, ever lose that rawness.  That ability to read words, to write stories, to color experience, to sketch illness, to paint feelings.  The ability to know and articulate their emotional experience, and to hold and examine those feelings with curiosity.  This is the essence of self compassion in medicine.

And I know from my own experience and the experience of my colleagues, that they will have to fight like hell to hold on to that.  They might be told that they are naive, that they won’t be able to “take it”, that they somehow can’t be competent and emotional at the same time…and yet nothing could be further from the truth.  It is this vulnerability that will make them courageous, wholehearted, capable physicians who will in fact heal patients, not just treat illness.

This is what these students remind me of, every time I teach this elective.  What it is like to be new to this field, and how I must keep coming back to that, over and over again, if I want to be good at what I do.  I am grateful for this necessary lesson, year after year.

So today, and in the week ahead, I invite you to join me in thinking about how self compassion is necessary for sustainability in your world.  What small steps can you take towards inviting more kindness towards yourself in day to day life?

With gratitude, Monisha

#selfcompassion