Can We Truly Find an End to All Suffering?

For the past 3 years as I have expanded my understanding and practice of medicine, I have been guided by my “North Star” to create and nourish a space where all can heal and be healed. As part of this exploration, I have been witness to pain and suffering I would not wish on my worst enemy- (although at this point of my spiritual journey I am not sure I could have or completely agree with the concept of a “worst enemy”).  In wishing to bring relief to such profound suffering and incorporate this intention into the essence of my being, I have been reciting, as part of a daily reflective practice, a set of mantras focused on these precise wishes.

The three mantras go as follows:

1. May there be an end to all suffering on Earth

2. May there be peace for those who seek it

3. Be your own strength

Over the past few months, however, following a deeper study into the Five Mindfulness Trainings of the Vietnamese thinker and poet Thich Nhat Hanh, I have started to examine my first mantra a little more closely, questioning whether “an end to all suffering on Earth” would actually be as joyful as I initially imagined?  After reading this last sentence you may be saying to yourself, “What in the world is he talking about? Of, course we would want to live in a world where pain and suffering have no place in our common language and understanding.” If we collectively approach the concept of suffering from this perspective, I would certainly agree, admitting that in reciting and sharing this thought for close to three years, it would be close to hypocritical not to agree. As with all things in this world, however, we live with dynamic understanding and are blessed with the capacity to evolve our present beliefs (never being defined by their content), and to engage in purposeful reflection, entertaining alternative perspectives that may at first seem completely contradictory to our present vision.

In pursuing such practice, I now believe that what I truly desire is not for THE END of SUFFERING, but actually for THE RELIEF of an INDIVIDUAL’s SUFFERING. Digging a little deeper, one can start to contrast the concepts of Relief vs. Eradication, Cessation vs. Destruction, Impermanence vs. (Non) Existence. For without my own experience of debilitating anxiety and depression, being devoured within the disturbing black hole that is our deeply flawed medical education system, I would certainly not be here breathing today, writing and urging for all humanity to bear witness to our world of suffering all the while striving to create a more joyful and loving place to live. Despite waking each morning with a hopeful smile wishing at my core to remain free from the torment of wrongful desire and selfish gain, I indeed long to have eyes that will forever see such acts of selfishness, of jealousy, of hatred, for it is with these eyes that the seeds of my compassionate spirit are watered and given life. If not for the tears of a grieving son following the unexpected passing of his father, would I find the strength to go forth opening and extending my compassionate heart?   

Having grown in my faith, accepting much of the immeasurable uncertainty in this unexplainable world, I realize there is no good answer to the questions I have posed, and perhaps the best I can do to reach a state of reasonable understanding is to suspend my disbelief and hold two supposedly contradictory wishes in a state of paradoxical acceptance.

The first wish being: To aid in the relief of an individual’s suffering

The second being: To bear witness to the suffering in this world so that I can generate a compassionate heart willing to aid all those in need on their own journeys towards healing and wholeness.

Revisiting my initial mantra from this new place of understanding, perhaps the succinct statement below would be the most precise revision.

 May I bear witness to the hurt, so I can live wholly for its relief.

Once again, I have no profound answers or reasonable explanations for the purpose of such disturbing suffering in this world.  What I CAN offer, however, is a truth that we CAN control how we PERCEIVE and RECIEVE this pain, and most importantly, we CAN control our RESPONSE to the EXISTENCE of such hurt.

So are you willing and able to help relieve the suffering of just one other person today? For maybe, just maybe, through the collection of such seemingly minute and “inconsequential” acts of compassion we can approach the asymptote that is a world without suffering.

What is Your Level of Understanding?

Because this is what happens when you start writing at 9:00 PM and things just keep rolling.

This is taken from my message: A Week of Compassion for August 7th, 2016.

               For many of us, Learning has become an after thought. Perhaps, because of the current construct of our academic institutions and the “there is always something more” paradigm, we have actually started “fleeing” or “escaping” Learning in order to find a more “comfortable” place and devoid of curiosity and challenge. In this flight we can also start convincing ourselves that Learning implies resolution and that when we get a multiple choice question correct on a test we have succeeded in learning something- in breaking the tape at the finish line. Like any process, however, Learning is a dynamic JOURNEY that is not restricted to lecture halls or libraries and encompasses something much greater than right or wrong. In order to truly embrace a life where Learning is a pursuit, a process of integration, we must open our eyes to the many ways in which we observe, appreciate and understand the world.

                 Buddhist psychology offers us an interesting framework in which to expand our concepts of learning and understanding. From this framework, the first level of learning involves the acquisition of knowledge through mere observation, hearing others speak, and reading the written word.  In short, this level is basically accepting what you hear and read to be true and incorporating that into your understanding of the world. This level, however, is rife with bias and assumption and it isn’t until we enter the next level involving conscious reflection, action and reflection once more that we begin to truly deepen our understanding. Encouraged by curiosity and the conscious choice to dig deeper, ask questions, and test what you have heard and seen, this level allows for a broadening of your lived experience, but it too, has its downfall in being quite energetically demanding, requiring regular, conscious choice in one’s action and purposeful reflection. It isn’t until we reach the final level of understanding where, through the lived meditative experience, we seamlessly integrate and internalize our world of ideas, descriptions and practices into something that is simply “just us.”

                   For those of you wondering, what in the world does this mean- this is just too out there for me, you are not alone, and so we offer an example of these three levels of understanding in order to bring all of these conceptual ideas into a grounded, practical perspective. Ever remember your mom telling you it was nice to say please and thank you? You might have thought this was important or on the contrary, rather silly, but in its early stages you accepted and understood this to be something you should do because your mom or dad said so. Level one understanding. Moving forward you started choosing to say please and thank you, greeting others with a friendly smile, giving a gracious hug or returning the favor of another with thoughtful card. Consciously choosing and reflecting upon the acceptance or outcome of your actions, you actually started to understand that showing gratitude and giving thanks was something you did not because your mom and dad said you should, but because it felt good to appreciate others, to connect, to rest in the joy that was that perfect hug. Level two understanding. 

                 Now many of us have likely stopped here, which isn’t a good or bad thing, it just simply is. To reach the third level, however, takes another experience all together, one of deeper contemplation and integration. Anyone know that person at work who always volunteers first to bring in food for the potluck and not just chips or soda,  the person who goes out of his or her way on a Saturday night to pick up that one thing from the grocery store you really didn’t need right at that moment, but would certainly be better off having, the person that offers you a ride home despite living on the other side of town, the person who is always there ready to listen as if you were the only person on Earth with problems? These people, it seems, are almost no longer consciously choosing to be gracious, to put others first, to embody compassion, it is just simply who they are and what they do. This my friends, is our attempt at describing the third level of understanding- an internalization that (in this example) gratitude and compassion are exactly what each moment requires, what every human deserves, and what the world truly needs- all of which, for the described “person” above, does not depend on the “conscious” mind, but on an innate understanding of human existence. Pure, manifested love, embodied joy, and selfless giving realized at all three levels.  

How Do You Pick Your Blueberries?

You may be thinking after reading the title for this post “What in the world does this have to do about health, or what are they teaching you again in medical school?” While I can assure you there is not a dedicated lecture for blueberry picking as part of our biochemistry foundations course, a class on such fruitful splendor wouldn’t hurt (and in my humble opinion- would likely help quite a bit). Terrible jokes and attempted puns aside, I am writing to you now to share a deeply moving story from my summer adventures, and yes, ask you the question you’ve been dying to be asked: “How Do You Pick Your Blueberries?”

BUT, before I delve more deeply into that question, however, I want to take a short tangent to express some thoughts related to this post. As I continue to reflect on all of my writing endeavors, from my “scientific” blog posts and random thought explosions (the ones that crash land into my I-phone, usually when its time to walk across the street or down some awkward steps), to my rambling poetry and weekly email of kindness: A Week of Compassion,

Shameless plug: Sign up here to receive the weekly email: aka more smiles and love flooding your inbox!

http://eepurl.com/b77RPX

I have come to realize that writing blog posts or stories on seemingly pure “medical” or “health” topics like “6 Nutrients to Heal Your Gut” or “10 Strategies for Incorporating Mindfulness into Your Life” just doesn’t speak to my heart, and, in truth, I know there are many much smarter and more dedicated individuals in the halls of holistic medicine who have already shared such thoughtful wisdom which will remain readily and constantly accessible for your brain to download. So I provide this realization, not to demean or bring down those writing such pieces, for I read and am nourished by such knowledge daily (PubMed rabbit holes anyone?), but to acknowledge their efforts without feeling a need to repeat or reinvent the wheels, and, more importantly, to clarify the true reason I am sharing this story (about picking blueberries) with you now.

It was July 3^rd, a hot steamy day in North Carolina. I had just spent the last two days with my paternal grandparents on gorgeous Lake Norman in Mooresville, North Carolina, and had now made my way to my maternal grandparents’ old home place in Huntersville, the farm of my childhood and still, current residence of my great uncle and aunt, Dan and Linda Whitner. Now, seven years following the passing of my maternal grandmother (Sydney Whitner Stancil) from metastatic cancer, I found myself walking through the overgrown grass and old go-kart tracks remembering those summers spent with my “country” grandparents. While my maternal grandfather (Bob Stancil) who is still alive and kicking, would likely boast beyond his true “country farm” status, my grandmother was born and raised at home in the soil, working in the family greenhouse and teaching youth in the local grammar school about the beauty held with our most precious neighbors: the world of plants. While showing up some 10 years late to be under my grandmother’s formal tutelage, I was lucky enough to attend my grandmother’s “home school,” full of lessons on baking banana bread, building and filling bird feeders, weeding the vegetable garden, and best of all, picking blueberries. Just ask my mom or dad what my favorite food was growing up and you will almost assuredly get an answer that involves blueberries- if blueberry pizza was a thing you can bet that would have been on the list.

But as I look back now, it wasn’t simply blueberries themselves or eating blueberries bought from the store that stoked my fire, but feeling the early morning dew over my shoes as we walked to the blueberry bushes, hearing the birds sing or cackle as we stole their precious fruit, or smelling the honeysuckles nestled nearby spreading a welcoming joy like no other. For you see, I wasn’t in it just for the blueberries, sure I would more than happily stuff my face with two fistfuls of violet deliciousness for every one that made it into my bucket, but I was there for the stillness, the calm, the peace of the morning with my grandmother, one of the only people in my family that seemed to understand and honor the wonder that was and is silence. In holding this space with nature, she taught me not only how to listen and be still, but how to feel through your heart into your hands with the rhythm of the Earth.

Try to grab eight ripe blueberries all at once, as fast as you could and you would end up with four green “rocks” and two brown leaves without the nearest speck of blue goodness For picking blueberries takes a gentle nature, a patient palm and a willingness to let fall was is to be in that moment. We have become so consumed in our modern lives to see how much we can fit onto our plates and still wake up the next morning saying I guess I can stumble out of bed and do it all over again. We are also commonly our harshest critics, unwilling to extend the same compassion to ourselves that we show to our loved ones. Being gentle with ourselves in each moment, resting in the joy that is our spiritual wholeness, and acknowledge that perhaps, OUR plans, or at least the timing of OUR plans, are not necessarily or likely THE plans. I profoundly believe in our free will and have spoken many times about the choice we always hold to pursue each moment from a place of mindful awareness, but I also deeply believe in a greater intention or “dharma” for our lives- in both life and death. Appreciating the talents and qualities that make each person unique and holding fast to your own deepest values for the joy they bring you are far and away the most important “truths” to our collective human existence.

So as I stood on the North Carolina red clay, amidst the resurrected blueberry bushes, transplanted on life support from my grandmother’s original patch to their current home in the backyard of my great uncle- years past their original life expectancy, I couldn’t help but smile seeing the face of my grandmother burning forever brightly in their dried-up roots. During the years under her caring eye, I had learned to receive each moment with peace, to grasp each blueberry with a humble hand, to cherish the love held within each fruitful bounty, the same love held within each of our hearts. While the years following this lesson have sought to hide and discard this truth, it has been alongside some of the most compassionate and generous friends that I have rediscovered my grandmother’s teaching, her blessing. Transformed from living human cells into the mitochondria, cellulose and membranes of these blueberry bushes, my grandmother was still with me in a new form, guiding my hands to her heart so that I could always hold her close. Suspend your disbelief or choose not to believe at all, it doesn’t matter to me, I have already decided to take the road that science cannot explain, breathing gently with each passing soul, asking the mysterious question, “How do you pick your blueberries?”

Spirituality in Medicine- An examination of religious service attendance and overall mortality among a cohort of female nurses

Whether by pure coincidence or divine action, within minutes of posting my last article regarding the imagery of an interconnected world existing amidst a “vibrational bowl” of love and the implications for those, like myself, wishing to practice medicine focusing on the spiritual being, I was “sent” a notification email from JAMA Internal Medicine informing me of a newly accessible, online first study entitled: Association of Religious Service Attendance With Mortality Among Women.

Already intrigued by the title I began reading through the abstract, and within minutes was already immersed in the body of the paper, piecing apart the intricacies of the statistical results and reflecting upon the ideas described in the thoughtful discussion. In an attempt to make the statistics a little more user-friendly I have presented the results of the study below as well as my own personal interpretation of the author’s conclusions.

Cohort Studied: “Attendance at religious services was assessed from the first questionnaire in 1992 through June 2012, be a self-reported question asked of 74,534 women in the Nurses’ Health Study who were free of cardiovascular disease and cancer at baseline. Data Analysis was conducted from return of the 1996 questionnaire through June 2012.”

1. A 33% decrease in all cause mortality for those individuals who attended one or more religious services a week versus those who did not attend any religious functions.

2. Decreased likelihood of dying from cardiovascular disease as determined by a hazard ratio (HR 0.79). A hazard ratio is basically the ratio of the likelihood of an event occurring for two different groups as defined by a single variable (in this case dying from cardiovascular disease for those who attended one or more religious services per week vs. those who did not attend any religious functions). A HR of less than 1 (such as the HR of 0.79 in this study) when combined with a predetermined p-value to show a “significant” likelihood of a true effect essentially means that the group of regular religious attendees were less likely to die from cardiovascular disease (CVD) than those who did not attend a religious service. Generally speaking, the smaller the hazard ratio (for example 0.35) the less likely the specified group with the defined variable (religious attendance) would suffer the measured effect (death related to CVD). It is important to note, however, that the researchers only found a significant decreased likelihood of death related to CVD as it pertained specifically to cerebrovascular disease (stroke) and other cardiovascular diseases (such as congestive heart failure) – but no such association with ischemic heart disease [heart attacks or in more medical jargon- dysregulated coronary vasculature (blood flow to the heart)]. 

Summary

The weekly religious attendees had a 0.79X less chance of dying from stroke and cardiovascular disease- but not ischemic heart disease, when compared to those who did not attend religious services.

3. Decreased likelihood of dying from cancer as determined by a hazard ratio (HR of 0.73). Sparing you a further “rabbit hole” description of a hazard ratio, I will simply share that the researchers also found a site specific cancer mortality effect for breast cancer (as this cohort was of female nurses) and colorectal cancer but not for any other forms of cancer.

What the researchers DID NOT find

1. Spirituality as a whole, if describable, had an effect on any other domain of health besides total mortality, mortality from cancer, and mortality from cardiovascular disease (excluding ischemic heart disease).

2. Populations outside of female health care workers- predominantly, white, middle class Christians did or would receive a benefit in regards to mortality as related to regular religious attendance.

3. Associations (as they were not directly measured) for quality of life across mental, emotional and physical domains for the regular religious service attendees compared to those who did not attend religious functions.

4. Specific mechanisms or pathways (outside of the associated mediators described below) for how religious attendance could cause the observed affects for decreased mortality. 

5. Spiritual practice, outside of regular attendance to a specific religious function, could not also give potential benefits as they relate to decreased total mortality and mortality from cardiovascular disease and cancer.

Addressing the practical question: How was the observed effect of decreased mortality mediated? 

One of the strengths of this study was the numerous confounding variables controlled for with regards to the primary variable analyzed (religious attendance) These variables included diet and exercise patterns, smoking, depressive symptoms, multivitamin use, medical diagnosis- comorbid disease and numerous demographic variables. Through all of this covariate analysis the researchers were able to isolate four primary mediators that likely contributed to the observed primary endpoints of decreased mortality.

1. Optimism 

2. Smoking Status

3. Depressive Symptoms

4. Social Support/Social Integration

Smoking was found to “explain” 22% of the observed effect, Social Support 23%, Depressive Symptoms 11%, and Optimism 9%. Additional mediators examined that did not show a significant mediating effect included: alcohol use, diet quality, and phobia related anxiety. The researchers calculated the “Social Support” score from multiple longitudinal surveys in the specified cohort and attempted to create a final score independent of social support associated with religious service attendance.

Summary

 No one mediator was found to strongly correlate with the observed effect of decreased mortality, however, it appears that non-smoking individuals with a self-reported positive outlook, minimal depressive symptoms and supportive social structures were the least likely to die during the time period of this study. Whether or not regular religious service attendance added a significant “value” for an individual outside of the mediators discussed is open for debate and certainly would be an area worthy of further study.

Implications and Ideas

Author’s Conclusion: “Religion and spirituality may be an under appreciated resource that physicians could explore with their patients, as appropriate.”

Personal Conclusion: Spirituality is a complex description of one’s personal beliefs, faith in a greater energy, being, or creator, as well as a motivating sense of purpose, connectedness with others/ the natural world and cannot simply be “quantified” by regular religious service attendance. This specific study provides some evidence that cultivating a positive social support network through regular attendance to religious functions (a “surrogate” for spirituality) can be a means to maintain health and avoid premature death. In the end, quantifying one’s own sense of spirituality is not likely possible with a single measure or combined variable, and the scientific method/ study through traditional clinical research designs does not provide a realistic means to determine the relative importance of spiritual practice to any one individual.

References

Li S, Stampfer MJ, Williams DR, VanderWeele TJ. Association of Religious Service Attendance With Mortality Among Women. JAMA Intern Med. 2016 May 16. 

Koenig HG. Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry. 2012 Dec 16;2012:278730. 

Vibrations: How Do You Share Your Love?

             So just yesterday, while reflecting upon a podcast from The Evolution of Medicine's Functional Forum entitled: Anatomy of a Calling- an interview with holistic physician Dr. Lissa Rankin MD, I realized (among many other things) why writing, studying medicine, and blessing others with my thoughts brings me so much joy: I have precisely no clue who or how any of my words or ideas will touch others. I have mentioned this concept before in some previous posts, specifically on the impact of the written word and my interest in writing, but as I wandered in the Pennsylvania woods, hearing Dr. Rankin speak of compassion and “wholism,” all within the context of her passion for psycho-spiritual healing, I couldn’t help but consider the reality that, yes, her “whole health” practice of nourishing the spiritual body was exactly the type of medicine, or dare I say, the type of “healer” that had been born in me, before I would ever consciously decide to attend medical school. Since discovering my desire to pursue functional, “root-cause resolution” medicine as a way to understand the complex nature of the human web of physiologic systems, I have only slowly begun to realize that this functional, evolutionary framework of understanding is only a piece of the puzzle, only one page of the story, merely a starting point for seeing the true capacity for healing made possible by acknowledging a relative unknown spiritual energy- our essence- the human soul. For a profession so profoundly defined by science and what can be experimentally determined, psycho-spiritual healing relies on nearly polar opposite values: intuition, belief, the acceptance and embracing of uncertainty, and the genuine desire to, perhaps, never know the answer to the question: Why? So while I share all of this perspective, knowing it is personal and focused primarily on my beliefs in the medical profession, there is, however, a powerful, imaginative thread that can be woven from these concepts into the larger stories of all humans alike. 

           During her intimate conversation (podcast) with James Maskell, Dr. Rankin describes an incredible image of an interconnected universe whereby there exists “a vibrational bowl” where love and light are intertwined, and we, as humans, have the capacity to instill a more positive, harmonious vibration, capable of travelling, in a state of dynamic continuity, to some other distant part of the “vibrational bowl.” Taking this imagery to a more practical level, and thinking within the scope of our Earth, we can imagine each small act of love, every moment of “paying it forward,” each gift of altruism as actually impacting or influencing the actions of another on the other side of the globe. Share some parenting wisdom with your child, give a hug to your ailing grandmother, or mow the grass for your currently disabled father- all of these acts of light and love can travel through this vibrational network and bless the spirit of someone in Australia, Slovakia or Mozambique, and make it all the more possible (or more likely) that he or she can share his or her love through a reciprocal act of kindness, or at the very least, make it all the more unlikely and impossible to create more suffering for another human being. No longer can we confine ourselves to only see the positive or negative effects of our actions through the lenses of our eyes, for these “vibrations of love” can disperse farther than we will ever be capable of seeing. Wouldn’t the world be a better place, if we all added vibrations of love, of light, of hope into this great bowl? While I may never be able to prove that my small vibrations ever influence the lives of those a thousand miles away, I can most assuredly tell you that I have felt the ripples of light wash over my soul from the acts of love and kindness shared by people I will likely never meet. For somehow this belief, stemming from the simple choice of being a source of light and warmth, for a person living in a world “obsessed” with rationality in science, is all the evidence I will ever need.

Unconscious Bias: Not Just a Medical Student Problem

            The other day, during my cursory reading of Medscape News articles (like any responsible medical student looking to stay up to date on the latest research/news in medicine and also willing to give at little a little time to topics outside of the functional and integrative medicine sphere), I came across an interesting and rather pertinent title: Medical Students: False Beliefs About Black's Biology Common. Delving into the first paragraph, I was quickly made aware that from the specific research cohort studied in the original article, "Half of (the) white medical students held at least one false belief about biological differences between black and white patients, a trend that affected both their perception of the patient's pain." The article went on further to say "The more false beliefs the students held, the more likely they were to rate a black patient as experiencing less pain than a white patient in the same scenario, and the less likely they were to make an appropriate medical recommendation." While slightly disturbed by the conclusions of the research study: it was not entirely "new news" to my ears as I have often appreciated the scope of both implicit and explicit bias in medical practice. From gender and sexual orientation to weight (obesity) and race, there is often significant implicit (or what I consider subconscious bias) as well as overt explicit bias seen in taking care of patients. 

            Stepping back from the article as judgment was already seeping from my skin, the natural defense mechanisms started to flood forth: "Well I'm pretty sure I'm not racist, and sure I'm a medical student, but this study doesn't really pertain to me." Just as we can be easily mislead by medical abstracts and headlines when it comes to the actual population studied (yes, not everyone falls under the demographic parameters of the Nurses' Health Study [I or II]), we need to remain vigilant when making recommendations to patients from clinical “evidence,” avoiding the recommendation, for instance, that a specific drug may be helpful for them, when in actuality, the study population from which your recommendation was made, was completely different than that of the person sitting in your office. 

            Staying vigilant, I continued to read on, only to see from the first commentary by the researchers of the cited study that the origins of the medical students studied was none other than the University of Virginia in Charlottesville. Just as quickly as I was already defending a position that perhaps this studied was not relevant to me, I was finding out that, indeed, I was actually one of the study participants! It is not everyday you read about a medical study and find that the recommendations or conclusions made actually involved your input, and couldn’t exactly be tossed aside like the leftover meatloaf. Having already made a joke/passing comment to my mother, before realizing I could have very likely been one of those “half of white medical students,” it became quite clear that this was indeed, a time to get back to my mindfulness roots.  Sticking to the idea “I’m special” and “this research study is not really pertinent to me,” was just not going to work. 

            Honestly speaking, judgment and pattern recognition can be incredibly helpful for clinicians in the fast-paced setting of diagnostic medicine, however, they can also be potentially detrimental and subversively harmful when carried through in a long term, continuous care setting. When we look at how a scenario involving implicit bias (not simply subconscious racial prejudice) might play out in the everyday medical world, I’d like to present a plausible and practical (constructed) example from a hard working family medicine clinic.

            After following a patient for nearly 10 years, family doctor Dr. A begins to glance over a chart prior to his next 20 minute follow-up visit, giving a look at the patient’s most recent set of labs and confirming, oh yea this is Mrs. B, a postmenopausal female, some hypothyroid issues, working on the hot flashes, has never taken any hormone replacement, doesn’t seem to be interested in cancer screening by the review here, lipids looking a little off since last visit-wonder if she’s changed her diet or gained some weight?  Before Dr. A even has a chance to drop a pen from his white-coat, he is already formulating questions to ask regarding her symptoms, a potential plan to rectify the perceived disturbed blood work, and further inquire into why Mrs. B is reluctant about cancer screening tests (who doesn’t want a colonoscopy on their 50^th birthday?). 

            While objectively speaking, there is almost nothing wrong with what Dr. A is thinking and hoping to achieve during this follow-up clinic visit, we can see that there would be at least few differences if we were to replace Dr. A with a third year medical student, just starting on his family medicine rotation and newly minted with coffee stains on a half-heartedly ironed white coat. While Dr. A is entering the encounter carrying a “weight” of past perceptions, past conversations, and judgments as to what Mrs. B may be thinking, the third year medical student is just seeing Mrs. B’s chart for the first time in his or her life (30 seconds maybe 60 tops), and is likely only carrying with him or her a stethoscope and shreds of paper meant for scribbling something illegible with regards to Mrs. B’s primary complaints. Following the brief “glancing over” of her chart, the third year medical student is aware that Mrs. B is a 64 y/o female here for a 6-month follow-up; her vital signs including blood pressure and oxygen saturations are within normal limits and the primary comment from the triage nurse states “happy to see the birth of her first grandchild last December.”  Stepping into our third year medical student’s mind, we might find some thoughts that include: “I have to make sure I remember to listen to her heart with my stethoscope on bare skin,” and “I wonder what the drug reps are bringing for lunch today,” –so yes, we can all agree there are appreciable and explicit differences between the medical student and the doctor when it comes to this clinical encounter. And while one might say, given the depth of clinical experience of the family physician, that of course, the doctor is better equipped to help and treat Mrs. B, but perhaps, we shouldn’t be so quick to jump to such conclusions. 

             Research has shown that given proper education and tutorials on cardiac auscultation, medical students fair just the same and sometimes better (and at least no worse) when it comes to properly diagnosing heart murmurs as compared to attending/practicing physicians. While one might say, “Yeah, but you are talking about a measurable skill, and I don’t really see how this applies to the scenario with Mrs. B or even to unconscious bias for that matter” My simple response to this, reasonable statement is this, “Yes, you are right, literally speaking, there is really nothing about listening for heart murmurs that seems related to unconscious bias, and likely isn’t relevant for Mrs. B but what if we ask ourselves a slightly different question: “Who do you or did you think would be better at diagnosing heart murmurs- the third year student or the family doctor? While I cannot tell you or predict your answer, I have my suspicions that it was likely the family doctor, or at the very least, most of us would hope that to be true. I can tell you that when I was asked this very same question as a third year medical student just a few short months ago, I quickly realized my answer, discovered a previously unconscious belief/bias, and for the first time really recognized what it was exactly that I was carrying into Mrs. B’s room besides my stained white coat: “I am just a medical student, what do I really know and what can I really do when compared to an experienced  practicing doctor?

            Bringing this post to a close, I would encourage everyone to see the bigger implications of the research study I have just described, seeing beyond medical students’ bias and beyond medicine in general. As human beings we are blessed with the capacity to perceive and cursed by the capacity to know and seek truth. As much as we would like to believe our conscious perceptions are not truth, even when it comes to something we think is so clear: 2+2=4, we “truthfully” only have a personal perception of our present reality, just as the person next to us has his or her own perception of the present situation. Scary as this sounds, it only gets scarier when we realize how much our subconscious and unconscious minds are actually “controlling” our behavior (see Stephan Guyenet’s post on his blog: Whole Health Source: “How Much do You Know About Your Brain?” if you dare to “know” more. 

            So what are we left with when it appears that our subconscious/unconscious mind is really running the show, allowing all of these deep-seated unconscious biases and prejudices to affect our actions and behaviors? Sounds like a terrifying proposition, but I choose to see hope and an opportunity for everyone to grow beyond this supposed “cage” of thinking--and guess what: it all starts with just a little mindfulness.  Realize the nature of the unconscious mind, realize your patterns of automatic thoughts and pattern recognition, realize you have unconscious bias that will likely not disappear, but that’s okay- we are not here to defeat the unconscious into unconsciousness because yep, you guessed it, it is already there. We can simply notice these patterns, biases and reactive thinking, all the while cultivating greater self-awareness, realizing that we all are carrying judgments and preconceptions (good or bad) into the inter-personal experiences of our daily lives.  In the end, we must all accept a truth, perceived or not, that we can be certain there is uncertaintyin our beliefs, and perhaps, it is best to mindfully step through the murkiness of this uncertainty knowing that maybe it isn’t uncertainty that we should be fearing, but certainty itself.