At Coaching for Doctors we are intrigued by language. In our Recalibrate program we spend a lot of time in retreat understanding the story through our use of language. What does the story mean? What does the story help you to do or be, what does it hinder? The narrative we hold can help us access unconscious bias and raise our self awareness. When an unusual word is used we are especially curious about it.
The word that caught my attention today was Fierce. I was at the gym near my home in Gippsland where the land and the community is being ravaged by bushfire and as I walked and ran on the treadmill I had the thought that I felt fierce, I pushed harder and broke some physical barriers because of this idea. I certainly felt it in my body. It was a whole of body experience but it came from a story in my mind. It was my mind that gave my body-feelings this name (which is technically more an attitude than a feeling). The more I said to myself I was fierce, the harder I worked and the stronger I felt.
I left the gym thinking about all the meanings for Fierce. We have seen many fierce things in recent days, mother nature has unleashed a force so fierce that her fires have driven people into the sea at Mallacoota. Our politicians have been fiercely rejected, even abused and our firefighters have been lauded with a fierce pride and gratitude. They have demonstrated a fierce determination and commitment in their work to protect people, animals and property. I wonder what you thought of when you read the heading I feel fierce. What meaning did your mind give the word fierce?
The Cambridge dictionary has fierce as an adjective. Fierce: 1) physically violent and frightening 2) strong and powerful 3) showing strong feeling or energetic activity 4) difficult. In the US Fierce is recognised slang meaning “Fierce!” Of exceptional quality, exhibiting boldness or chutzpah. This is the kind of fierce I felt today i the gym – bold.
I came home and read two articles that might also be described as fierce, authored by doctors. The first was by Dr Anne Malatt as she expressed her frustration at how junior doctors are treated after reading Adam McKay’s excellent book This is Going to Hurt. Anne wrote fiercely, concluding with a plea to her doctor colleagues to start taking better care of themselves. I share her strong and powerful (fierce) concern for our doctors. The second article was from RACGP News, where Dr Claire Denness shared her grief at her father’s death and wondered if she is a better doctor as a result of these experiences. She has written exquisitely about the impact of human connection as a daughter and with her patients. Here’s her conclusion:
“Maybe I have really understood now the beauty of life, its transience and fragility, and the immense privilege that is afforded to us when we become doctors. A privilege that is easy to lose sight of, sometimes. Maybe I really understand now that grief is an inevitable human experience, but, from my patients, I have seen and felt the capacity of the human heart to heal, repair and love once more.”
I could feel her fierce love (strong and powerful) for her father and her deep connection to her job, as I read Claire’s reflections.
The doctors who attend our Recalibrate program find their own story of being fierce! Some join us because they are determined to not burnout ever, some because they don’t want to burnout again. Some come because they are fiercely furious about the gaps they have after their medical training and want to deliberately develop their ‘soft skills’ so that they can care for their patients more effectively. Some come because they feel fierce about changing the culture in medicine, something like Dr Anne Malatt captures in her article, frustrated and disappointed about their health system not really caring, not really providing health for patients or doctors.
The medical profession once upon a time was built on compassion. The doctor arrived with a listening ear and a kind heart. He brought comfort and reassurance and often all he had to offer was ‘keep the fluids up, rest and use a cold flannel.’ He was fierce in his commitment, arriving by horse or walking at all hours of the night whenever he was called. He had many difficult conversations and bore witness to all kinds of human suffering. He was revered by the community he served.
Modern doctors have more to offer patients in terms of evidence and technology, but focusing only on science ignores the art and the human connection of medicine, that capacity to heal through human care, concern and love. The kind Dr Denness wrote about. Dr Malatt invites doctors to love themselves and I share her plea. Too many doctors burnout every year or become detached or cynical about their job or their patients. Doctors individually need to be fierce in this decision, saying the system is burning me out may be true, but it is not helping as a story for individual doctors. Each individual person must take a stand and be fierce in their protection of their own health. Senior doctors must model this to junior doctors and support them in their efforts to take better care of themselves. Administrators and funders must recognise that without healthy doctors who maintain long sustainable careers there is no health system. Each must be more fierce in their endeavour to challenge the prevailing culture that leads to doctors in distress, burnout and leaving the profession of medicine.
A fierceness is required because there is too much patient demand and not enough resources (including workforce). The dilemma continually put forward is that the doctor can never see the patient left without response, that the doctor is compelled to work beyond their finishing time and be double booked in clinic because it is their job to respond to those in need. Of course the doctor who works this way is also more at risk of making an error, more at risk of being in conflict with their colleagues and more at risk of self harm (through a motor vehicle accident on the way home from work, a needle stick injury or suicide).
Our modern doctors are also fierce in the competition of their careers. Getting into medical school, seeking a place in their preferred training program, suffering the public humiliation dispensed by some consultants during training and coming back again tomorrow, tolerating imposter syndrome and showing up each day to build their confidence and skill. There is a long list of how a doctor must be resilient, fierce in determination and persistence. This same determination and persistence, to say no for instance, to unreasonable and unsafe work practices, can help to bring about cultural change in health. Doctors please support each other in saying no and in questioning the prevailing way your work is delivered.
Choose one of your own stories, review it as I have done here with fierce and see what you can learn. The story you tell yourself makes a difference. I invite you to think about this word fierce. What does it mean to you? Is it aggressive or bold? What does fierce have you doing? Does fierce mean you back yourself in useful ways or end up in conflict? What does fierce look like in others? When you name it does the story bring positive or negative connotations? Do you think of fierce differently for yourself to how you think of it for others? If you do, why is fierce different in others to how it is in you? Does it bring energy and action and if it does, are you using it in a useful way?
One last thing. Ask yourself what is the opposite of fierce? Your opposite. A whole new round of story making may show itself. What can you learn from this opposite story? Remember the story you tell yourself comes from your mind and affects your attitude, your body and your behaviour. You choose which story you believe.
Understanding the messages our mind and body have for us requires attention and awareness, skills that can be learnt. When we are aware and paying attention there is much to be learnt. What are you aware of and paying attention to in 2020? I am fierce about helping doctors be well. I hope you notice something to be really fierce about that enables you to be well and less at risk of burning out. My best wishes for 2020, may you be well!