First Do No Harm- Including to Yourself

Jessie Mahoney, MD

In order to be the best healers possible for others, we have to show compassion for and take care of

ourselves. This means not engaging in behaviors that can hurt us. This includes not criticizing ourselves, judging ourselves, and harshly blaming and/or shaming ourselves. It means refraining from perfectionism, and addictive substances to feel better. Doing no harm to yourself includes showing yourself grace and compassion when you are imperfect.

In 2017, the World Medical Association voted to unanimously approve an additional clause to the Hippocratic Oath that states “first do no harm.” The addition reads: “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”

In a recent coaching session with several Anesthesia Fellows, we worked on how to respond to perceived mistakes in a healthier way.

Asking the question, “What would compassion do?” is a powerful tool.

Compassion for the patient and for you. Compassion for future patients, for your colleagues, for your loved ones and family, and for the world. In the face of perceived or actual mistakes, this question can open you up to learning and growth.

“Unlike self-criticism—which asks if you're good enough, self compassion asks what's good for you.” – Kristin Neff, PhD.

“Self compassion provides us the life raft we need to navigate through tough times. By deepening self compassion, we discover untapped reserves of strength and resilience and wisdom that help us survive the storm—and we strengthen our resources to better navigate future storms.” – Shauna Shapiro, PhD, Good Morning, I Love You

It's a phenomenon of modern culture, and especially medicine, to be hard on oneself. We are compassionate towards others--our patients, loved ones, and colleagues, but rarely to ourselves. Showing ourselves compassion is often seen as self-indulgent in medicine. It is common to hold ourselves to unattainable expectations of perfection. When we fall short of perfection, which is inevitable, we often feel shame and sometimes are shamed by others. When we think we may have fallen short in any way as a physician, almost all physicians, ruminate and perseverate in ways that don’t serve them. It's almost a universal experience to lose sleep, worry, become anxious, depressed and feel shame. Feeling shame makes it hard to learn and grow from these experiences, which is exactly what would help our future patients and us as physicians and humans the most. In Dr. Shauna Shaprio’s book, Good Morning, I love you, she explains that: “Shame robs our brain of the resources it needs to respond directly to the challenging situation.” “When we feel shame, the amygdala, the part of our brain that is central to memory decision-making and emotional responses, triggers a cascade of NE and cortisol chemicals that increase our cortisol level, narrow our perspective on perceived threats and inhibit our cognitive flexibility. “ “If we want to learn from our mistakes and keep from repeating them, we need a compassionate mindset, not shame.”

Mindfulness and self-compassion change our neural connections. They make it easier for us to learn. When you bring a compassionate response to a difficult situation, you are more likely to be able to learn from your mistakes.

In my coaching work with a physician who is a Quality Lead in a large academic Emergency Department, she shared that it was easy for her to show compassion for her colleagues during quality case reviews, but not for herself. She almost always believes that her colleagues are smart and did their best to provide “the best care with the information they had in the moment.” She sees their case reviews as learning and growth opportunities for everyone. She rarely sees case reviews as failures or anything of which anyone should be ashamed. But, when she or anyone else, has a question about her own care, she immediately turns to self-judgment and shame. “What did I do wrong?” If a patient has an unexpected outcome the question is “what did I miss?” “Did I make a mistake?” As a quality lead, she felt it was necessary to hold herself to a higher standard than her colleagues. And her experiences and beliefs are not unique. It's the culture of medicine to hold ourselves to a higher standard than our colleagues and grant others compassion that we do not show towards ourselves.

What if our quality leads modeled self-compassion, kindness and curiosity in the face of their own perceived short comings? What might change in the culture of medicine? The following is a reflection I wrote to help physicians start to become their “own inner ally, rather than inner enemy.”

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