By Mick Krasner, MD
I have been thinking a lot about the traditional paradigm in medicine of defining patients by their problems. This framing that focuses on deficits, deficiencies, and things to be fixed permeates the ways in which well-being and ill-being are approached. And more than that, this paradigm defines the nature of the challenges facing us as health professionals. We speak of burnout, exhaustion, objectification, unhealthy teamwork, moral distress, and other experiences of being part of a flawed system.
The problem list features prominently and centrally in the patient medical record and directly influences the working basis for our decisions and actions. Likewise, the systemic, structural, and individual problems health professionals encounter become the basis for our collective reactions to these problems. These reactions include decisions to attend trainings to build our individual resilience (with the underlying message that we are not already resilient enough), develop new policies and procedures for improving existing structures, take a “break” temporarily or permanently, or choose to ignore these issues, instead seeking meaning and satisfaction from other domains of our lives.
Having taught MBSR (mindfulness-based stress reduction) programs for over 20 years, I reflect on the theme of the 2nd class of this eight-week program which explores the relationship between attention and perception. This thematic element asks of participants to examine that what we attend to and how we attend creates our understanding. The relationship between attention and perception, woven through the Mindful Practice in Medicine program and influenced by ideas from Appreciative Inquiry, implies that where we focus our attention influences our reality.
Consider the following provocative possibility- that our collective concern, attention, and focus on the problems facing health professionals and the health care system and how we frame these problems contributes to the creation of our reality and interferes with the creation of potential solutions. Before you stop reading, let me assure you that the problems in health care are all very real, and have very real and significant impact on our lives and the lives of our patients and indeed on everyone involved in health care- which is the entirety of all of us and our communities.
Asset-Framing, a narrative model that defines people by their assets and aspirations before noting the challenges and deficits, invests in people for their continued benefit to society. Trabian Shorters, the creator of the non-profit social impact network BMe Community states “Narrative tells us which facts to even credit, which facts to ignore, which things are real, which things are false, narrative literally tells you who you are, it tells you who matters, where you should go and where you should not go. Narrative is really the key to how we frame our lives.”
Asset-Framing is about defining people by their aspirations rather than their deficiencies, challenges, or problems. Once we have identified people by their deficiencies and problems, they become an object to be fixed or dealt with or manipulated and are no longer people. Once we engage with people as problems and obstacles, we become the problem as well. When we acknowledge people’s aspirations before going into their challenges, we have a truer story of that person.
How does this relate to our work in healthcare? Supported by our understanding of the connection between attention and perception, Appreciative Inquiry directs our attention toward capacities and successes. This is further influenced by the findings of Self-Determination Theory that connects intrinsic motivation with autonomy, efficacy, and relatedness. In other words, we individually and collectively have agency and competency in the creative process of transforming aspirations into action and change, and connection and relationships animate that process.
Asset-Framing can help light the way toward positive change and energize our resources that change is possible. The recognition of our aspirations can direct us toward a more meaningful health care professional experience, a more effective and connected experience of the health care system, and a more joyful, kind, compassionate and equanimous human experience. It can inspire us to feel empowered to create possible futures that are more workable than the present. My call to action- to spend more time contemplating and exploring our individual and mutual aspirations, can inspire us to re-envision the frame of our lives, and then to enact that vision. The fruits of that exploration may surprise us all.