by Ron Epstein MD
In addition to my teaching and clinical work, I lead research teams devoted to helping patients and their families have a voice in their care and helping clinicians develop the skills to communicate effectively. Good communication with others depends on knowing yourself; mindfulness and self-awareness help you to calibrate and adjust to the inevitable biases in perception and judgment that you might have.
Increasingly, though, I see the skills that we need as clinicians as relational and collective, not merely individual. Patients trying to be active partners in care need clinicians working with them to welcome and facilitate their participation. It’s a two-way street. But there’s more. Patients live in a social network of individuals that provide information, emotional connections, advice, and warnings, not only transportation, food, and shelter. And we as clinicians also participate in social networks to promote excellence in care and our own well-being and survival.
In my mind’s eye, I see every moment in my clinical life as meetings between social networks as well as meetings between individuals. Social networks are rarely static; they are fluid, changing, and transforming based on our external and internal environments. Being mindful – attentive, curious, beginner’s-minded, and present – is not merely individual; mindfulness also resides in the space between social and individual. I say, “in the space between,” because to regard mindfulness as either one or the other – social or individual – only captures part of the reality. And that “space between” is in dynamic flux; it is a process, not a thing. It changes shape, moves and expands, and contracts with each breath.
This view – social and individual – is beautifully developed in a recent book by my friend and medical school classmate, Dan Siegel. Dan is a child psychiatrist and prolific writer about mindfulness and mental health. His most recent book, “Intra-connected,” 1 explores how the delusion that we are separate “solo-selves” can lead to burnout, moral distress, despair and intolerance, and, on a global scale, to political and environmental strife. He suggests that we are, to a degree, individuals connected to one another, and also parts of some larger whole, capable of inhabiting the worlds of “me” and “we.” Our perceptions of the world, our thinking, our values, our emotions, and our presence arise in each of us as individuals, as collectives, and in the space between us, as a “shared mind.” 2-5
Health professionals’ feelings of isolation, burnout, and frustration have mushroomed during the pandemic and its aftermath. The stresses related to staffing shortages, lack of face-to-face meetings, cumbersome and disorganized health care systems, and excessive attention to through-put rather than quality have led to a deterioration of our sense of joy and well-being in medicine. Depending on who you are and your work environment, one first step might be in considering your sense of “me” and “we” in your work life.
Take a moment to bring to mind the team or group or organization with whom you work. In what ways is it me-like, and in what ways is it we-like? Now, if your team was functioning optimally, what would you observe about the team – as a member of the team? What would you observe about yourself as a team member? What would you notice about the quality of leadership in the team? What would others notice about your team? How would you and your team handle conflicting perspectives, errors, uncertainty and moral distress? And, how would you be contributing to the me-fulness and the we-fulness?
Exploring these questions myself over the past three years of the pandemic, I came up with one way to build that sense of “me+we” by considering the social network to which I belong and expanding my awareness and sense of inclusion. To take a first step, reflect on members of your social network that help you thrive and feel connected; those who make you feel more whole and those with love, wisdom or insight. Also consider those who challenge your worldview; and those who might not yet be part of your “bubble.” Then, consider how each member of your social network might help you bring energy, joy, purpose, meaning, resourcefulness, and robustness to your work, how you can help bring energy, purpose, resourcefulness, and robustness to theirs, and how you each can offer greater flexibility and creativity in navigating the me-we world of your health care teams and organizations.
1. Siegel DJ. IntraConnected: MWe (Me + We) as the Integration of Self, Identity, and Belonging. New York, NY: W. W. Norton Company; 2022.
2. Chatel-Goldman J, Schwartz JL, Jutten C, Congedo M. Non-local mind from the perspective of social cognition. Frontiers in Human Neuroscience. 2013;7::107.
3. Epstein RM. Whole mind and shared mind in clinical decision-making. Patient Educ Couns. 2013;90(2):200-206.
4. Epstein RM, Street RL, Jr. Shared mind: communication, decision making, and autonomy in serious illness. Ann Fam Med. 2011;9(5):454-461.
5. Zlatev J, Racine TP, Sinha C, Itkonen E. The Shared Mind: Perspectives On Intersubjectivity. Amsterdam, Netherlands/ Philadelphia, PA USA: John Benjamins Publishing Co; 2008.