Aaron Wong, ND, RTC
Imagine how we would feel if we went to work feeling passionately inspired to see all of our patients. Challenges would come up, but in those times we would know we could make decisions clearly and ethically and that if we needed help, we could rely on the support of others. As doctors, we could be fully present with our patients, but also know that others had our backs as well. We would go into work feeling refreshed because, in our off-time, other healthcare professionals helped take care of us emotionally, physically, mentally, and spiritually. We could then be emotionally responsible with our patients, being there for them completely without any of our projections landing on them. What a gift that would be for us (as doctors) and our patients alike. I believe that the most balanced and sustainable way to be the best doctors we can be involves self-care and a developed self-awareness through personal, spiritual, and shadow growth work.
This concept of self-care, balance, and personal work sounds so simple in theory; however, its application can present challenges. I believe this model to be at the cutting edge of changing medical practice and how we conduct ourselves more ethically and authentically as healthcare professionals. Naturopathic physicians can be leaders in this paradigm shift. Much of it begins with really looking at ourselves and practicing what we preach. Taking care of ourselves involves no secret recipe; the foundational roots of our own healing are found within our guiding principles and the Therapeutic Order. In applying naturopathic principles and the Therapeutic Order, naturopathic physicians have the inherent advantage of having a deeper understanding of the material than the average patient and being able to really dive in and take a holistic look at ourselves in terms of our own personal and spiritual growth. Awareness around self-care to prevent burnout and compassion fatigue is gradually becoming more mainstream for healthcare professionals.1,2 Our very own medicine is the solution to the sustainable health of our profession and maybe other professions as well as we look forward.
Here is how “Physician Heal Thyself” lies in the roots of our medicine…
Living By Our Naturopathic Principles
First, Do No Harm (Primum non nocere)
Do no harm to others
In order to do no harm to our patients, we must strive to be sound – mentally, physically, emotionally, and spiritually. It should be obvious that physicians meet the minimum requirements of holistic health to make clear clinical decisions. This means that it is our responsibility as doctors to be in the right state of mind when making clinical decisions for our patients, rather than being in a burned out, mentally fragile, reactive, triggered, or emotionally distressed state.
Not doing harm also applies to the words we use and the state we are in when we receive our patients and deliver our treatments. It can be as minute as the thoughts or judgments we carry into our treatment rooms. Patients can feel our unconscious communications even when things are not said overtly.
How many times do we hear horror stories of other practitioners from our patients?
You may have heard about the doctor that:
- didn’t take the time to listen to their patient
- dismissed their patient’s symptoms or their experience
- gave their patient relationship advice based on “my own experience”
- berated or scolded their patient for not doing their treatment homework
- was so uncomfortable when the patient cried that they uncomfortably changed the subject and left the treatment room
- got into a verbal shouting match with their patient
These are examples of how our own stuff as physicians can enter the treatment room and potentially cause harm to our patients. It isn’t physical harm and might not have immediate danger, but in the holistic framework of our medicine, it’s harm, nonetheless, and interferes with the healing and therapeutic process; it also isn’t responsible or ethical conduct for a physician.
We want to be able to have a sense of peace within ourselves, so that when we receive our patients we can be fully present with them and show empathy and compassion. Every patient visit presents an opportunity for us to show a genuine curiosity in what our patients are going through and to offer them the ability to be heard, understood, and cared for. This starts with emotional responsibility, which means that we take care of our own internal process outside of patient visits so that it doesn’t get projected onto our patients. We want our patients to feel our open hearts and a real sense of connection.
Do no harm to self
When we have a tendency toward a Nux vomica-like mentality of overwork, we put ourselves in an unsustainable state of depletion.
As much as self-sacrifice is considered noble in some contexts, it is not a tenet of holistic medicine. Sacrificing our own well-being for the health of our patients is not only unsustainable, it also leads to burnout and irresponsible medicine.3
The Healing Power of Nature (Vis medicatrix naturae)
How do we honor our own vital force as the doctor? For me, naturopathic medicine is a calling. It aligns deeply with my values and what I want to see in the world. It moves my spirit and helps me feel aligned with purpose and passion. I believe that this joyous and deeply heartfelt place is where our medicine should spring from. As naturopathic physicians, the passion we have for our work is a powerful force that can inspire change. It vitalizes us and our patients alike. Recognizing when we are not in spiritual alignment or living our purpose/passion is crucial in practice. It might present as a symptom that calls for self-care or personal work, highlighting our own need for growth or change within ourselves.
Identify and Treat the Cause (Tolle causam)
As holistic physicians, self awareness is the greatest gift. We want to know our shortcomings and our faults. Developing self-awareness of what needs healing within ourselves is a blessing that helps us take steps toward personal growth.
As physicians, we sometimes assume we can figure things out all on our own. But just like everyone else, we also need help at times.
To identify and treat our own cause of disease, asking for outside help from another healthcare professional can be truly humbling. When we can eliminate our own bias and get out of our own way, reaching for that outside perspective can bring tremendous relief. From a holistic perspective, it’s perfectly OK and even encouraged to seek help when we need it.
A fine balance is required in being in a helping profession. Our input or self-support/self-care has to equal, if not exceed, our output or healing work.
Identifying and treating the cause can mean being faced with a choice to be vulnerable with our struggles and to ask for help when we need it.
Doctor as Teacher (Docere)
We want to lead by example for our patients. Practicing what we preach is a necessity. It behooves us to walk the talk as a facilitator in holistic health because our genuine and authentic first-hand experience with our recommended treatments usually comes across to our patients. A lack of experience in navigating our own emotional territory will show as an obvious lack of confidence; it will also appear incongruent because our words won’t match our unconscious communication.
Because of the power dynamic between doctor and patient, it is expected that we will be able to hold a container of safety for our patients. To be able to practice holistically, we need to walk our own path with curiosity and courage. Doing self-healing work takes bravery, but also inspires others to follow our lead. We need first-hand experience with deep levels of healing work. We can’t lead patients to where we have not ventured ourselves.
This doesn’t mean that we need to be perfect, but it does require deeper self-awareness than was taught in our naturopathic training. This means having the willingness to make an effort to gain insight and to take action towards growth when necessary.
Treat the Whole Person (Tolle totum)
Taking care of our own mental, physical, spiritual, and emotional well-being honors the self as a whole person. As healers, we have the privilege of nourishing our own spirit through helping others in their healing journey, and we have the luxury of having the experience of this healing first-hand if we choose it.
Considering ourselves as a whole person reminds us of our humanity. It is a reminder that we are worthy of support and that we matter, just like any other human being.
Prevention (Praevenir)
Knowing that our work is never done, and having the foundation to work with our struggles as they come up in our lives, is vital and also key for a sustainable career in a caring profession.
The principles come full-circle here. We need to do our own work as prevention, ie, to prevent harm to both our patients and ourselves.
Walking Our Talk
If we are following the Therapeutic Order, we can easily establish our own foundation for optimal health, which is a necessary and important step to being in naturopathic practice. If we do not practice self-care and live by the principles of naturopathic medicine, how can we possibly expect our patients to follow us and believe in our medicine?
The area of holism that I believe our patients and our world need more help with than anything else is the area of mental and emotional well-being. Historically, we have been taught to deal with our mental and emotional states in unhealthy ways. In our culture, we have been conditioned to not enter emotional territory. Emotions are vulnerable. The judgments we have around emotions are evident in our language and are unhealthy. We hear and say things like, He or she is so/too emotional, Get over it, Stop crying, Boys don’t cry, Don’t be sad, or You’re being extra (taught to me by one my teenage nieces).
New paradigms around mental and emotional well-being are emerging. Naturopathic physicians can be leaders in this arena, but we have to first look at ourselves and be able to work on our own personal shortcomings as individuals and as a whole. We are exceptional at addressing physical ailments in natural ways, but we have more to explore and learn when it comes to mental and emotional well-being, even though we expect this of ourselves.
So how do we get better at this? How do we better navigate the mental and emotional field with our patients? The starting point is exploring our own emotional state. Our own personal/spiritual/shadow work strengthens our ability to help our patients. I firmly believe that we cannot lead patients where we have not walked, and doing our work builds empathy and compassion. Doing our own work helps us be more accountable, authentic, and transparent in our patient interactions, which builds trust and genuine connection. An invaluable lesson in healthcare is becoming better with boundaries; recognizing the clear line between us (as the healthcare provider) and the patient is knowing our values, our worth, and our job.
If we push through our feelings and ignore how we feel in the interest of getting things done and working hard to “power through,” that is the mindset we will bring to our patients.
We may think that we are naturally good in all of these areas, just based on being naturopathic doctors. In reality, we can probably all use some help in improving in these areas on an ongoing basis, and assuming we are good at something that we have little formal training in only leads to denial, ignorance, and irresponsibility.
I know that looking at these areas over the last few years has helped my practice along with my overall health and well-being. One of the major lessons I have learned along the way is to reach out and ask for help from those I trust – people who walk their talk every day. Naturopathic physicians can be leaders in setting an example of sustainable healthcare practice that equally considers self-care and the care of others. All of the guidance we need is within our guiding principles if we so choose to see it.
References:
- Sanchez-Reilly S, Morrison LJ, Carey E, et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013;11(2):75-81.
- Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385.
- Collier R. Physician burnout a major concern. October 2, 2017. CMAJ. 2017;189(39):E1236-E1237.
Aaron Wong, ND, RTC, is a naturopathic physician and registered therapeutic counsellor in Vancouver, BC, Canada. Dr Wong is the Clinical Director of Butterfly Naturopathic, where his clinical focus is mental, emotional, physical, and spiritual well-being. He created the Conscious Clinician Movement to help healthcare professionals become the best versions of themselves and to evolve and transform healthcare. Dr Wong is a graduate of the Boucher Institute of Naturopathic Medicine, where he is also a clinic faculty supervisor. Dr Wong is the first naturopathic physician to complete the Teacher Certificate program through the UBC Faculty of Medicine. Personal profile: https://www.facebook.com/aaron.h.wong.9803
