Reflections on the Sidney Project: Can We Talk? Can We Give Voice to the Taboo Topics That Are Usually Not Embraced in Residency Medical Education?
by Janet Lynn Roseman, PhD, R-DMT, MS
The entire Universe is condensed in the body, and the entire body in the Heart. Thus the Heart is the nucleus of the whole Universe. —Sri RamanaMaharshi 1
My life changed after witnessing the death of my father, Sidney, who passed away in 2009 at the hands of a wounded medical culture that in my opinion refused to acknowledge that his life was a life worth saving. This horrific tragedy came on the heels of the death of my mom, who I also adored. After my mother’s passing, I had the opportunity to know my dad from the bones and saw his softer side emerging. His presence was a soothing balm for me, as I struggled to inhabit a world without her. My dad had always been my rock; however, now, we had a closer bond, firmly rooted, and that bond continues although he is not physically present. I was driven to take action in an effort to guide physicians to remember their sacred oath to ‘‘first, do no harm.’’ It was my hope that through reflective education another daughter could be spared from navigating the same journey that I experienced. This paper discusses the Sidney Project in Spirituality and Medicine and Compassionate Care, and briefly explores the concept of Jung’s ‘‘wounded healer’’ as a rich source of physician’s self-reflection and subsequent empowerment and the author’s belief of its foundational importance in medical education. During the Sidney Project program, residents explored these wounds through dialogue, somatics, meditation and arts-based techniques.
The Sidney Project
I created the Sidney Project in Spirituality and Medicine and Compassionate Care to provide physician residents an opportunity to receive training and awareness of the significance of spirituality, compassionate care and caring in the medical encounter. The program offered 16 participants from various disciplines opportunities to explore and reflect on compassionate medical training, including hands-on guidance and tools for the integration of spirituality and compassionate medicine into daily patient encounters. Participants also learned strategies for improving the patient/physician relationship and candidly discussed with peers their fears, joys and concerns in a safe environment cultivated over three months of weekly meetings held at two hospitals in South Florida: Broward Health Medical Center and University Hospital. The program included residents from several disciplines at Broward Health whereas the participants at University Hospital were all residents in the psychiatry program. Participants completed a pre and post survey identifying their previous experiences with the subject matter; at the end of the program, they presented papers based on their research on any aspect of spirituality and medicine and compassionate care that they were drawn to. They also received certificates of completion. I was fortunate to find a great deal of support to orchestrate the program and I am grateful to Dr. Joseph DeGaetano, Dr. Mariaelena Caraballo and Dr. Natasha Bray for their encouragement and for opening the doors to this project.
Various themes were discussed including:
- Self-Care and Self-Renewal
- Rediscovering the Soul of Compassionate Medicine
- The Power of Healing
- Revisiting the Osteopathic Oath of Healing
- The Asklepian Tradition and the Wounded Healer
- Patient Centered Interviewing Skills
- Humanistic Excellence: Presence, Silence, and Connection
- Breaking Bad News
- The Role of Spirituality in Medicine
- Art Therapies in Medicine
I hoped that by creating a safe forum where physician residents could share narratives and challenging patient encounters that explored the human side of illness, they could not only acquire and discuss self-care strategies, but discuss their emotional terrain with peers including the taboo topics such as physician woundedness and beliefs about the mythology of physicians. It was hoped that through this exploration they could develop a keener consciousness of the importance of compassionate medicine. It is noteworthy that participants cited that the sharing of stories about both patient connection and the failure to make these connections was important to discuss and honor with peers.
In my experience as teacher and therapist, the creation of safe space is not something that can be organized or taught, it is cultivated. I believe it is a sacred interchange created by participants who feel enough trust and respect for their colleagues to share their experiences and opinions openly, knowing that their point of view will be witnessed and most importantly heard and received. This sense of trust evolves organically and is often communicated nonverbally through an energetic exchange so people know, deeply in their core, that it is safe to speak and that they will not be judged. To feel that one can communicate one’s authentic story and that it was heard and received and could make a difference in another person’s life is always a blessing. The cultivation of such sacred space in medicine I believe can help remind physicians that their work can be a spiritual practice if they choose.
Echoing Native American philosopher Eber Hampton, ‘‘Health practitioners must be concerned with spirituality, at the center of which is respect for the relationships that exist between all things. We must nurture these spiritual relationships and allow them to work on us.2’’ The creation of these ‘‘spiritual relationships’’ between physician residents and their patients was a goal for the Sidney Project. It is significant that when residents had the opportunity to share their narratives withmembers of the group candidly and in an environment of trust, these ‘‘spiritual relationships’’ could flourish and provide nurturance for participants. Such nurturance is foundational for physicians and can offer the chance to improve the physician/patient encounter.
In a study on compassionate patient care, Anandarajah and Roseman found that it was possible for physicians to see ‘‘medicine as providing opportunities for them to grow in compassion, essentially employing medicine as a spiritual discipline.3’’ This consciousness of compassion and chance to integrate medical practice as a spiritual discipline also can be a natural conduit for the cultivation of self-compassion. The idea of physician self-care is not new; however, providing a forum that includes both the light and the shadow emotions of patient care experiences can be an important part of physician self-care. I would strongly suggest that it is not only important but it should be required training in all residency medical education to provide for a safe forum to discuss such narratives without fear of being judged by supervisors and peers in order to prevent the projection of one’s own wounds on the patient-physician encounter. As psychotherapist Carl Jung stated at the end of his life, ‘‘Only if the doctor knows how to cope with himself and his own problems will he be able to teach the patient to do the same.4’’
Although the Sidney Project addressed many topics, feedback from the participants indicated that the opportunities to talk about patient cases and share ‘‘real feelings’’ in small group settings were most meaningful. At the end of the program, one resident said, ‘‘Thank you for sharing your thoughts and opening up and sharing stories. It’s been a pleasure getting to know you all better. Our discussions are what I enjoyed the most.’’
According to Natasha Bray, DO, MS, Director of Medical Education at Broward Health, ‘‘The spirituality in medicine course allowed residents to bond together and feel supported in exploring the challenges with keeping humanism in a highly scientific and often depersonalized medical establishment. Little time in medical education is set aside for reflection on how treatment plans often challenge the very core of our patients. The loss of privacy and dignity is often given little attention as patients are shuffled through a busy clinical day. Equally neglected is the emotional stress and turmoil that physicians in training experience in the lack of time that is devoted to thoughtful reflection on the lives that we touch. Physicians are taught to compartmentalize their emotional response to allow for clear thinking in the care of patients. While this is often necessary in themoment, they are taught to not experience the human connection with their patients and therefore damaging the sacred patient-physician relationship.’’ Such compartmentalization often erodes the physicians’ opportunities for self-care and reflection and the chance to discuss openly the mythology of being perfect (an unrealistic expectation for any profession) was very important to participants.