For several years, I''ve been leading a group singing session at my hospital on Monday afternoons. My repertoire consists mostly of spiritual Jewish melodies, American folk songs, and Rock tunes from the ''60s. The music serves as a wonderful bridge among participants, and the forum gives patients and caregivers a chance to ask me questions about cancer and its treatment.
There''s another reason, too, why I value the encounters. To put it bluntly, I suck as a guitarist. When I make mistakes--I always do--another of my dimensions comes into view. My vulnerability.
In the best-selling book Daring Greatly, Dr. Brené Brown, professor of social work at the University of Houston, defines vulnerability as the process of "daring to show up and let ourselves be seen." She cogently argues that vulnerability is at the core of meaningful human connectivity.
Being vulnerable has always appealed to me, but there are obstacles. In our society, there are unequivocal messages: Be strong! Man up! Some people equate vulnerability with weakness. Accordingly, although I like the idea of vulnerability, dissonance emerges.
In my profession, there are additional barriers to dissuade physicians from being vulnerable. From the time when Freund popularized the concepts of "transference" and "countertransference," we have been on guard to prevent unconscious redirection of feelings between doctor and patient. I—vulnerably—admit to being a maverick on that point. I feel that my peers and even my mentors have over-corrected for their anxieties about crossing boundaries (and, frankly, for their fears of being sued). As a result, the relationship between patients and their physicians is often sterile rather than sacred. Freund worried that physicians and patients would become emotionally entangled. I worry that the two parties are no longer emotionally engaged.
As I''ve matured, I''ve taken steps to allow my vulnerability to manifest. Today''s patients are aware of their rights and, partly thanks to the Internet, they’re very well educated. At the outset of my career, I was startled and scared when patients posed challenging questions. I tended to dodge or try to re-direct. With time, however, I’ve come to understand that my avoidance was not genuine. Now my goal is to take ownership of my knowledge gaps, to say, "I don''t have the answer to that, but I''ll find out by reading the literature and speaking with experts." Although vulnerability sits embedded in that acknowledgement, I find that patients don''t think less of me for not knowing all. Rather, they seem to draw closer, realizing, I think, that we both share the common bond of being human.
Vulnerability has fortified my relationships with colleagues. Several years ago, one of the junior faculty members confided that while treating a woman for an advanced cancer of the tongue, he had failed to notice a nearby advanced tumor in the vocal cords. When I saw how distraught he was, I managed to overcome my tendency to suppress a story from my past. As a young doctor treating a patient for a small skin cancer, I forgot to do a thorough physical exam and, therefore, missed a tiny nodule in the man''s prostate. By the time the prostate cancer was detected, it was no longer controllable with a simple course of radiotherapy. Although both the young doctor and I were devastated by our respective oversights, my colleague understood what I was telling him. We all make mistakes. And in my case, the "failure to diagnose" made it harder to achieve cure, so it had, of course, been agonizing to share my failure with my patient and later with a peer. Yet, in both scenarios, my vulnerability was met with gratitude, and somewhat ironically, deepened trust
The real challenge, though, is to assume the risks of vulnerability in our private lives. In so doing, we have an opportunity to experience intimacy with the people we care about. But there is not just the issue of risk. There is also the matter of propriety. Nearly a year after embarking on this blog, I notice a continual lowering of my resistance to speak about personal flaws. If Dr. Brown were to click on "52" I would hope she’d applaud at least my effort, but I imagine she might simultaneously caution me against oversharing and indiscriminate disclosure.
Specifically, she discusses the concept of "floodlighting." The term refers to our inclination to overwhelm listeners with too much information, so that they tend to recoil when we carelessly discharge our vulnerability. When that happens, according to Dr. Brown, people often "…wince, as if we have shone a floodlight in their eyes."
There are dangers when we expose our vulnerability, but overall, the positives, I think, considerably outweigh the negatives of inauthenticity, of not being who we genuinely are. So, I think, we must learn to deal with the risks of vulnerability by finding ways to feel comfortable with feeling uncomfortable, so that we can truly be ourselves and ultimately, grow beyond what we are today.
Until next Monday, Shalom.