Cultivate, curate culture of compassion in your practice
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“Culture eats strategy for breakfast.”
– Peter Drucker
Since I was last in your company (while I write, I imagine myself surrounded by a group of colleagues who, like me, spend a meaningful percentage of their time taking care of patients with dry eye disease), I had a very nice 2.5-week break from my daily routines of office and OR. My vacation culminated in a celebration of my birthday arranged by my darling bride, Beth, and my daughter, Megan. Although I write an annual column about my New Year’s dry eye disease (DED) resolutions, and I do make a perfunctory effort to come up with a personal resolution or three, it is actually on my birthday each January when I take the measure of where I find myself each year.
As a prompt for this tiny introspective indulgence, I engage in a little thought experiment each birthday: If one could choose to stop the aging processes at a particular point, arresting the degenerative effects of getting older at the expense of other more positive changes such as the accumulation of wisdom, is this the birthday on which I would choose the red pill? In return for stopping the physical and mental decline brought on by age, one would lose the ability to continue to grow in all other ways. I will tell you my answer in a bit.
In management circles, it is said that any organization gets the culture that it deserves. We have all been taught that nature abhors a vacuum. Those organizations that consciously and purposefully choose a culture, and then do the hard work necessary to curate that culture, tend to be more successful than those that ignore culture. Those that fail to create a culture must make do with whatever culture grows in that untended vacuum. Super successful enterprises of all kinds that choose and then curate the right culture for their particular space usually end up being better at whatever it is they do. I propose that a DED clinic should cultivate a culture of compassion.
Of course, a willing culture is not enough to foster success. There must be a baseline level of expertise involved no matter what your business might be. I think of this expertise as the “table stake” or ante. For us in the dry eye world, this includes the acquisition of an understanding of the underlying causes of DED. We must be able to parse the various clinical presentations of DED so that we are able to make an accurate diagnosis of the particular flavor of DED present in any given patient. From here, a leap must be made, analyzing the data, formulating a plan consistent with our findings and then helping our patient to implement that plan. All of this can be rather formulaic if you are so inclined; a protocol-driven process can be quite successful in the diagnosis and treatment of DED.
Is that enough, though?
One of the lovely things that I enjoyed over my end-of-the-year break was the luxury of reading for pleasure. Do you do that, treat yourself to time to read without any expressed goal other than the joy of the written word? My brother-in-law Peter and I trade books back and forth. We are particularly fond of the work of Blake Crouch, a science fiction writer. I think I may have mentioned his novel Dark Matter in a column once upon a time. His latest, Upgrade, is about an effort to save the Earth and the humans who inhabit it from themselves by unlocking the untapped cognitive powers in our brains. As that relates to the treatment of DED, think of the proposed “upgrade” as increasing all of our clinical competencies as the single means to improve our ability to treat patients with DED.
Dry eye disease is in many ways a disease of chronic pain. To be sure, not every patient with DED is in pain all the time, but the patients we all remember certainly are. We saw a young woman in the clinic this week who lives every day with pain that never goes below 5 out of 10; it is usually above 8. As it turns out, her pain, while centered on her eyes, is an example of non-DED neurogenic pain. What she needed from me and the rest of our DED team at SkyVision was enough clinical competence to decode her story and her findings and arrive at this diagnosis. Even though we offered no treatment, what we all provided her was more important than any prescription we may have had at our disposal.
We offered her the collective grace of our compassion, an expression of our humanity, listening to her story and sending her back to her neurologist reassured that she need not add DED to her burden.
2022 was a hard year for the White family, one in which we learned an awful lot about what it means to live in pain. We are all fine now, thank you, and I would like to think that the lessons we learned about not only ourselves, but also about how we go about our mission as health care givers, were simply reminders, not epiphanies. Chronic illness and chronic pain can rob us of our humanity. To be fair, one need not empathize with someone so afflicted in order to sympathize with their plight. What I learned is that in order to help save another’s humanity, we need to be fully engaged with our own.
Without giving away the ending, Upgrade teaches that the best of humanity can only be approached through the invocation of compassion. In the pursuit of whatever the best possible care of DED patients may be, IQ alone is not enough. Expertise, as described above, is not enough. Medicine, in our case the care of dry eye, is more — it has to be more — than simply an inexorable march toward greater knowledge and competence. For us to successfully treat patients afflicted with this chronic, painful disease, we must create a culture of compassion in not only ourselves but in the entirety of our practices. A compassion that surrounds our knowledge and our competence and guides us in the treatment of the person who sits before us at the slit lamp rather than simply the disease presented.
And my annual thought experiment? Is this the year I would choose in which physical and mental decline would be arrested at the cost of no longer growing in any other ways? No, not quite yet, I think. On balance, there appears to be more growth to be had. My physical challenges appear to have made me better at living and working in the culture of compassion that we have created and curated in our little part of the DED world. As much as anything else, it is the compassion that we all bring to the treatment of each patient with DED that ultimately makes the difference.
Net, on balance, the sum of whatever declines I may have weathered have been more than balanced by the wisdom I have gained by being better at both giving and receiving compassion.
- For more information:
- Darrell E. White, MD, of SkyVision Centers in Westlake, Ohio, can be reached at dwhite@healio.com.
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