A Physician's Skills of the Heart

<An interview with David Leach, MD, CEO of the Accreditation Council for Graduate Medical Eduction (ACGME)

Why do you think it is important for physicians to connect their inner lives with their work in the world?

It turns out that healthcare is better if the whole doctor shows up. One of the problems with healthcare is that it requires such intellectual rigor that frequently just the intellect shows up. While we have honed the skills of the head and of the hand, we need to pay much more attention to the skills of the heart. Courage & Renewal retreats honor the heart and create a safe space for the heart to emerge. People get used to, and develop, a disciplined approach to the skills of the heart. It dramatically improves health care.

Patients need more than sympathy. They need a doctor’s objectivity but also the doctor’s subjectivity to be fully present. This work makes better doctors because it enables the whole doctor that has the hands and the heart to show up at the bedside.

How are the principles and practices of Courage & Renewal work applicable in medicine?

Throughout medical training, you come to accept the frenzy of modern healthcare that doesn’t enable or even permit a deep feeling, therapeutic relationship with patients. You come to accept patients not being treated in ways that are fully respectful. The principles of Courage & Renewal work restore that space. It creates a space in which you can actually have a healing relationship with a patient, where you can deeply respect and understand their needs and your own abilities and your own limitations.

Parker speaks of institutions being not external to ourselves but rather, projections of ourselves. To the extent that our institutions are rigid or uncaring it’s because my heart is rigid or uncaring. When an individual can be fully present, an institution can ultimately be fully present and fully supportive. It is terribly important work – as important or more important than the wonderful advances in genetic engineering and in imaging techniques and so on, because it gets at the missing dimension of healthcare.

How did you first hear of Parker Palmer? What was most compelling to you about his ideas?

I first encountered Parker in the late 1990s, and it was in summer camp at Dartmouth. Each year Paul Batalden, MD convenes about 70 people – doctors, nurses, and health care administrators. We gather for a week to explore ways of improving patient care. Paul played a video tape of Parker’s remarks at the Institute for Healthcare Improvement. The tape was profoundly moving and I realized that it had as much to do with the teachers of medicine as well as teachers in other professions. When I returned home, I called Parker. I didn’t know him, I’d never met him, but I asked if I could give his name and the title of his book for a Parker Palmer Courage to Teach Award for medical residents and program directors. We hit it off in a wonderful way.

I took the tape back to the ACGME board – some of the major players in American medicine. I played the video at a board meeting, without any comment or introduction. At the end of the tape people were crying, and people were saying, “Who is this man?” It turned out be a very good way to introduce Parker. The idea of living divided no more, of not violating any deeply held inner truths with your external behavior has such power and such attraction that is universally appealing.

Could you tell me more about the ACGME Parker J. Palmer Courage to Teach Award?

The award is to recognize ten exemplary program directors of residencies who find innovative ways to teach residents and provide quality health care. We’ve had over 500 nominations per year. The awardees are individuals who are treating their work as a vocation rather than an occupation, who have responded deeply to a calling, and uniquely, are deeply authentic and living “divided no more.” The award includes a celebratory dinner and a $1000 honorarium. The second part of the Award is a retreat supported jointly by ACGME at the Fetzer Institute, in which we use the principles of Courage & Renewal.

Parker always says we teach who we are. That is very evident in these awardees. They’re all unique, they’re all different, and it is because they are teaching who they are and that comes through in the nomination letters. We consider the authenticity of the program director. We see incredible stories of heroism. For example, an awardee in New Orleans, after Hurricane Katrina, called parents of every resident every night to make sure that they knew that everybody was alright.

How do you see this work being carried further into medicine?

We have about 80 awardees right now, which is one percent of program directors and they infect their own institutions. One of our awardees is an anesthesiologist at Duke. She did grand rounds by reading poetry. There were a couple hundred people in the audience, they were silent. No applause. Nothing. She thought she had failed miserably. The next morning, she opened her email and found over 100 responses from those attending saying it was the most profound experience they had ever had. Institution by institution, these awardees are infiltrating and infecting the institution with moral goodness.

Are there any other ways that you could share how being part of the Courage work has influenced you in your life?

It’s been one of the highlights of my professional career. I fit into my skin again. I feel like a whole human being, and I’m not living a divided life. I don’t know that I would have had the courage to do that without going through this experience. It’s been one of the absolutely seminal experiences of my life and I’m deeply grateful for Parker’s work. It has helped me and it has helped a profession that I love.