Hospital(ity): On Being and Bringing Your Authentic Self to Work
“Just be yourself.”
This adage was often shared with me as an encouragement before medical school and residency interviews. Yet when I have conversations about “being oneself” at work as a surgical resident, I’m met with something between confusion and disagreement. The hospital, I’m sometimes told, is no place to attempt authenticity. This reaction is unsurprising, given that most of us in medicine have trained within a framework which promotes neutrality rather than authenticity, wherein practitioners are encouraged both explicitly and implicitly to operate from an objective position (rather than out of their own belief systems). We are frequently complicit abettors in this imagination of professionalism that, for patients and practitioners alike, supplants a “who” with a “what.” From the language of surgical patients as operative “cases” to the proverbially anonymous “57F w/ HFrEF 35%” to labels like “my intern” or “the attending.” Despite the reality that much of our waking time is spent with our colleagues, our authentic selves are often in danger of erasure.
When it comes to authenticity in modern medicine, sociologist Brené Brown has helped me articulate what I long to see (and be) over and against anonymous neutrality. She writes, “Authenticity is the daily practice of letting go of who we think we are supposed to be and embracing who we are…the choice to be honest…to let our true selves be seen.” In the business world, leadership characterized by authenticity (rather than neutrality) is associated with more constructive behavior amongst employees, more trust and hope in the organization and in its leaders, and even improved performance. In a vocation as interpersonally complex as medicine, authenticity begets the same benefits—even going so far as to alleviate burnout.
And yet, in day-to-day decisions and conversations with patients, many healthcare practitioners report reluctance in consciously acknowledging the importance of their authenticity. How did we get here—nameless and neutral providers treating nameless and neutral problems?
Neutrality and Authenticity at Work
This problem started around the Enlightenment with the reimagining of the world as one whose properties could be explained by natural systems rather than as a function of supernatural forces. The physician, once more akin to a religious healer, was transformed into a natural scientist who could determine reality empirically—independent of external bias. Over time, neutrality infiltrated not only the natural sciences, but also the spheres of morality and ethics, becoming a core tenet of the four-principle framework of bioethics known as “Principlism” which dominates ethical training in medicine today. Thus, beginning early in medical training, neutrality is upheld as a crucial component of “good” patient care.
But I think this is only part of the story. Even as medicine embraced a medical professionalism of neutrality and objectivity, society began embracing an ethic of individual authenticity. This is what the philosopher Charles Taylor describes as “expressive individualism”—a “you-do-you” form of authenticity that emerged from the late eighteenth century Romantics and propagated in the post-war era. Individualist authenticity is the idea that each of us has a unique and individual way of “realizing our humanity, and that it is important to find and live out one’s own, as against surrendering to conformity with a model imposed on us…by society, or the previous generation, or a religious or political authority.” Nestled in this ethic of authenticity that allows each person to “do their own thing” is also a “soft relativism” that sees individual freedom as exclusive from a commonly held set of virtues. In that sense, even though individual authenticity seems to celebrate and encourage being oneself, it actually fosters a kind of neutrality. Individualistic authenticity requires us to be neutral as it is the only way to avoid “the only sin which is not tolerated: intolerance.” Neutrality, then, is a byproduct of a kind of paradox: both a push for objectivity in medicine and an individualistic distortion of authenticity.
As an antidote to this ethic of neutrality and individualistic authenticity, we might look beyond the Romantics or the Enlightenment, further back to the beginnings of our vocation where hospitality was paramount, a medicine whose very nature required that we be known in order to know and nurture others.
Practicing and Performing Hospitality at Work
The early Christian church established the first hospitals (xenodochia)—structures whose explicit purposes were to house and care for sick strangers. These early spaces of healing operated under an ethic of hospitality—a radical pattern of relating to guests or strangers who, in a state of sickness, were not often socially related. Theologian Luke Bretherton connects this hospitality with authenticity, noting that because hospitality welcomes strangers, it also situates people within their own particularities and values while maintaining the premise that each one belongs. Thus, rather than presuming any commonality in values among strangers, hospitality celebrates authenticity while maintaining real community. Even when beliefs differ, this ethic of belonging permits patients and practitioners to both acknowledge their values and welcome strangers all the same.
The modern hospital faces the challenge of being re-formed to invite and nurture this ethic of hospitality. Efforts to do so are already underway; the purpose of “The Healer’s Art” course developed by Rachel Naomi Remen is to cultivate authentic community and restore humanism in medical trainees. Courses like this are effective for those who elect to participate, but to the extent that they are optional, the pursuit of authenticity and hospitality is at risk of remaining individual rather than institutional.
And although hospitals are now disconnected from the faith traditions within which they originated, perhaps they might once again borrow from these ancestral institutions to make hospitality a communal, normative pursuit. For example, theologian Stanley Hauerwas notes that for the Christian church, the virtue of hospitality is formed in the ritual performance of gathering together. As the church performs hospitality in its gatherings, the habit of hospitality is cultivated, and in a time of great stress, “the community trusts the habits formed from those skills, and concentrates on doing the obvious.” In other words, by gathering to practice making space for strangers within their particularities and values, the church is able to perform hospitality when the moment arises to do so.
Practitioners gather to rehearse simulated codes, complex end-of-life discussions, or difficult procedures in order that they might cultivate the habits to perform those skills in real-time. And although the idea of gathering with one’s colleagues with the explicit purpose of cultivating hospitality and supplanting neutrality with authenticity may evoke feelings of discomfort or irritation at “another thing to check off,” the premise is no different than any of the other essential components of training and patient care for which we set aside time. A “hospitality hour” could be as integrated into the rhythms of the hospital as Morbidity & Mortality or Grand Rounds. Rather than a forced meet and greet, this would be a space where medical trainees unmask—an unstructured time to simply be without expectation of a specific “wellness” by-product, such as number of conversations had, or particular subjects discussed. This could even be baked into the flow of rounds, setting aside five minutes at the beginning of rounds to “perform hospitality” to one another before launching into the workflow. It would be an intentionally created space, one free of handoffs, charting, or any of the other clinical sounds that hum in the background, drowning out connection.
At first, the practice of inviting strangers in, traversing nuanced and challenging topics with one’s particularities “out in the open,” would have to be structured in some way. But over time, the ritual of convening and communing over food and drink (as just one example of how such time might be spent) would make relating to one another with authenticity a habit. Then, when presented with a “real-life” discussion to navigate with a patient or a challenging decision to be made in conjunction with another clinician, we would have inculcated the habit of doing so as one’s whole self, saying to each other “come as you are; you belong here.”
By situating practitioners into community with one another, healthcare’s ancestral spirit of hospitality reinvites authenticity into the vocation of healing. Hospitality resists the neutrality that the emotionally detached story of healthcare promotes. Hospitality resists the individualism that modern “authenticity” promotes. The borrowed ecclesial practice of ritual gathering is one way to begin cultivating hospitality, and to remind both patients and practitioners that even in the hospital, it’s okay to just be yourself.
Painting: Miss Nightingale at Scutari, 1854; also know as “The Lady with the Lamp” (1891) by Henrietta Rae
