Medical Reflections

Reflections of, and reflections on, medicine, health care and the provision of care. The junk drawer of a mind that works in medicine and is interested in compassionate care and medical education.


"We usually look outside of ourselves for heroes and teachers. It has not occurred to most people that they may already be the role model they seek. The wholeness they are looking for may be trapped within themselves by beliefs, attitudes and self-doubt. But our wholeness exists in us now. Trapped though it may be, it can be called upon for guidance, direction and most fundamentally, comfort. It can be remembered. Eventually we may come to live by it."

Rachel Naomi Remen
Kitchen Table Wisdom

"Integrity usually comes to people slowly and takes them unawares, as part of a natural process of maturing or through the need to be there for someone else who is counting on them. But it can appear full-blown in times of crisis or loss."

Rachel Naomi Remen
Kitchen Table Wisdom

"In a culture like ours …. there are subtle, enduring consequences that look like personal inadequacy, failure of will, inability or unwillingness to live deeply. … [T]hese problems or struggles are not bad psychology, worse parenting or lousy personality development. … What we suffer from most is culture failure, amnesia of ancestry and deep family story, phantom or sham rites of passage, no instruction on how to live with each other or with the world around us or with our dead or with our history."

— Stephen Jenkinson (via evokit-notes)

(Source:, via evokit-notes)

"If your life to you is a straight line, then it is a disaster when things repeatedly show up and a sign that you aren’t getting far. But if your life is a spiral, circling around the Ancient Tower, then each time they show up it is a blessing, and a chance to bring your wisdom to bear on living well."

— Stephen Jenkinson (via creaturesoflight)

"With global commercialization, clothing that is true to one’s place and people is one of the first casualties, and now all you can tell from a person’s clothing, probably, is where they shop."

— Stephen Jenkinson (via evokit-notes)

(Source:, via evokit-notes)

In this short video Deborah Kimmett applies the rules of improv to working with others.  

What could happen in health care if we applied these two rules:

- Say “yes and …”

- make people look good

By simply accepting, and then trying to build ON, other people’s ideas and making our coworkers look good we could change the climate of our work places, the experience of working in them and, I believe, deliver better care.


"Physician, heal yourself: thus you help your patient too. Let his best help be to see with his own eyes the man who makes himself well.
—Friedrich Nietzsche, c. 1884"

"Well-run libraries are filled with people because what a good library offers cannot be easily found elsewhere: an indoor public space in which you do not have to buy anything in order to stay. In the modern state there are very few sites where this is possible. The only others that come readily to my mind require belief in an omnipotent creator as a condition for membership. It would seem the most obvious thing in the world to say that the reason why the market is not an efficient solution to libraries is because the market has no use for a library. But it seems we need, right now, to keep re-stating the obvious. There aren’t many institutions left that fit so precisely Keynes’ definition of things that no one else but the state is willing to take on. Nor can the experience of library life be recreated online. It’s not just a matter of free books. A library is a different kind of social reality (of the three dimensional kind), which by its very existence teaches a system of values beyond the fiscal."

"In more detail, the study of literature - poetry, novel, drama - can be helpful in three different ways to those dealing with illness. To begin with, it can extend and give cognitive shaping to the sympathetic imagination. The point here is that the social sciences dealing with illness, if they are to be sciences or respectable academic disciplines, must stand back from the phenomena and present their accounts in the detached prose style of science. On the other hand, literature involves us directly and makes us vividly and emotionally aware of what it is like to be in the situation the social scientist discusses. Literature develops our sympathies and makes us feel something of what it is like to be a relative or a helper of someone who is ill. It may even provide some feeling of what it means to be handicapped or ill. Literature therefore develops sympathy of the passive or empathetic kind. Now, passive sympathy easily generates motivation to act, and active sympathy, however well meaning, can be blind, clumsy or humiliating unless it is informed by a sensitive understanding of particular situations or relationships. Literature has this other aspect, namely, that it can sensitise sympathy or give it a cognitive shaping. In other words, imaginative literature can develop in a doctor or nurse a perception of real need."

— Downie, R. S. “Literature and Medicine.” Journal of Medical Ethics 17.2. (1991): 96 (via themedicalchronicles)

"The Heart is the Engine" - Evalyn Parry

In her brilliant performance “Spin” Evalyn Parry says this about the bicycle and about the physical heart. But in art, especially her art, the open heart is the emotional engine.  It is the engine that delivers the rich meaning that comes of seeing the world through the prism of her  brain.

I loved everything this performance, the rich intricacy, the history lesson, the political stance, the personal reveals, the deeply felt emotion and connection across time and space between strangers. We in medicine have so much to learn and I think some of it was being taught by her tonight:

- The value is in the doing

- There is meaning and connection everywhere and the more disparate the elements the more unique the light they cast on one another.

We need to keep an open heart and approach the richness of the human stories we are surrounded by with wonder and reverence - there is meaning waiting for us everywhere.  In our work too, the heart is the engine. How much more texture and meaning there would be if we could keep our hearts open and allow our emotional hearts to be our engines.