Navigating the Complexities of a Strained Medical System

*Originally published on PsychologyToday.com on March 13, 2024.

Ancient wisdom offers a powerful lens for healthcare providers.

We continue our journey on the Buddha’s Eightfold Path towards the end of suffering and the cultivation of compassion and balance in our lives as healthcare providers. Last time, we took our first step onto the path with our compass in hand, otherwise known as the “Right View.” We now explore the second step, the right (or skillful) intention,” which is how we set our view or cognitive perspective into action. ⁽¹⁾ Using the right intention is how we engage and interact with the world. If we step skillfully on this path, we will hopefully see compassion developing in place of suffering.

What stands in our way is a broken medical system—one plagued by administrative burdens, run by corporations, and fueled by productivity rather than quality, resulting in a depersonalized conveyor belt of care. Doctors and other healthcare providers experience a “moral injury” when they witness violations against their deeply held values and beliefs. One enters healthcare intending to deeply care for patients, though when working within a system where one doesn’t feel supported, it’s easy for burnout to develop. ⁽⁴⁾ How can one use the right intention to ease the burdens created by this huge, systemic problem? How is it even possible to alleviate the suffering caused by this?

To gain insight into this, we return to The Buddha’s ancient teachings, where he describes the three main categories of unskillful intention (the antithesis of right intention) that ultimately lead to suffering:

1. Greed
2. Ill Will
3. Hostility⁽²⁾

Using a more modern lens to interpret this, we can view greed as an unhealthy attachment—an idea, a habit, or a thought pattern that does not serve us. Ill will encompasses thoughts and actions governed by anger and aversion, and hostility is guided by cruel, aggressive, and violent thoughts towards self and others.

Right intention works in opposition to these three categories and includes

1. Renunciation (of attachments)
2. Good Will
3. Harmlessness

Following these tenets can keep you on the path to contentment. Here is what it can look like:

1. Work on letting go of (or renouncing) the anger or the preoccupation (attachment) with what triggered the anger. Don’t approach the difficult situation with aversion and a desire to destroy under the guise of making things better. This does not mean you cover up how you feel or succumb to the inequities. Rather, it empowers you to become curious about the anger without letting it consume you.
2. Work on ways to relate to the system and use the tenets of relinquishment, goodwill, and compassion to create a new nourishing intention or action plan. Ask yourself, is this anger serving you? Most likely, it is not. Instead, it causes more suffering the tighter we hold onto it. Notice your feelings, but don’t let them become you.
3. Taking this further, you can counter ill will with loving kindness. Studies have shown that embracing this practice of wishing happiness and alleviating suffering towards self and others brings a better emotional state.⁽³⁾ Instead of hostility, use compassion as your vehicle to alleviate suffering.

How can this approach push against the broken system? Right Intention helps us develop our strength to weather this by fostering self-compassion and improved psychological well-being. ⁽²⁾Right Intention also paves the way for improved interpersonal relations, which is how we relate to the world and the people within it. Our actions do not occur in a vacuum, and their impact can be catching. The more we fosterthe right intention, the more it can infiltrate. We can disassemble the system from the bottom up, laying down a foundation of compassion that absorbs the burnout and moral injury that challenges healthcare workers today.

In the next posts in this series, we break down the specific actions that make up the right intention: Right speech, right action, and right livelihood. These collectively entail the practices of virtue that allow us to put renunciation, goodwill, and compassion into action. These three steps on the Eightfold Path cultivate outward actions that build upon each other and help create the foundation for the last steps on the path (right effort, right mindfulness, and right concentration) in which we can start healing from within.

References

1. The Noble Eightfold Path – Way to the End of Suffering. Bhikkhu Bodhi. 1984.
2. Steps to Liberation – The Buddha’s Eightfold Path. Gil Fronsdal. 2018.
3. The effect of loving-kindness meditation on positive emotions: a meta-analytic review. Frontiers in Psychology. 2015.https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2015.01693/full
4. Moral Injury in Health Care: Identification and Repair in the COVID-19 Era. J Gen Intern Med. 2022 Nov; 37(14): 3739–3743. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377663/