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Greetings from a kindred spirit! You, dear reader in 2055, your colleagues, family, friends and neighbours are, I hope, so familiar with the services and programmes of RENEW that you take them for granted. In the late 20th century, however, RENEW was only a seed. It began as a not-for-profit enterprise to help people sustain or regain their enthusiasm, effectiveness, and purpose by giving them the wherewithal to renew themselves—and their relationships, organizations, and professions. If in 2055 you do take RENEW's services and programmes for granted you may find it hard to understand why its formative years were so difficult. In those days, many doctors were reluctant to acknowledge the personal challenges of our profession and were uneasy about trying something new. Fortunately, we pressed on. Why?
In the 20th century's last decade, times were tough for physicians, other health professionals, and their patients in the United States. Costs were high; opportunities for listening, learning, and teaching were scant; relationships were topsy-turvy, with internet-empowered patients firing questions and making demands. It was difficult for practitioners or professors to gain satisfaction, much less pleasure or even joy, from their life and work. Many worried that they were shortchanging their families, friends, and communities. Some became convinced that their own health suffered as professional pressures robbed them of the time and energy to do the things they counselled their patients to do—take exercise, read, write, play the zither, socialize, learn something. This was close to home—even my own home, because my husband and daughter are physicians. And I decided to try to help.
Colleagues and I launched RENEW first to offer health professionals services and programmes that would help us cope with the turbulence and competing imperatives of our commitments. Our inspiration was John W Gardner, PhD, a statesman-scholar who understood the unhappy consequences of unrelenting strain and inspired many with his books and speeches about renewal. John wrote, ‘the release of human possibilities within an ethical and moral framework [is] crucial to the flourishing of any society.’ My colleagues and I concluded that flourishing should be the goal. Flourishing is central to the sound practice of medicine: when health professionals overlook family and personal needs, they can become cynical, exhausted, hard on themselves, and hard on others.
Three decisions underlay the launch of RENEW.
First, we chose to work with groups rather than individuals, because the learning curve is easier to climb in good company, as people listen to and incorporate others' ideas and begin to feel less alone. Conversing also builds community—so necessary for living a full life and giving excellent care.
Second, we embraced two theories that we saw as essential to renewing—‘learning theory’ and ‘change theory’. Learning theory holds that adults learn best by experience and stories, because we are motivated to learn about life. Change theory posits that individuals proceed through about six stages of change, often in an untidy fashion with progress, regress, twirls, and repeats, ranging from precontemplation to relapse and ending at maintenance (one hopes). It is essential to determine which stage the would-be renewer occupies so that he or she can use appropriate tools to press on. Our forebears did just that, for Charles Darwin noted, ‘It is not the strongest of the species that survive, nor the most intelligent, but the ones most responsive to change’.1
Third, we did not make presentations. We engaged people in ‘participations’ that began with discussions about values.
We defined values as:
We asked audiences to call out their own values. Astoundingly for cautious people, they did so. We saved and tallied responses—honesty, family and friends, self-respect, reliability, kindness, hard work, learning, joy. We asked people to write down their own values after the session and to discuss them with their dear ones. (Reader, take some moments now to do the same. You may learn something.)
Using these values as a platform, we explored barriers and boosters to change—signs of trouble; practical tips to leading a (less) complex life; friendship; and leadership. And we paid close attention to the dodgy psychological underpinnings of doctors: many of us show obsessive/compulsive tendencies which, though probably good for medical practice, have the downsides of vulnerability to criticism, a desire to control, and (surprisingly) low self-esteem.
Looking at the published work, we noted that the attitudes and activities of the healthiest physicians are characterized by: strong relationships; subscribing to a religion or seeing oneself as ‘spiritual’; taking care of oneself; enjoying work; maintaining a positive outlook.2 We created materials to measure whether a person needed to renew, such as the ‘Renew-O-Meter’ (Figure 1).
We also provided easy and anonymous access via the website [www.renewnow.org], and had tapes and white papers available. We reminded ourselves and our participants over and over that: it is not selfish for physicians to take care of themselves; it is self preservation!
Our grand rounds, seminars, and workshops reached thousands in clinics, hospitals, private practices, and medical and nursing schools. Outside medicine we soon began working with teachers, environmentalists, community volunteers, foundation staffs, school administrators, lawyers, directors of programmes that help youngsters stay out of trouble, and leaders in both private and public sectors. People were attracted to RENEW by its appeal and its results. On occasion, we evaluated outcomes 3-6 months after programmes and received responses such as, ‘I started leaving the office at 6.30 pm. I began to attend grand rounds regularly. I started a men's book club. Thanks for the kick in the butt’.
To meet the demand, we developed a programme to teach people how to convene ‘Conversation Groups’ across the USA, and by 2004 RENEW's reach extended to Arizona, California, Georgia, Louisiana, Maine, New Jersey, Pennsylvania, and Washington. A physician commented, ‘It's made me more empathic toward my patients. I realize I need to spend a little more time and listen, just like I want to be listened to’, and a nurse educator said, ‘Appealing to people's honesty, integrity and caring brings out their best, and now I can put this to work’.
RENEW also worked with national organizations to promote acceptance of the concept that doctors must be healthy for patients to be healthy. After a series of plenary sessions and workshops, the American College of Physicians changed its ‘core values’ and its ‘mission’ statements. The Core Values statement now includes the sentence, ‘Responsibility: we maintain healthy personal and professional lives to most effectively serve our patients’. The ACP's Mission statement includes as part of one goal ‘... To support healthy lives for physicians...’.
We have also pressed forward with our goal to integrate renewing principles into medical school curricula. Although the scholar and former chair of the Department of Medicine at UCSF, Lloyd Hollingsworth Smith Jr, once said to me that ‘Changing a curriculum is harder than moving a cemetery’, we were able to convince the Stanford Medical School to incorporate RENEWing in 2004.
In short, we need to learn, to renew throughout our lives. Merlin had it right:
‘The best thing for being sad,’ replied Merlin, beginning to puff and blow, ‘is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins, you may miss your only love, you may see the world about you devastated by evil lunatics or know your honor trampled in the sewers of baser minds. There's only one thing for it then, to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust and never dream of regretting. Learning is the thing for you.’3
Box 1 Principles of RENEW
As I write, RENEW is a 5-year-old enterprise that has emerged from its formative years with its cornerstones intact and its principles (Box 1) and methods well honed. With luck, its foundation will also serve as a springboard, so that RENEW's services and programmes will increasingly be adopted by people-centred organizations and institutions elsewhere. RENEWing will be part of everyone's life and work.
So that, as you read these words, you will say, ‘Of course!’ I hope.