“With rare exception, the majority of surgery residents and practicing surgeons who prematurely leave surgery do so because they find the work to be physically, emotionally or spiritually incompatible with the vision they have for their life.” Am J Surg 214:707, 2017

I’ve read a great deal about physician wellness, suffering and burnout and I’ve given (and heard) many talks on the subject. The classic talk on burnout, including some of my early talks, can be summarized as “Exercise more, eat well, pay attention to your family and friends.” I am in no way belittling these things as important, but…. as a good friend said to me the other day “If I have to hear one more lecture on burnout that tells me to add an hour of exercise, an hour to plan and cook my meals and an hour to meditate to my already crazy day, I’m going to shoot myself!”

Not too long ago, a friend recommend I read A Bigger Table: Building Messy, Authentic, Hopeful Spiritual Community by John Pavlovitz.  He was in Houston yesterday, and I was able to go hear him speak. John is a Christian pastor, but his words and ideas can be used by everyone, regardless of whether you are religious or not and, if you are, regardless of the faith you hold

John’s idea, which is neither doctrine nor theology, involves creating a “bigger table” in our lives, a table that has the four “legs” of radical hospitality, total authenticity, true diversity, and not having an agenda.

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It’s human nature to surround ourselves with people that are just like us.  But, when we only include people like us in our lives, our potential for growth and happiness is limited as a result. I truly believe that this “small table” mentality contributes to physician suffering and burnout, which means that the idea of building a bigger table may be just what we need.

So, what might a “bigger table” look like for physicians who are struggling with the “why” of their practice?

Radical hospitality. Dr. Francis Peabody famously said that “the care of the patient is in caring for the patient”.  The same holds true for our colleagues, patient families and everyone around us.  If we cultivate an appreciation, even love, for these people – regardless of how difficult they are or how much we disagree with them – we are practicing radical hospitality. As in so many of the gifts we give to others, this is a gift to ourselves, too.

Total authenticity.  We all need a place to be absolutely, completely ourselves… unfiltered, loved, totally accepted.  I’ve always told my trainees that the single most important factor in choosing where you practice is the people you will be joining.  There is no location, salary or title that will ever make up for working with people that don’t let you be truly, authentically you.

True diversity.  This is not just diversity in the sense we are used to hearing about.  In addition to religion, race, gender, age and sexual orientation, true diversity means accepting and listening to people that have totally different views than you.  Ouch.

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During his talk, John told the story of “Sign Guy”.  He was having lunch with a gay teenager when they noticed a man outside the window.  He was carrying a sign that said gay people were an abomination and that they were going to hell.  The young woman asked John “What about ‘sign guy’… how do I invite him to my table?”

We all have “sign guys” in our lives that, like it or not, we should invite to the table in order to have true diversity, but (and this is really important), we have to agree on “table manners” first. Which brings us to the fourth leg of the table…

Agenda free table.  The concept of the bigger table is that we are choosing to sit at the table together because we know the power of listening, the power of really understanding each other. Although we can and should invite everyone to the table, no one should stay who is intentionally trying to change or hurt someone. Being agenda free is one of the non-negotiable “table manners” for all who want to sit at a bigger table.

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So how do I think this translates this into our day to day work?  For a start…

Spending more time learning the stories of our patients… not just “taking their history”.

Working to see administrators and leaders as people who care like we do… not just defending our specific point of view.

Calling out the agendas and implicit biases that keep us from hearing the soft voices of colleagues who are young or discounted for other reasons.

Checking back the next day to be sure that a colleague who said he’s “fine” really is.

Doing all this even though it’s hard, especially when it comes to the “sign guys” in our lives.

I’m sure there are others… what would you add?

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 “Grab some wood and some tools, friend. We have work to do.” John Pavlovitz