college connection
PROFESSIONALISM
FIVE FUNDAMENTALS OF CIVILITY: BE AWARE
The Spring issue of College Connection
provided an introduction to “The Five
Fundamentals of Civility for Physicians,” a
series of articles that examines the impact
of incivility to a profession and strategies
to foster civil behaviour. This article, written
by Dr. Michael Kaufmann, focuses on the
importance of demonstrating respect for
others and oneself.
And it didn’t help that you and your spouse
don’t agree on how that problem should be
managed. Further, sleeping in, you left home
in a hurry, skipping breakfast. Under all of
these stresses, even you weren’t aware of how
these things were affecting you. Neither were
you aware of the impact of your behaviour
upon the technician. You immediately regret
the manner and tone you used. But it was too
late — primed and challenged, you “shot the
first thing that moved,” an act of incivility that
might have been avoided.
Mindlessness
Imagine you just arrived at the clinic to
conduct rounds. It’s a busy morning and
you’re reviewing the status of several patients
when a technician approaches saying: “Good
morning. Mr. Smith’s dog has had a bad night
and Mr. Smith has some questions for you.
You should call him right away.” Irritated and
frustrated, you turn to the technician and
snap: “How do you expect me to talk to Mr.
Smith when I don’t even know the case?” The
technician leaves in a huff of indignation.
The technician probably doesn’t know this
behaviour is uncharacteristic of you. She
has no way of knowing that you had trouble
sleeping due to a recurrence of back pain,
along with your ongoing concerns about how
your teenage son is struggling in school.
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College Connection
Reflection and self-awareness practices
help veterinarians examine many aspects of
themselves that contribute to their thoughts,
moods and actions. Without this awareness,
we can be said to be functioning “mindlessly”.
That’s fine when considering mechanical
skills, such as driving a car, considering
how often this action has been successfully
performed in the past, resulting in the desired
level of unconscious competence. But
mindless interactions with colleagues and
co-workers can sometimes lead to uncivil
behaviour, chosen indiscriminately. In fact,
mindlessness accounts for many deviations
from professionalism, which seem to occur
more often when veterinarians find themselves
in pressured, emotionally charged situations
There is plenty that requires attention in order
to be truly self-aware: your physical state,
emotional state, temperament and personality
style, communication style, attitudes and
cognitive distortions, assumptions, biases,
knowledge gaps, personal values, and so
much more. Everything we experience is
perceived through these filters shaping our
thoughts, reactions and deeds.
Mindlessness can catch us up into negative
emotional, cognitive and behavioural
patterns without our being able to intervene.
Mindlessness also prompts shifting of blame
and avoidance of personal responsibility. In
short, if we are not mindful, or sufficiently selfaware, and just allow our attention and actions
to be engaged in these negative loops,
choosing civil behaviour would be difficult; we
might even do harm to ourselves and others.
Mindful Self-Awareness
Hence we see the connection of mindful
self-awareness to civility. Gilbert describes
this form of awareness as accepting, nonstriving, contented well-being. He says
that mindfulness practice puts people into
the “being mode” rather than the “doing
mode.” Self-awareness is the moment-tomoment, non-judgmental recognition of
what’s happening within us. The goals of
mindful self-awareness include enhanced
expression of core values, such as empathy
and compassion, the courage and ability
to see the world more as it is rather than
as one would have it be, and the humility
to recognize, tolerate and embrace one’s
“blind spots” — areas of weakness — while
leveraging our strengths.
Cultural Awareness
If the simple definition of culture is “the
way things are done around here,” then we
need to pay attention to that as well. Our
behavioural choices are influenced broadly by
external norms and expectations just as they
are by our internal status and the behaviours
of others. Civility is easier to choose if one is
aware of the cultural influences, positive and
negative, all around us. Kindness is good,
meanness is not. Teaching by asking tough
questions is fine, shaming is not. Humour is
fun, sexist jokes are not. Ultimately, one by
one, we are able to make civil choices.
Barriers to Awareness
Barriers to self-awareness are numerous
in veterinary training and practice. Fatigue,
dogmatism, emphasis upon an overly
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