Flourishing
What?
- Flourishing concerns the goodness and fulfillment of a life as a whole. The five domains are happiness and life satisfaction; mental and physical health; meaning and purpose; character and virtue; and close social relationships. Feeling happy or achieving professional success alone does not establish that a person is flourishing.
- Flourishing involves meaningful activity that develops and expresses who we are, rather than simply staying busy. It is a long-term pursuit compatible with hardship or suffering. Pleasure, wealth, honor and power may be pursued in its place, even when they undermine these deeper goods.
So What?
- If medicine seeks the patient’s good, clinicians need to understand what matters in that person’s life and what living well could mean for them. A favorable medical result alone may not capture their concerns, relationships or hopes.
- Physicians need to examine their own flourishing too. Prestige, income, influence or pleasure can displace health, relationships, meaning and character. Asking what human fulfillment requires helps expose the costs of living by “I will flourish later.”
Now What?
- Examine each of the five domains: where are you doing well, what has been neglected, and what separates your present life from a flourishing one? Consider how a choice in one domain supports or strains the others.
- Choose one step you can take during training. Study and practice virtue. Consider how family, work, education, and community, including religious community, can help you live well. Pay and working hours alone do not measure flourishing.
Clinical Case
Jess is a first year resident in general surgery, coming off of a four-week block of inpatient consults. She enters the hospital at 4:30am, so that she can have enough time to pre-round on all of her patients prior to 5:30am rounds, so that the attending can then head to the operating room.
She’s had to work, on average, six days a week, so the remaining day she has off, she often used to catch up on sleep. As Jess enters a two-week elective block, she realizes that she has not seen her college friends for this past month, and she has just been in survival mode.
She’s also been pushing off the discussion on marriage with her boyfriend of three years, because she doesn’t think she could handle wedding planning with everything going on in her life as a resident.
Case 1: From a Physician's Perspective
You had heard the trauma surgery rotation was tough, and it was. Twelve-hour days, six days a week, capped off by a weekly twenty-four-hour shift. After internal medicine in September and six weeks of general surgery, this final rotation brings you right into the holidays. Like you have been telling yourself for two months, you just need to get through it, and then you will have time to rest, see your friends, restart the exercise routine you abandoned in October, return to the daily twenty minutes of quiet that used to feel essential. These months have just been too compressed. Your friends understand; besides, David and Brittany just had a baby, and Arthur is deep in law school applications, so they would not have had time anyway.
But something has been bothering you, and it is not the hours.
Last week a patient and her family began crying after receiving a cancer diagnosis. You were standing at the back of the room, behind your attending, and you noticed with a kind of cold surprise that you felt almost nothing. Before medical school you had volunteered at a hospice every Thursday for two years. You came home from those shifts tired and sometimes tearful, but with a feeling you could not quite name, something like the satisfaction of having been somewhere that mattered. Standing in that room last week, the main thing on your mind was when you were going to study for your shelf exam.
You told yourself it was burnout, temporary, a product of exhaustion. You told yourself the feeling would come back when you were an attending, when the hours were better and the pressure had lifted. You have been telling yourself some version of this for three months.
On the last day of the rotation, an elderly patient you had been following for two weeks dies quietly in the early morning, before rounds. You had liked him. He told bad jokes and asked about your life with what seemed like genuine curiosity. You stand in the hallway outside his room for a moment before moving on to the next patient. You are not sure what you feel. You are not sure that is the same as feeling nothing. But you are no longer certain it is not.
Case 2: From a Patient's Perspective
J.B. is a forty-seven-year-old high school history teacher, nonsmoker, no significant medical history. He comes in for his annual visit looking well. His blood pressure is borderline. His physician, after some discussion, orders a lipid panel and runs the numbers through a cardiovascular risk calculator. The ten-year risk comes back at 7.1 percent. With a daily statin, it drops to 5.3 percent.
J.B. listens carefully. He is the kind of person who listens carefully.
His physician explains that no one will ever know whether the medication helped him, that it reduces his risk by roughly one in fifty over the next decade, and that studies have not shown that statins reduce overall mortality in patients with his profile. J.B. says he needs to think about it.
He goes home and thinks about it for longer than his physician probably expected. What he keeps returning to is not the numbers. It is the fact that he has spent the past three years more or less coasting. He gained twenty pounds after his divorce. He stopped coaching the junior varsity soccer team, which he had done for nine years, when the schedule started conflicting with the days he had his kids. He has not read a book for pleasure in longer than he can remember. He eats lunch alone in his classroom most days and tells himself he prefers it. He is not unhappy, exactly. He just feels like a slightly thinner version of himself.
He calls his physician's office and asks whether exercise would help. His physician, having reviewed the literature, tells him honestly that studies have not shown exercise programs to reduce the risk of heart attack or stroke, though they may reduce the risk of developing diabetes. J.B. thanks him and hangs up.
Then he signs up to coach soccer again anyway.
Discussion Questions
- What are your initial reactions to Jess’s situation?
- In which domains is Jess flourishing, and which are strained or neglected? Are the domains equally important, and when might a tradeoff between them be justified?
- Even in a demanding hospital setting, how might Jess cultivate flourishing and meaning now?
- How do balance and flourishing relate? Would choosing a residency or practice mainly by compensation relative to working hours necessarily help someone flourish?
Editorial Note: Case selection
Uses Jess, the primary clinical case. Two undergraduate alternative cases are available in the linked source lesson.
Sources
Sources: LearnWorlds lessons and the earlier Canva one-pager.