7.2 - Reflection

What is self-reflection and how is it different from mindfulness? Why is self-reflection so vital to quality patient care? How can we fruitfully reflect on our experiences without falling into navel-gazing? In this episode, we explore reflection as key to the practice good medicine, revealing how this simple habit is crucial to personal and professional growth, identity formation, and flourishing.

17 minutes • Published May 26, 2025 • Download • Transcript

Recommended readings

Physician Resilience: What It Means, Why It Matters, and How to Promote It, Ronald M. Epstein and Michael S. Krasner (2013), Academic Medicine link
Cultivating the Inner Life of a Physician Through Written Reflection, Andrea Vicini, Allen F. Shaughnessy, and Ashley P. Duggan (2017), Annals of Family Medicine link
Slow Medical Education, Richard M. Frankel and Howard S. Beckman (2015), Academic Medicine link
Mindful Practice, Ronald M. Epstein (1999), Journal of the American Medical Association
Integrity and the Virtues of Reason: Leading a Convincing Life, Greg Scherkoske (2013), Cambridge University Press link

Transcript

[Intro music]

Welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Thank you for joining us and we look forward to engaging with you through this podcast.

[Music]

Welcome back. My name is Michael and I'm joined again by Dr. John Rhee.

Today we'd like to talk about reflection as vital to medicine.

This episode follows on our episode with Dr. Margaret Chisolm on art and the moral imagination.

During that episode, we talked about the importance of understanding and processing our experiences as vital to practicing good medicine.

Building off of that discussion, we would like to explore today the power of reflection and how it can help us better serve our patients.

So, John, why don't we just start right at the very beginning? What do we mean by reflection? And to help us answer the question,

I thought I'd use an example from a paper discussing the value of written reflection in cultivating the inner lives of resident physicians.

So here's how the reflection goes.

I'm feeling super frustrated today because I have to fill in for blank resident who called out sick for the night clinic with conjunctivitis and a sore throat.

I was really looking forward to a night off and heading to the movies with one of my buddies.

I've been thinking about it all day, trying to figure out why it has me so ****** off.

So using that as an example, maybe we could analyze a bit what is reflection and why is it so important?

Thanks so much, Michael. And I really love that example, both because of the visceral feelings it brings out in me,

remembering that having happened to me so many times in residency, being called in from sick call,

and also this resonance seems to have already a lot of good qualities in terms of starting on the path of reflection.

So there's a mindful sense in which you he or she is aware of the fact that going in has made him feel something inside. Right? An anger or just frustration probably is more what it is.

And with that, being able to identify that emotion itself, I think is like an important first step.

But reflection is this taking time for inquiry and questioning our experiences. And that includes questioning things like our assumptions,

interactions,

and all of those things that form our inner life. And by inner life, I mean those things that are happening within our hearts, within our minds.

And with reflection, we take time to process the formative moments in our lives and days and doing it with intentionally dedicated time.

So this brings together some of the things that we've talked about in prior podcasts, which includes this spirit of inquiry or curiosity Studio sitas to what is happening both internally and externally,

but also having this subsidiary awareness, this making explicit the unconscious processing and lines of thinking,

allowing us to see our unconscious habits or how we perhaps act in a way without really thinking.

And so I think it goes to say, perhaps even without explicitly stating how important this could be,

that if we just go through our lives in a sense in which we're not reflecting on the moments that we're experiencing,

then one, we can't actually deepen a sense of gratitude because we are not giving thanks or just really deeply appreciating the moments that are really important.

But then also we are we or we may be acting in a way that is habitual and sometimes habitually bad, including how we react to others.

I see this especially working with patients at the end of life, because at the end of life, there's a sense in which people are much more reflective overall about their life.

And because of that, there's a sense in which every moment or everything that they're doing bears a deeper weight. And I think that that is actually an important part of processing one's experiences that makes end of life both intense,

but also potentially very beautiful in the way in which one reflects on all of these things.

Thanks, John. So two clarifying questions to go deeper into our understanding of reflection. One would be what is the goal, the actual object of our self reflection? I think it can take many forms, I imagine, and many people have different motives for that.

And then also, as you mentioned, with the example of the reflection, he uses a lot of mindful awareness of what's going on inside of him.

And so what would be the difference between reflection and simply mindfulness or presence?

Yeah, oftentimes when we talk about meditation, reflection,

mindfulness,

it seems like we are talking about an inert process, or at least a process in which we're not doing anything right. And I think that that is oftentimes the mistake people have,

because mindfulness, reflection is a very active process because what we are doing there is actually to strengthen certain neural networks and also to create new or build new perspectives of looking at things in order to change our behavior.

Because the goal is clarity and attention to the tasks at hand.

And when we think about these different neural networks, the default mode network or the task attentional network,

there are different balances of these networks in our brain. And oftentimes when we're in this network of just like doing, doing, doing next thing, thinking only about the next thing, then it becomes really hard to just be go back to a place where we are very present in the now,

in this moment. And I think probably as I'm saying this, a lot of people are maybe self reflecting on the fact that this is true,

that sometimes it could be so hard to just remain in this present moment and continue doing so, rather than allowing our mind to jump to the million things that we have to do,

whether that is in the next few minutes or, or hours or days, or even all of these things that have happened in the past.

And so I think one of the important things to consider when we're thinking about self reflection is that it always does have to start with the mindfulness. And so going back to our presence podcasts, if we're unable to practice mindfulness and be able to be very much in this moment and recognize what is happening interiorly in this moment,

and also bringing our focus right now to this very moment,

this vertical plane that we've talked about before,

then it's very hard to do self reflection because then it's hard to recognize the emotions, the feelings, but also the guiding of the will in order to try to mold our actions or future actions towards the good.

Here I think that for those who tend to be perhaps monologuing, because that is, I think, a potential pitfall of self reflection is that you might do it just sitting there thinking again and again and again about something that has happened in the past and not making any progress.

And this could happen for days, weeks, months even. This could actually be a very chronic,

almost anxiety driven process.

And here it's better sometimes to just set aside where one may write at the beginning to get thoughts onto a paper and with that process easier. That's why journal writing sometimes is a better form of self reflection than just thinking,

because just thinking can result in this monologuing of potential circles around a particular thought.

Okay, that makes a lot of sense. So it's mindfulness, but then also using that to change our actions and see what has happened in the past and moving forward rather than a sort of rumination, as you were saying.

That's right.

Great. And so why do we need self reflection specifically in medicine? Why is it so important?

Yeah, so the other day I was,

and it's similar to this residence example, but you know, at the hospital and there was a patient's family that I had to update, but I knew that the patient's family was not Very kind.

I guess we always come across, or we often come across this in our training, where sometimes there could be a family that's. That's just really angry or just rude,

and we find ourselves getting very distressed by that situation. Right.

And so I found myself both avoiding that room until later in the day,

but also feeling really anxious anytime I was even near that room and almost feeling relieved when I passed that room, and nobody was in there other than the patient.

But I think that all of that is really important, both from this mindfulness and reflection standpoint, because later on, as I realized with a mindful approach that I was doing this,

I then reframed that and thought, okay, how could I grow in this moment and grow in this ability to be patient or kind or generous to this family?

And also perhaps the other virtue of this Studio C tests her curiosity. Right?

I brought all of those skills with me and leaned into it,

and that was the process of the mindfulness which allowed me to be present with my emotions, recognizing what they were, but also then being able to act right, in a way that is towards the good, which is then to go and actually do the care that is needed for this patient.

And as always, these things happen where when you approach it with this sense in which you want to grow,

you know, it's not a hundred percent of the time, but that patient interaction ended up being a really good one.

We're taking on this approach of curiosity made the family actually feel. Feel like they were really heard.

And by identifying the fears that were driving the anger there that. That also helped calm them down,

we ended up having a very good conversation there.

Right? And so reflection allows this cultivation of choosing the good, recognizing good values and trying to put those into practice,

and also allows for cultivation of our personal and professional identity,

because we are reflecting on that inner life within us,

trying to identify what is the good that I'm pursuing here, what are my tendencies, including my weaknesses?

Perhaps some of those weaknesses might be avoidant behavior, for example.

And how can I, therefore, knowing that that's my weakness, confront it and really lean into it?

So, and training is one of the most formative times in our life, right?

It contributes to a huge portion of that tacit knowledge that we carry and shaping our personal and professional identity.

And so reflection is really important here because we have to be aware of the ways that we are formed and trying to also absorb the good formation, right? And then also sift through the things that we recognize are not good habits that perhaps we're encountering in the hospital.

And of course, if we are able to be in the current moment,

moment by moment, then we are able to actually live fully each moment and therefore live more joyfully or retain that joy of practice despite all of the external pressures or the things that we don't have control over.

Thank you, John. Yeah, that's very, very clear. That example especially why reflection is so important for patient care and also just flourishing as a doctor.

And I think one other area that I can see reflection being valuable is making sure that you are not over relying on sort of an expedient approach to medicine where you're depersonalizing the patient and seeing them just as a disease,

where, although sometimes it can be necessary in very urgent or emergent situations,

this expedient approach can lead to overreliance on the chart, not seeing the patient for themselves,

and just an overall hyposkillia, as it's called.

So clearly reflection is important both for ourselves in our identity formation and also for our patients, so we can pursue what's in their best interest.

And so how do we practically pursue reflection? What might this reflection look like?

Yeah, great, Michael. I think some of the things we've talked about already, but one is that intentional time is needed and as we talked about before in the Presence podcast, that intentional time does have the first start with growing in this mindfulness, this ability or practice to be in the present moment,

so that we can therefore grow and recognize all of those emotions that we recognize that we just talked about and also pursue the good.

I think the second thing, which we already talked about is also writing sometimes in order to prevent that monologuing, as we're trying to set aside specific time for self reflection,

that we could instead put things on a paper,

right on paper, and therefore be able to reflect on it in a way that doesn't, that doesn't. Isn't at risk for that monologuing.

I think the third is that there's also an importance of processing with others.

This recognition again that we are dependent with each other is another theme in the Hippocratic Society,

but without of course complaining about it, but rather seeing it as a moment in which another can help us broaden our perspective. So of course we have to approach all of those times that we are engaging another person in our self reflection,

where we want to gain new insights, including if those new insights may be difficult for us to stomach, because some of those new insights might be aspects of our habits or how we go about things that are really important for us to think about or reflect on.

And sometimes Others can broaden that perspective.

I think fourth is what you just mentioned, Michael, talking about this over reliance on the chart or,

or this narrowing of vision, which is this overall left brain versus right brain approach that we have often talked about on this podcast as well.

You know, as a neurologist, I'm not talking about it specifically being left or right brained, maybe more dominant versus non dominant hemisphere.

But what I mean by that is this narrow viewing of things where we hyper-see the details,

rather than this widening of view of things where we're able to see the whole person or in a decision narrowing to too many details that makes us anxious and therefore unable to make a decision versus stepping back and seeing the overall good in things.

And so here we're trying to continually do this thing where we're broadening from the narrow vision to the wider vision.

Because in our culture today there tends to be too much of the narrowing of vision that makes it hard for us to see the bigger picture at times.

And that itself requires also self reflection and can be a practice and in which we attempt to do both at our times of reflection, but also processing with others can help.

And then fifth, over time, when we have this mindful approach to things in the moment,

then we can also bring to self reflection brief moments throughout the day where we're reflecting on the morning, for example, where we could have a time set in the middle of the day.

It could even be an alarm where we briefly think about like how did I live this morning, how did I go about things in this morning and maybe make some decisions or goals for the afternoon to try to, even during that day,

rework or redo or perhaps grow in some of the things that we were struggling with that morning.

Those all sound like very, very helpful tips. Thank you, John. And I think one thing that I would add just from the trainee or student perspective is to seek those who are mentors for you or people that you look up to and see maybe how they reflect on things and ask them,

even as you were saying,

to be an external source of helping you reflect or asking them about things that may have happened that you may have questions about that you're not sure how to reflect on yourself.

Yeah, that's right. And I guess one other thing is something we've mentioned on prior podcasts too, but this idea of just slowing down and trying to unitask, not multitask, being very intentional about each task.

And even as you're entering a patient's room or even as you're charting,

there could be an internal slowing down. It doesn't mean you have to type any slower,

but rather an internal slowing down of trying to be very present and not rushing into it, but rather like sitting calmly and then taking a moment and then starting writing.

Right? There's a difference there between doing something frantically, right, frenetically,

versus doing something in a way in which we have an interior slowness where we're intentional about each task and intentionally slowing down to do that.

I think that's the same for all these things that we're talking about, especially when it has to do with reflection. Reflection, including the writing part, but also finding that intentional time for reflection.

Wonderful. Thank you, John. This sounds like the beginning of a very necessary habit for flourishing in medicine.

And so thank you all very much for joining us. Please check out our references to learn more for some of the academic articles that we use to inform this podcast,

and we will see you all next time on the Hippocratic Society Podcast.

Thank you very much for joining and reflecting with us today.

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