Bhagavad Gita for the Physician.

This communication presents verses from the Bhagavad Gita which help define a good clinician's skills and behavior. Using the teachings of Lord Krishna, these curated verses suggest three essential skills that a physician must possess: Excellent knowledge, equanimity, and emotional attributes. Three good behaviors are listed (Pro-work ethics, Patient-centered care, and Preceptive leadership) and supported by thoughts written in the Gita.

MODERN CHALLENGES

Modern health-care professionals face multiple challenges at work today. Created by a combination of social, environmental, academic, medicolegal, and professional issues, these challenges may have a negative impact on physician health – physical, psychological, and spiritual. Stress, frustration, and dejection work together to produce a state of compassion fatigue and burnout, which in turn impairs self-health as well as delivery of health services to patients.

While health professionals and nurses have been speaking about the need to focus on their own health, few resources are available to help them to do so effectively. What is needed is an expert physician teacher, who leads by example, to help health-care professionals optimize their health. Such guidance, delivered with the strength of experience, will be accepted with the confidence of trust.

TIMELESS SOLUTIONS

Indian literature is a storehouse of wisdom. The Bhagavad Gita, a classic Sanskrit epic, describes a conversation between guru (teacher) and disciple. Arjuna, confused and unable to handle stress on the battle field, seeks guidance from Lord Krishna.[12] Lord Krishna explores and analyzes (diagnoses) Arjuna's condition, explains its origin and underlying basis (psychoeducation on pathophysiology), and helps him overcome his distress by equipping him with positive coping skills (intervention). Thus, Lord Krishna fulfills the responsibility of a physician teacher, by helping his student overcome his limitations and achieve his full potential.

This brief communication presents selected verses from the Bhagavad Gita which will help modern health-care professionals understand their role in society and fulfill their duties as a clinician and healer in a satisfying manner. This will enhance their own coping skills and assist them in handling external stressors more effectively. These skills are especially important in today's world, grappling with increasing distrust and violence against health care professionals.

PHYSICIAN-FRIENDLY TAXONOMY

We categorize the physician-friendly advice contained in the Bhagavad Gita as follows:

Attributes of a good physician

Excellent knowledge

Equanimity

Emotional equipoise.

Behavior of a good physician

Pro-work attitude

Patient-centered care

Preceptive leadership.

EXCELLENT KNOWLEDGE

The medical profession is based on scientific knowledge and skills. For health-care professionals, continuing medical education is an essential part of professional life. The Bhagavad Gita reinforces this by praising the pursuit of knowledge. The verses below encourage us to learn from esteemed teachers and strive to improve ourselves with focused dedication.

Lord Krishna encourages Arjuna to approach his teacher to learn the truth, in a submissive manner, while rendering service to him. He also gives the confidence that “self-realized” souls will impart knowledge to improve the student because of their experience. This is exactly how learning occurs in the medical profession.

Lord Krishna encourages Arjuna not to get dejected but upgrade himself so that he can deliver his duties with a clear mind and soul, – his biggest friend. At the same time, he reminds him that the same mind, if contaminated, can become his biggest enemy. Urging Arjuna, the Lord says.

“try to understand the true nature of ----knowledge by approaching illumined soul. Asking him to question them with an open and guileless heart, suggesting those wise seers of Truth will instruct him in that knowledge. In a way he urges to continue upgradation with a humble mind with the help of wise men.“

Glorifying a devoted professional as the one with sublime knowledge, who continuously updates himself by his own efforts avoiding degradation. This is an important attribute of a good physician.

“------dispel-----darkness born of ignorance by the illuminating lamp of knowledge”

“On earth there is no purifier as great as knowledge: ------”

“He who has mastered his sense, is exclusively devoted to his practice and is full of faith, attains Knowledge;

EQUANIMITY (HUMANE VALUES)

Gently reminding that science alone does not make a good physician, Lord says one also needs to inculcate humane values of compassion and care. These, and other such values, are listed in the Bhagavad Gita. The suggestion contained in verse 6:9 reminds us to treat all patients alike, irrespective of their background. Time and again, doctors are faced by patients with different backgrounds and behaviors. The Lord reminds us that a doctor should continue to work for patient betterment in an unbiased manner.

“He who is free from malice towards all beings, friendly and compassionate, rid of 'I' and mine balanced in joy and sorrow, forgiving by nature, ever-contented and mentally united with Me, --has a firm resolve, ---is dear to Me.”

“absence of pride, freedom from hypocrisy, non-violence, forbearance, straightness of body, speech and mind, devout service of the preceptor, internal and external purity, steadfastness of mind and control of body, mind and the sense.”

“Acts of sacrifice, charity and penance----must be formed—are purifiers of wise men”

Finally, Lord Krishna says he who looks upon well-wishers and neutrals as well as mediators, friends and foes, relatives and inimical, the virtuous and the sinful with equanimity stands supreme.

EMOTIONAL EQUIPOISE

The Gita advises us to aim for a state of emotional equipoise. Emotional equipoise is not a “dissociative” or emotionless state. Rather, it is a state which allows expression of empathy, without letting subjective or reactive responses cloud one's clinical judgment. Though the term “emotional equipoise” is being used for the first time in the context of health-care delivery, it has been used earlier by poets.[3]

We propose the term “emotional equipoise” to describe a balanced and rational mental state, which allows the health-care professionals to perform their duties in an appropriate manner, irrespective of external stimuli. This may also help minimize compassion fatigue.

“completely rid of attachment, fear and anger, -------”

“Constant equipoise of mind both in favorable and unfavorable circumstances”

“The Karamyogi, who is contented with whatever is got unsought, is free from jealousy, ----and in balanced in success and failure, is not bound by his action.”

Moderation and control

Apart from learning science and humanity, the health-care professional is expected to practice moderation and control in every field of life. This habit, which overlaps with emotional equipoise, can also be termed an equipoised lifestyle.

“-----this yoga is neither for him who overeats, nor for him who observes a complete fast; it is neither for him who is given to too much sleep, nor even for him who is ceaselessly awake.”

” All living creatures follow their tendencies; even the wise man acts according to the tendencies of his nature. Of what use is any external restraint?”

Anger management

The concept of emotional equipoise includes anger management as well. The Bhagavad Gita reinforces the importance of anger management, suggests ways of anger management, and suggests ways to improve one's skills in this regard. These teachings are especially important in today's world which is full of situations stimulating irritability and frustration. The Gita suggests simple, yet effective, methods of meditation and relaxation as the way to overcome these emotions.

“He alone who is able to withstand ------the urges of lust and anger, is a Yogi; and he alone is a happy man”

“Shutting out all thoughts of external enjoyments, with the gaze fixed on the space between the eyebrows, having regulated the outgoing and the ingoing brcaths flowing within the nostrils, he who has brought his senses, mind and intellect under control-such a contemplative soul---is ever liberated.”

“Holding the trunk, head and neck straight and steady, remaining firm and fixing the gaze on the tip of his nose, without looking in other directions.”

Lord thus urges an ideal physician to perform his/her duties with full commitment keeping anger, irritation, and frustration away.

PRO-WORK ATTITUDE

The Bhagavad Gita repeatedly calls upon us to perform our duties as efficiently as possible. Working for the sake of work, rather than any external reward, should be our aim. There is no excuse for not working according to the needs of our profession. This is perhaps the strongest message of the Gita.

“-----it is not advisable to abandon a prescribed duty---”

“------do perform your allotted duty; for action is superior to inaction”

“---do ----efficiently perform your duty, ------”

“-----perform your duty, -----for the sake of sacrifice alone”

“------he who ------does not perform his duties---- lives in vain”

“One's own duty ----is preferable to the duty of another well performed.”

Action

While the construct of action overlaps that of duty, it is not exactly similar. Action reminds us to translate our theoretical knowledge into practical work. It also covers the sphere of physical activity and exercise. Action is a synonym for duty and work. Lord Krishna enjoins us to act, i.e., to work, in life. This reminds us not to shirk our professional work, and to keep ourselves physically active.

“Surely, none can remain inactive even for a moment; ------”

“Desisting from action, you cannot even maintain your body”

“--------the Yoga of Action being easier of practice is superior to the Yoga of Knowledge”

“It is the ignorant, not the wise, who say that Sankhya yoga and Karmayoga lead to divergent results.”

“The Karamyogi perform action only with their senses, mind, intellect and body; without the feeling of 'mine' in respect of them-------”

PATIENT-CENTERED CARE

The patient–physician relationship is a complex one. While Arjuna looks up to Krishna for assistance, the Lord has no qualms in accepting the humble post of Arjuna's charioteer. Similarly, the physicians work as a charioteer for their patients, serving to steer them to health. This process can be achieved only though continuous interaction, marked by reciprocal respect.

The Bhagavad Gita reminds physicians to be humble and to practice patient-centered care in its true spirit. At the same time, it counsels the patient to accept physician advice in intricate matters of medicine. The Bhagavad Gita contains verses which convey the need for patient-centered behavior and the importance of individualized clinical decision-making. These remind us to be humble and to keep our patient at the center of our profession. It reminds that one is only a medium of service and it is better to be humble and be a medium of goodness.

“----be you only an instrument”

“Thus has this wisdom, more profound than all profundities, been imparted to you by me; deeply pondering over it, now do as you like.”

Quite often, medical inaction is preferred to unwarranted action. Avoidance of unnecessary investigations, diagnosis or labeling, and treatment, described in modern parlance as quaternary prevention, is alluded to in the Gita. It reminds the physician to act in right direction and not in the wrong way. These lines also strongly discourage practices such as cross pathy, claiming false qualifications, and treating beyond ones limitations.

“-----For mysterious are the ways of action”

“He who sees inaction in action, and action in inaction, is wise among men; he is a Yogi, who has performed all actions.”

PRECEPTIVE LEADERSHIP

Health-care professionals are respected people in the community. Other members of the society look up to them for advice and guidance. Therefore, we should strive to put our thoughts and theories into practice. It is expected, therefore, that the diabetes care professional should follow a healthy diet and lifestyle. This will help improve acceptance and adherence to suggested interventions.

“For whatever a great man does, that very thing other men also do; whatever standard he sets up, the generality of men follow the same.”

“A wise man---- should get them to perform all their duties, duty performing his own duties.”

OUR WORK IS FOR A KING

(Motto of Dame Edith Brown, Founder Principal, Christian Medical College, Ludhiana, India).

Finally, we must remember that being part of the medical profession is a blessing. Whatever work we do, is not for ourselves or our patients alone; we must view every clinical consultation, every diagnostic or interventional procedure as an offering to a higher power. This will ensure that we have performed it to the best of our ability. This in turn will lead to all-round satisfaction and health, both for doctors and for the community we serve.

----“some striving souls, observing austere vows, perform sacrifice in the shape of wisdom though the study of sacred texts.”

“---sacrifice through Knowledge is superior---”

“-----He who does his duty without expecting the fruits of action is a Sanyasi and Yogi both----”

“Offering the fruit of actions to God, --------”

SUMMARY

The teachings of the Gita eassure us that a true professional, by dedicating all his work to the almighty, attains an eternal, imperishable state. In his devotional service (here medical profession), he should rely entirely on, and be fully conscious of the creator. Anyone who works with these thoughts in mind is truly able to serve humanity with utmost dedication. Introspecting these words brings a sense of belief in, and relief to, our increasingly beleaguered/challenged profession.

“The Karmayogi-----attains by my graces the eternal, imperishable state, ----mentally dedicating all –actions to Me---”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.