Patient Care as Sacred Rite: How Confucian Li Can Bring Meaning to Medical Practice
George C. Bao, MD, Assistant Professor, Hospital Medicine, Weill Cornell Medicine
Burnout is afflicting more and more physicians. Alongside the multitude of factors such as long hours, low compensation, tedious clerical duties, increased computerization of practice, and rushed patient encounters, one major contributor to burnout is the inability to find meaning in daily clinical work. Contemporary analytic philosophers suggest that meaningful pursuits give people a sense of "coherence," "purpose," and "significance," which may be missing in doctoring today. Consequently, many doctors feel alienated from work, and some retreat from clinical practice by shifting attention to administration, research, or non-work-related activities.
One system of philosophy that may bring about a recognition of meaning in clinical work comes from the Confucian tradition, which emphasizes the importance of li, commonly translated as "ritual action," in individual and social behavior. Under Confucianism, li is a set of rules, practices, or decorum that imitates a sacred, universal order. According to the philosopher Herbert Fingarette, this sacredness is not bestowed by an otherworldly God but is intrinsic to humans and human activities when performed according to li. Furthermore, li is not merely ritual acts performed during religious ceremonies or special occasions but encompasses the entire spectrum of interaction with humans, nature, and even material objects. Thus, everyday interactions between physicians and their patients, colleagues, and work environment can conform to li.
In realizing the sacred in every ordinary task, work is no longer sterile, mechanical, and temporal but living, spiritual, and holy. Human work and related social affairs take on liturgical, ceremonial qualities. Submitting to li, physicians approach work with mindful, priestly devotion. Furthermore, work takes on artistic qualities, as acts carried out with li adhere to aesthetic standards—what is li is also what is beautiful. Submitting to li, physicians behave as careful artists or performers would to create beauty in their surroundings. The degree to which their words, expressions, postures, gestures, dress, and actions adhere to etiquette and aesthetic customs determine the degree to which their doctoring work becomes sanctified.
Finally, according to Fingarette, physicians practice humaneness (ren) toward patients and colleagues by submitting to li. This is because humaneness, or love, is not so much an internal psychological matter (e.g., having the right sentiment, attitudes, or intentions toward others) as it is a social matter requiring concrete, deliberate, and right action. To be humane, one must "conduct oneself toward others' as though in the presence of an important guest,' as though 'officiating at an important sacrifice,' in short as though others have the same fundamental dignity as oneself."
Ultimately, sanctification of work through li, allows physicians to rediscover meaning in clinical work. Doctoring, which can feel mechanical, technological, and depersonalized in modern times, can once again be comprehensible in the context of its essential purpose: providing compassionate care for the sick. Moreover, physicians can once again feel an utmost sense of significance and divine weight in their work, as both practitioners and recipients of li become connected to a cosmic order by partaking in the daily liturgy of work and social interaction.
One system of philosophy that may bring about a recognition of meaning in clinical work comes from the Confucian tradition, which emphasizes the importance of li, commonly translated as "ritual action," in individual and social behavior. Under Confucianism, li is a set of rules, practices, or decorum that imitates a sacred, universal order. According to the philosopher Herbert Fingarette, this sacredness is not bestowed by an otherworldly God but is intrinsic to humans and human activities when performed according to li. Furthermore, li is not merely ritual acts performed during religious ceremonies or special occasions but encompasses the entire spectrum of interaction with humans, nature, and even material objects. Thus, everyday interactions between physicians and their patients, colleagues, and work environment can conform to li.
In realizing the sacred in every ordinary task, work is no longer sterile, mechanical, and temporal but living, spiritual, and holy. Human work and related social affairs take on liturgical, ceremonial qualities. Submitting to li, physicians approach work with mindful, priestly devotion. Furthermore, work takes on artistic qualities, as acts carried out with li adhere to aesthetic standards—what is li is also what is beautiful. Submitting to li, physicians behave as careful artists or performers would to create beauty in their surroundings. The degree to which their words, expressions, postures, gestures, dress, and actions adhere to etiquette and aesthetic customs determine the degree to which their doctoring work becomes sanctified.
Finally, according to Fingarette, physicians practice humaneness (ren) toward patients and colleagues by submitting to li. This is because humaneness, or love, is not so much an internal psychological matter (e.g., having the right sentiment, attitudes, or intentions toward others) as it is a social matter requiring concrete, deliberate, and right action. To be humane, one must "conduct oneself toward others' as though in the presence of an important guest,' as though 'officiating at an important sacrifice,' in short as though others have the same fundamental dignity as oneself."
Ultimately, sanctification of work through li, allows physicians to rediscover meaning in clinical work. Doctoring, which can feel mechanical, technological, and depersonalized in modern times, can once again be comprehensible in the context of its essential purpose: providing compassionate care for the sick. Moreover, physicians can once again feel an utmost sense of significance and divine weight in their work, as both practitioners and recipients of li become connected to a cosmic order by partaking in the daily liturgy of work and social interaction.