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Transparent Reflection

Posted By Jeff Ring, Thursday, September 4, 2014

The floor of this cozy office that has served as my professional home for the past nineteen years is littered with folders, charts, articles and books.  I pick up a yellowed transparency from my early years of teaching and hold it up to the light.  “B is for Background; A is for Affect…”

I catch my own reflection on the shiny plastic…an uncanny vision of the teacher I am today…thinner hair…graying temples.  Wiser? Yes.  Confident?  Thank goodness!  I glimpse how far I have evolved from the naïve, tender behavioral scientist who began his integrative care and teaching journey here in 1995, at that time with ‘high tech transparencies!’



Throughout this process, I have been reflecting on an amazing human energetic pull which mystically draws us to a certain profession or avocation, as it has drawn me to collaborative care with physicians.  “Calling” is a remarkable human phenomenon.  It consists of heeding an internal voice…a tugging on the soul…an illuminated pathway on an otherwise gray and muddled map of life.

When my parents divorced and I felt as if the entire world had broken apart, a therapist provided me with a caring vision of a way forward.  She also helped me cope with a mother who was navigating several chronic medical conditions.  Later in middle school I realized that learning and speaking Spanish came easily to me.  These three threads wove together in a vision of someday providing precious integrated mental health services in Spanish to the underserved Latino/a community of my native Los Angeles.

"Calling" is a remarkable human phenomenon How many people can say that they have lived out their calling as I have, with deep fulfillment, for almost twenty years? I am grateful for the opportunity to serve.  I am grateful for how much I have grown in treating patients and in shepherding residents to bloom into exquisite healers (mostly in underserved communities!).  I am grateful for program directors and colleagues who have patiently mentored me along the path to become the teacher I am today.  I am grateful for the enthusiastic welcoming of my ideas, input and interventions in the shared mission of caring for vulnerable patients with residents on a steep, exhausting learning curve.  I pack to leave with great ambivalence and a heavy heart. 


My days are now mostly filled with tearful goodbyes. Moreover, my days are filled with direct, honest conversations about my impact on others and their impact on me. These exchanges happen with residents, patients and colleagues. I swim daily in the humble waters of sadness, appreciation, disappointment, joy and spiny questions about my decision to leave.

Very soon, someone new will sit at this desk, and eventually will gather the courage to walk down the hall and dive into collaborative teams with medical colleagues and learners. What are the pearls of collaborative, integrated care that I carry with me into my next endeavor and which I happily share with my replacement? These include: Gifts, Curiosity, Reflection, and…of course…Transparency.


My mother was a gifted and creative special education teacher, and I have taken her dedication to learning into my work.  I hunger to know more and to understand others more deeply.  Each patient provides a new challenge of how to help, and how to discover the tools that empower us as a team – physician and psychologist – to bring relief, support, acceptance and change.  The joy of working in a collaborative learning relationship is the same joy of attending college as a learner...that of uncertainty, investigation and discovery.  To work in a situation where my psychological curiosities interplay with medical colleague’s medical curiosities is to throw rocket fuel on both the learning process as well as on patient care.  Diversity of perspective is precisely the propellant that I have found so intellectually invigorating. 


James Hillman, the gifted Jungian Analyst, wrote that experience does not become meaningful without essential reflection.  Our physician colleagues are incredibly busy, battered by challenging patients, painful narratives, overwhelming documentation demands, and personal burnout potential.  A unique role for the Behavioralist is providing a place and space for reflection on one’s work, and self-reflection on one’s internal experience.  Moreover, we serve as reminders of, and cheerleaders for, a regular mindful experience of inner reflection.  My goal has always been to train outstanding physicians who have a long shelf life, protected from the caregiver burnout inherent in this work.  The encouragement of and modeling of reflective practice is an essential nutrient toward this goal, and a rich foundation of the psychological contribution to enhancing care.

Reflective practice is an essential nutrient and a rich foundation 



Truth be told, there are things that we will never fully comprehend:  A mysterious fetal demise.  A tumor that disappears without treatment.  An unexpected death in a seemingly healthy youth outside of the expected lifecycle.  The culture of medicine seeks to determine an answer for every clinical presentation.  This attitude is inculcated in blazing Socratic pimping on medical rounds, and boils in the hearts of dedicated doctors who desperately prescribe the optimal cure.  The Behavioral Scientist often serves that essential ethical role of reminding colleagues of what cannot be known.  Leah Hager Cohen’s aptly titled book I Don’t Know: In Praise of Admitting Ignorance’ reminds us that it may not always be optimal to pretend an understanding that we do not possess.  It may be unfair to wear such a mask in front of patients, and we may pay a greater personal price than we realize when we do so.  Might there not be value in joining the other in a shared experience of ambiguity.  I have strived to work in an honest, transparent way, and to hold the same expectation for honest transparency in return from colleagues and in their work with patients.  


Almost twenty years later, ‘B’ still stands for Background and ‘A’ still stands for Affect, even if they now twirl with graceful entrances on Power Point slides or swoop through a Prezi forest!  I am grateful for my nineteen years in collaborative medical care and education, and for all the gifts I have received.  I am grateful to CFHA for this invitation to transparent reflection in preparing this blog, allowing me the opportunity to move my own wealth of experience into deeper personal meaning.                                  

What’s next for me?  I better take a deep breath, bend down, and get this office floor cleaned up to make way for the next behaviorist to take my place.  I smile at the remarkable journey that lies ahead for that fortunate individual, and I look back wistfully at a time long ago when I first arrived.  


Jeffrey M. Ring, Ph.D. has served as Director of Behavioral Sciences and Cultural Medicine for the past nineteen years at the White Memorial Family Medicine Residency Program in the underserved community of Boyle Heights in Los Angeles.  He is Clinical Professor of Family Medicine at the Keck School of Medicine at the University of Southern California.  Dr. Ring is the first author of Curriculum for Culturally Responsive Health Care: The Step-by-Step Guide for Cultural Competency Training (Radcliffe Oxford, 2008). In October, he begins as a Principal Consultant for Health Management Associates, assisting organizations in enhanced delivery of integrated health and behavioral care to vulnerable populations.


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