A sense of coherence

In his book Switch: How to Change Things When Change is Hard, Chip Heath points out that whenever human beings are faced with great challenges, there are some people and groups that stand out as “bright spots” of exceptional innovation and adaptation. During this pandemic, I have seen many bright spots bring light to the darkness. Li WenLiang, Anthony Fauci, my AFM team leader Kris Kordana, and Kaiser Permanente come to mind. But have you ever wondered how these bright spots manage to rise above their own fear and despair, maintain positive attitudes, and make progress amid chaos and uncertainty? Me too. Part of the answer lies in the study of salutogenesis (the origins of wellness; as opposed to pathogenesis, the origins of disease) and the research findings of Israeli sociologist Aaron Antonovsky. Professor Antonovsky was particularly interested in how some women survivors of great hardship, specifically the death camps of World War II, emerged from the depths of their suffering believing that life was good and that their lives had meaning. Why didn’t their horrific experiences destroy their spirit, or at the very least, leave them as hollow women whose lives ended with a whimper? Antonovsky argued that their grit was based on their “sense of coherence” (SOC), a three part disposition that dictates how one reacts to circumstances.

I like Hirsch, Lazar, & Braun-Lewensohn’s 2015 description of the three elements of SOC:

• Comprehensibility is the ability to see the world and life events as understandable, ordered, and to some extent, predictable
• Manageability signifies one’s confidence that he/she has the necessary resources to deal with environmental demands successfully
• Meaningfulness indicates the belief that life is worthwhile and that its challenges are worthy of the investment of effort and resources. 

The good news for physicians is that we are already deeply rooted in the three pillars of SOC.

• We were the idealistic teens who thought that we could harness our energy and talents to effect positive change in a chaotic adult world ruled largely by entropy.
• We were the dreamers who had the confidence to believe that we would survive the rigors of the premed grind and gain admission to medical school.
• We were the courageous medical students and residents who drew on our newly acquired book knowledge, shiny new stethoscopes, and Scut Monkey handbooks to see one, do one, then teach one for the sickest patients tertiary academic medical centers could throw at us.
• And today we are the healers who find meaning in dedicating our lives to the important work of caring for our patients and the communities we serve.

COVID0-19 is a formidable foe, a worldwide pandemic for the ages. Our profession is well positioned to adapt to this event with a unified sense of coherence that is based on our proven ability to comprehend and manage great challenges and our shared belief that life is absolutely worth fighting for. As physicians, we have a responsibility to let our SOC shine and bring light to those around us.  #BeABrightSpot